Upper Lip Fuller on One Side Than the Other After Restylane

Question

After having Restylane in the upper lip, why does the doctor rub it, and why does one side look fuller than the other?

Brent Moelleken, MD · Answer

The biggest cause for early asymmetries after filler injection into the lips is swelling or slight bleeding into the tissues.  Often by 1 week post injection, this swelling has "ironed itself out".  At that time, additional injections may be considered.
Restylane tends to clump a bit, so massaging the areas can smooth out the lumps immediately after injection.
Fillers do not even out asymmetries in the cupid's bow.  Placing more and more filler on the low side will only result in a very plump, and lower, lip on one side.  So it is nice to note any asymmetries before injection and point out to the patient that not all asymmetries will be fixed by injections.

Leila Kasrai, MD, FRCSC · Answer

Sometimes, the injected filler can be smoothed/evened out by gently rubbing the treated area. However, this should only be done by the injector and is not necessary. At this time, your lips may be affected by some swelling which makes one side look fuller than the other. You should be able to gauge your results better about 2 weeks after your treatment.

Harold J. Kaplan, MD · Answer

Your injector is messaging the product to make sure it distributes evenly under the skin around the injection point. Ideally, we would rather have more injection points rather than have fewer that need a lot of massaging. 
If your injections look uneven after 1-2 weeks after the swelling has subsided, schedule an appointment to discuss this with your injector. You'll most likely have two choices at that point:
1.  Reverse the injections with hyaluronidase (an enzyme that breaks down the Restylane) and start over.
2.  Get more Restylane injected into the area of the lip that is smaller.

Otto Joseph Placik, MD · Answer

Uneven results after Restylane may be attributable to:

Pre-existing asymmetries of which you were unaware
Injection techinique
Restylane properties
Swelling

1. If you have pre-existing uneveness (and most do) , the restylane may make this more obvious. I occasionally did not notice old scars (and the patients forget about them too) unitl I have injected the lip. Scar tissue does not expand like normal tissue and it can create a tethering effect like a tight band which creates a bulge or lump on either side of the band. Like a muufin top that suddenly appears when you put on a tight pair of pants. It is difficult to compensate for a smaller lip on one side because injection of more restylane amy make it bigger but also make it appear to hang lower.
2. Injection technique: a dental block is less likely to cause swelling/bruising/bleeding in the area but some patients do not like this due to the amount of numbness in the area. Injecting local anesthetic into the lip can cause swelling which distorts the area and difficult to assess injection of the restylane. Any injection of material can cause bleeding on one side and not the other which can also distort the result. Generally these do resolve with time
3. Restylane tends to attract water and soften the immeadiatley firm result. Massaging the product after injection helps to reduce the edema (swelling from injection and disperse the material similar to flattening a ball of dough so that it is less "round.
4, Swelling after any surgical procedure can be affected by your head position as well. Elevating you head after surgery helps to minimize this. But if you slightly lean your face while sleeping to one side, you will notice more swelling on the side you leand towards. Also people tend to have more swelling in the morning than at night.
Give it about 2 weeks, if you are still concerned return to your doctor to discuss these matters!

David Shafer, MD, FACS · Answer

Ann Marie, 
All of the filler induce swelling at the points of injection which starts almost immediately after your injection and then for a several days post-injection.  You can even see the difference if you ask to see in the mirror right after your injections.  If the right side was injected first, when you look in the mirror after both sides have been injected, the right side will look fuller since it has been swelling for a few more minutes than the left side.  This swelling resolves over a few days.  However, it is possible that you have underlying asymmetry of your lips or had more product injected in one side or the other.  This is easily correctable if you are willing to have more product injected in the smaller side.
David Shafer, MD
New York City

Monika Soni, MD · Answer

Thank
you for your question. I can understand your concerns but there will be a small
asymmetry after the lip augmentation and each lip will react differently. To
ensure that there is even distribution of the filler, massaging is done. It
takes up 2 weeks for all swelling to resolve to see your final results.
Best of Luck!

Hardik Soni, MD · Answer

Thank
you for your question. I can understand your concerns but there will be a small
asymmetry after the lip augmentation and each lip will react differently. To
ensure that there is even distribution of the filler, massaging is done. It
takes up 2 weeks for all swelling to resolve to see your final results.
Best of Luck!

Kris M. Reddy, MD, FACS · Answer

There will be slight asymmetry post treatment as each half of the lip will react differently. Massaging the lips post treatment is common to ensure even distribution of the filler. I would suggest you do not judge the treatment for 7-10 days post treatment.

Pat Pazmino, MD, FACS · Answer

Restylane is a very popular and effective dermal filler. Patients enjoy it because the results last for approximately 6 months but the benefits are immediate. As you have read on this board, it is possible to have unsatisfactory results when using this filler inappropriately. For this reason, it is important to only work with a board-certified plastic surgeon or dermatologist who has great deal of experience with these fillers. They will be able to provide a balance and natural looking results. In your case, you should schedule a visit with a board-certified plastic surgeon who can assess your lip and determine if you may need additional Restylane to balance out the uneven results or if some Restylane may be extracted or dissolved with a medication

Philip Young, MD · Answer

Unevenness may be due to differential swelling. One side may have received more manipulation than the other side and has become more swollen.  You should wait at least 2 weeks before doing anything drastic.
The ways to correct it are to add more to the side that has less or is smaller. Or you can take some out of the side that has more by injecting an enzyme to digest the Restylane.  You should go to someone that has experience in doing this to have a successful result. Knowing aesthetics is also the key to getting a great result.

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