Follow up to my previous question: Very bad bruising with Juvederm - Healing Process. (photo)

Hello, Well I hope this is just a bruise.  If it is a bruise then it will clear up within 2 or so weeks.  Your picture could be more clear and I cannot touch the site, however, it appears to me that you may have an injury to the skin.  I repeat that I am not 100% positive without a better examination.  You should see your doctor for a physical exam ASAP in order to identify if you are bruised and/or you have a skin injury.  It is a possibility that hyaluronic acid fillers (or any filler) can be inadvertantly injected into a small blood vessel that feeds the overlying skin with oxygenated blood.  If the blood vessel gets obstructed with the filler then the surrounding tissue can get injured.  It's synonymous with a heart attack or stroke.  Assuming this is a skin injury (necrosis) and you are a week out, the damage may be done and the healing process will take longer (weeks).  The treatment for this type of injury is to flood the injected site with hyaluronidase.  Hyaluronidsae is an enzyme that dissolves the filler.  I would still do this treatment at a week out.  The aspirin in that case may have not been a bad idea at all because it will thin the blood to that site.   Keep using the vaseline often and maybe try not to put make-up on it if possible. You need to see your injecting doctor or a referral from him or her to another specialist.  This is a tricky question because of its sensitivity and my lack of examining you.  It does not mean your doctor necessarily injected you wrongly.  Internet questions and answers are limited in ways.  Good luck.  Please let me know what happens. 

The lips are a very vascular therefore the chances of bruising are increased in that area.  Unfortunately, bruises can occur even with the best of injectors.  Bruising should last for approximately 1 week.  If you don't feel that the bruise is healing properly or you have concerns with your treatment,  you should see your Doctor for an assessment.   

Bruising after injections of filler can occasionally happen, even in the best of hands. I always tell my patients that if it is something that concerns them, then it is something that concerns me. You need to get in and see your doctor. It is most likely just a bruise, but what your physician should be worried about is this actually representing early signs of necrosis from the filler injections. This is very rare, but it is something that your physician should be ensuring is not happening.It sounds like they already thought of this, and that was the reason for the warm compress and the aspirin. Nonetheless, if that is something they are suspecting they should be seeing you!To boot, if your physician has experience with lasers, they can easily use a pulsed dye laser to erase any bruising that you have, or at least help it go away more quickly. It's quite impressive actually.Be sure to choose a dermatologic surgeon, oculoplastic surgeon, facial plastic surgery or plastic surgeon who is board certified and fellowship trained in one of these core four

It always recommended to have an in person examination of an area of concern like this with the Dr. who injected it.  If it is in fact just a bruise you can apply arnica montana topically to help the bruising go away faster, this is available over the counter at most health food stores.  You can also take it orally in a pill form.  I would do both for faster results.  For the chapped skin there is a product by Hymed called reconstructive cream that works great for skin issues like this.  

This appears to be bruising from injection around a blood vessel likely to resole in 1-2 weeks as the clot will be absorbed by the body. it will turn to different colors like blue, green, and yellow. not to worry.

Dear Mariemount1,

Injectable soft tissue fillers
such as Juvéderm® or Restylane® are
excellent for soft tissue enhancement, lip augmentation or wrinkle reduction,
as well as facial shaping. One of the
dreaded complications of soft tissue filler injectables is getting an
intravascular or intra-arterial injection, which can compromise the blood flow
to an area of skin, resulting in death of that skin, necrosis and
scarring. Your postoperative course is
atypical for that kind of process and analysis of your photo now, on day three,
reveals that it’s probably more related to bruising and ecchymosis; however,
mild intravascular injection ischemia cannot be ruled out. If it is an intravascular injection which
compromises blood flow, there are a number of treatments that need to be
instituted immediately, one of which is aspirin. So, the advice of your treating physician
would not be inconsistent if that were the tentative diagnosis. Other treatments, however, which would be
more important would include the use of hyaluronidase to take down the Juvéderm
to relieve the vascular compromise, as well as topical vasodilators such as
Nitropaste.

It is difficult to tell from the photo that was sent, but it is very important you seek the advice of your
injection physician almost immediately to confirm whether or not there’s been
some vascular compromise. If it is a
bruise, then you can be reassured that the bruise will eventually resolve and
it is unlikely that this kind of severe bruising will occur with any frequency,
especially if a microcannula is used.
Microcannulas are blunt-nosed needle tip injection devices that greatly
minimize the risk of intravascular injection and minimize the risk of
bruising. Perhaps discuss with your
injection physician if they have expertise with the use of a microcannula.

My strong advice would be to seek the advice of a physician who
injects Juvéderm quickly to ensure there’s no vascular compromise.

I trust this advice is of some help
and best of luck.

Sincerely,

R. Stephen Mulholland, M.D.

Certified plastic surgeon

Yorkville, Toronto