Should I be concerned about necrosis due to white lip color after filler? (Photos)

Question

Lip filler 1cc. Several hours after needle injection, white color to upper lip. I called derm. office and they didn't look at my pictures just said Benadryl and switch between warm/ cold compress.

Steven H. Williams, MD · Answer

White color, or blanching, of the skin at injection site could be a sign of vessel occlusion. Please follow up with your injector as soon as possible just to be safe. In addition, I do not recommend using cold compresses at this time, but massage, warm compress, and aspirin would be best. Good luck.

Camille Cash, MD · Answer

Occlusion of the vessel can cause blanching and is typically painful.  it is best to follow up with your injector for an evaluation to rule out this issue.

Center for Aesthetics and Plastic Surgery - Grand Rapids · Answer

Thank you for your question and photos. Impending necrosis caused by dermal filler injected into a vessel can present with immediate or somewhat delayed blanching of the skin. The blanched skin usually presents with associated pain to the area, and can progress to pain in an area outside of injection/reticular lacy red pattern of the skin if blockage has truly occurred. My recommendation would be to follow up with your injector urgently. Refrain from using cold compresses. Massage the area gently, use of warm compresses, and consider oral ASA 75mg. If a hyaluronic acid based filler was used, hyaluronidase can be injected to dissolve the filler, but I would see your injector for further evaluation.

Jacqueline Calkin, MD · Answer

Impending necrosis is painful and it doesn’t appear that you are at risk, however it’s impossible to be sure from a photo. Your doctor should absolutely have looked at your photos OR preferably had you come into the office. Did they ask you about pain and other symptoms?   If they told you to do warm compresses, that tells me they consider necrosis a possibility. In my opinion, it’s inexcusable not to see a patient under those circumstances as early intervention is critical. If they asked you all the appropriate questions and determined you were not at risk, that’s different story. If you have any concerns still, go and see them. Best to you.

George Davis, MD · Answer

Thanks for your question.  Necrosis can occur after a few hours but its usually one sides and very painful.  From your pictures, it appears that the coloration is uniform.  Most likely post injection swelling and possible early bruising.  I would avoid the cold compress as some studies show that can actually cause some skin irritation.  If you have any further concerns, schedule an appointment with your injector.

Leonard Grossman, MD · Answer

You don't have necrosis in your lip. It is simply a bruise which will resolve with time. Good luck from New York City

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