Juvederm swelling 4 years post-op, why is this happening? (Photos)

Although unusual, we have found (and I have seen myself) patients in whom the HA filler seems to last for many years in this area.   Often you do well for  a couple of years, and then it can start to swell and will often look blue under the skin.  Injections of hyaluronidase will dissolve this, so we can assume that it is most likely persistent filler.  It may take more than one injection to get rid of it completely.  This has been seen with both Juvederm and Restylane.  

It's unlikely that this swelling is related to your previous filler
injections over 4 years ago. The filler should be completely dissolved in your
body by now.  Despite the low probability, it could be that the filler has become trapped and causing inflammation in which case you could have some hyaluronidase injected into the area to rule this out. Otherwise, the lump could be caused by something else so I recommend seeing
your GP to determine the root cause. The underlying cause could be
responsible for your initial swelling in this area when you first had your
injections.

Thank you for your question. I do not believe this is due to your previous filler. Your Juvederm filler would have dissolved a long time ago. The lump you are feeling is likely something else as Juvederm would not remain in your body for 4 years. Any swelling from your filler would have happened within the first week after injection as it is not possible for this to occur 4 years later. I recommend having a consultation with you primary physician to determine the cause of the swelling and lump you’re experiencing. Best of Luck!

If there is suspicion that there is any degree of persistent filler after a few years I would first attempt to dissolve it, which may take more than one injection, to see if that improves the issue.  I would see your injecting physician in order to properly evaluate the area. 

In general, HA derivatives like Juvederm are well tolerated & safe. However, there have now been several cases of delayed adverse effects. I did a little research and found the article Foreign Body Reaction to Injectable Hyaluronic Acid: Late Granuloma Formation in the Annals of Dermatology (2015 Apr; 27(2): 224–225. Published online 2015 Mar 24). They propose low grade bacterial infection on a foreign body, such as Juvederm, may result in a delayed granulom formation:  "There are several theories regarding the cause of this reaction. First, impurities may lead to hypersensitivity responses. Second, disintegration of the cross-linked product may provoke an inflammatory response. Third, recent studies propose that concomitant bacterial inoculation during the filler injection may cause late granuloma formation. In most cases, bacterial infections become clinically apparent within several days after HA injection. However, biofilms consisting of bacteria, their nutrients, and wastes on the surface of foreign bodies enable persistent minimal infection with little host response, and they become symptomatic months or even years after. Foreign body reactions to biofilm rather than to pathogenic bacteria may produce delayed granuloma formation." Their case is similiar to yours and I recommend you see your family physician or internist. A biopsy of the area will be required for diagnosis.

While I understand the association, this is definitely not your previous filler causing the swelling. First, the filler would have dissolved a long time ago - if you do feel a lump it is likely something else as Juvederm would not remain in your body for four years. Second, any swelling from filler would happen within the first week post injection and could not occur (in relation to filler at least) four years later. I definitely recommend consulting with your GP to determine the cause of the swelling.