Uneven Lips And Accentuated Nasolabial Folds After Juvederm, should I have this dissolved?

Question

Nearly 3 weeks ago I had Juvederm injected in the lips and nasolabial folds. 1ml per fold and 1ml divided in the lips. Is it possible that Juvederm accentuated the folds around my mouth and nose? The mouth corners were treated...is that causing the unnatural smile? I realize the lips are uneven and may be overfilled for my small mouth as well. Lip corners are now hidden. My question is whether to have it dissolved and treat the cheek area to lift the mouth folds? Thank you!!

Nelson Lee Novick, MD · Answer

Without photos, I can only comment in the most general way. But, the short answer to your question of whether in fact you need to have your treatment dissolved is probably "Yes, unfortunately."  Most tissue swelling (edema) that results from filler and volumizer injections that may distort the results resolves between two to four weeks following treatment. So, from the story, it would seem that what you see now is what you got, and since you are unhappy enough to second guess your treating physician by querying the RealSelf staff, rather than directly contacting the treating physician, I would venture to say that you very likely need to have the injectables dissolved with hyaluronidase and then to seek a second opinion for appropriate re-treatment. With this in mind, I have some additional comments, one of which you already alluded to in your question, and that is how best to treat smile lines. Nowadays, as opposed to ten or fifteen years ago, experienced injectors evaluate the cheek and mid-cheek regions first and augment these with volumizing fillers, an approach that not only improves falling and sinking cheeks, but the smile lines (nasolabial folds) that often secondarily result or are accentuated by the shrinkage and descent of the cheek fat pads above. We have found that oftentimes injecting the smile lines directly, as was clearly done here, can worsen the folds, rather than improve them, which seems to be what you are describing. Moreover, treating the angles of the mouth following direct treatment of the smile lines could be responsible for the unnatural smile you describe. And  we have all heard of the overfilled, unnatural-looking  "trout pout" lips ("duck lips," "sausage lips) created by inexperienced, novice injectors, which again seems to be what you are describing. Finally, experienced injectors are unlikely to use ordinary Juvederm or simple Restylane for the above purposes. In my NY office, for example, for cheeks, I  might use Voluma XC; for the lips, Juvederm Ultra Plus XC; and for the angles of the mouth Restylane Lyft. (In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available, I would select Stylage XXL for the cheeks, Princess Volume for the lips, and  Hyaluronica 2 for the angles of the mouth.)  Bottom line, next go-round make sure to vet your physician well and insist upon seeing his/her before and after photos before agreeing to proceed. Best of luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Though your lips appear to be okay it appears that your smile line filler was placed too low along and around the corners of your mouth and after 3 weeks should be dissolved as they are unlikely to get better.  Hope this helps.

Karol A. Gutowski, MD, FACS · Answer

The choice to dissolve it is really up to you. If you really don't like it, ask for it to be undone.

Steven F. Weiner, MD · Answer

This is obviously poor placement of the filler and needs to be dissolved. I would remove with Hylenex. I can't see the lips , but if not happy with those, also dissolve those. Consider elsewhere for future treatments. I  now use Refyne and Defyne for lips and NLF for more natural appearance.

Richard O. Gregory, MD · Answer

Should it be dissolved?  Yes  It appears too full, but that is a judgement call.  Hyaluronidase is very effective in melting the hyaluronic acid.

Leonard Grossman, MD · Answer

It is virtually impossible to answer your question without seeing the photographs of you prior to the treatment. Good luck from New York City

Uneven Lips And Accentuated Nasolabial Folds After Juvederm, should I have this dissolved?

Answers (6)

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