Vascular occlusion after lip injections that left a dent above my lip. Should I stay away from filler? (photos)

Question

I experienced vascular occlusion, which started with a slow bruise above my lip line, then extreme swelling and pain. I’ve been getting filler for 13 years and never experienced this. Judas’s was injected, to reverse the lip filler, 4 hours post injection. 6 wks later, I had the filler re-injected to my lips and the same thing happened! I’m now left with a vertical dent above my lip which I didn’t have prior to my lip filler. Is this technique of injector or should I just stay away from filler?

Yannis Alexandrides, MD, FACS · Answer

This probably can be quite difficult to treat. Expertly placed filler could improve things. However, if a scar has formed inside the lip, they might need to also perform a scar subcision to improve this further.

Gabriele C. Miotto, MD · Answer

Thank you for your question. From your pictures it seems that you have a very small area of volume deficiency in your left upper lip. It is possible to improve this deficiency with a small amount of filler using superficial injections with a cannula to avoid the vascular supply of the lip. Maybe that will be just enough to improve the lip shape. Hope this helps. Best, Dr Miotto

Kenneth D. Steinsapir, MD · Answer

I would recommend changing injectors. It is critical to use hyaluronic acid filler. These are products that are every effectively broken down with hyaluronidase enzyme. You also need an injector who maintains a supply of hyaluronidase on hand at all times to reverse an occlusion should one develop (it happens). I keep 8 to 12 vials of hyaluronidase on hand at any time. That is more than enough to manage these situations. Immediate intervention is essential. Are you just unlucky? I suspect injector technique might have an influence on outcome. I can't argue with letting this heal for 6 months.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  I would allow your tissues at least 6 months to heal and then pursue additional treatment with either a different provider and/or the use of a cannula to prevent this occurrence.  Best wishes.

Fernando Colon, MD · Answer

It could have been a hematoma or an occlusion either one
are risks and can happen in the best injector hands.
Having had 2 incidents I would suggest to stay away from fillers
for a year. Then the indentation alone may be treated without 
augmenting the lip and see how you tolerate it and if  you like it. 
Then if everything is well you will need to make a decision with your 
doctor to discuss if the risks of injecting the lip are worth it.
Be conservative and cautious. Best wishes.

Shaun Patel, MD · Answer

I would give your lips some time, probably several months, to recover prior to additional filler injections. I would consider another injector and have the filler injected using a cannula to minimize the risk of intravascular injection.

F. Victor Rueckl, MD (in memoriam) · Answer

That dent may actually smooth out on its own over some time. I don't like the idea that you were injected only 6 weeks after a severe vascular occlusion like you had. Personally I would have suggested you wait at least 3-6 months. It's not the filler that's the problem. It is definitely injector-dependent. "This answer has been solicited without seeing this patient and 
cannot be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

Val Lambros, MD, FACS (retired) · Answer

filler injections in the best of hands can result in vascular occlusions if that's indeed what you had.  I would wait a while and try again if you wish. Though  vascular occlusions can happen with cannulas   I think that they are safer than needles around the lips where the vessels are more mobile, hurt less and bruise less.

Vascular occlusion after lip injections that left a dent above my lip. Should I stay away from filler? (photos)

Answers (8)

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