Wavy, Bumpy Bottom of Top Lip After Filler - What Has Gone Wrong? (photo)

Question

Have had 0.5 Juvederm Ultra smile injected (first time) 2.5 weeks ago (body not border). After the intial swelling had gone down I was happy with the overall volume but not happy with all the bumps along the bottom of the top lip which is also lopsided (to my right). I massaged for about a week starting 48 h after the injection but have stopped now as I have seen only v slight fading of bumps. What should I do??? have more filler to correct gaps? Hyaluronidase may cause more damage than good...

Anil R. Shah, MD · Answer

Wavy lips might need filler along the stomal portion of the lips.  Lip filler bumps is fairly common after filler.  The bumps can occur early on and many settle down.  Although massage after filler is considered a mainstay, beware that massage can drive the filler into another location if done too early.  
Reasons for bumps after filler:
Technique- Filler may have been used too superficially or wrong type of filler
Mouth movements- In some patients their movements can promote the accumulation of bumps and an alternative technique can be advocated.
Treating lip filler bumps:
Observation +/- massage-  Should be done for almost all lip filler bumps for 2 weeks.  For our patients we usually advocated massage after 48-72 hours to let the filler settle into place.
Reversal- A reversal agent can be used such as Vitrase to dissolve the filler if there is a large obvious persistent bump
Additional filler- An expert filler injector can used improved technique to mask the lip bumps.
The application of lip filler is very technical and should be done by an expert injector.

Sam Naficy, MD, FACS · Answer

Unfortunately, it looks like your Juvederm was injected unevenly or too superficially and this caused the lumps to show. The choices are only inject Hyaluronidase into the lumpy spots or allow the Juvederm to dissolve over time. My hunch is that you will be happier if you dissolve the unevenness sooner than later. Your provider should be able to do this for you at no charge. You may require a Juvederm touch up but if injected deeper or by a more experienced injector your appearance could be greatly improved. Good Luck!

Monika Soni, MD · Answer

Thank you for your question. It is common to have some swelling after fillers for lip augmentation which can take up to 2 weeks to resolve. You can apply cold compresses to the area to help reduce swelling and bruising. It is also advisable to avoid any NSAID’s before and after treatment as they tend to thin the blood and increase the risk of bruising and swelling. If you have any other concerns please contact your treating physician. Best of Luck!

Michael J. Brown, MD · Answer

Hello AlexUKice,Thank you for posting your question. I suggest returning to your provider to discuss your concerns. Over time the Juvederm will diminish but that can take months. If you are looking for a quicker result, then hyaluronidase may be your answer. Just make sure you are injected by a board certified plastic surgeon or someone skilled in these injections. Hope this helps!Best wishes,Dr. Michael J. BrownNorthern Virginia Plastic Surgeon

Gail Nield, MD, FRCPC · Answer

Uneven swelling can occur for up to 2 weeks following lip injections. Certainly your injector may have injected incorrecly, but in addition, I would never advise anyone to massage their lips after filler has been injected, as distortions may occur from inadvertently moving the fileer around. Filler may be somwhat mobile for up to two weeks, and therefore, Never massage filler! Unless you have had Sculptra, but this is not for the lips.

Sheri G. Feldman, MD · Answer

Your pictures at 2.5 weeks look like the bumps have improved substantially since the original Juvederm injection. My advice is to leave them alone as they should continue to fade as your body absorbs the material. You can try a small amount of Hyaluronidase. It is not harmful and most injectors do not charge for it if they were the ones that injected the Juvederm for you. Your injector wants you to be happy with the result!

Cheryl A. Hull, MD · Answer

Juvederm is a smooth gel and you should not be able to see the product or feel it. Since it was injected into the mucosal part of your lip, it is more noticeable when the product is unevenly distributed. I have found that gentle massage to the bump between your thumb and finger helps smooth and disperse the product so no "bumps" are visible. It will not smooth our immediately, just be persistant. Even though it has been almost 2 weeks post injection, I would try massage before adding more product. If massage did not work, then consider adding more product to help even out. I agree that hyaluronidase has its own risks-try to avoid. Hope this helps.

Darryl J. Blinski, MD · Answer

I only see a "bump" on the left lore off central lip. Either have a small amount injected into the right lower or live with it for the next few months. Injecting Hyaluronidase is very risky and expensive.

F. Victor Rueckl, MD (in memoriam) · Answer

At this point, although the lump may resolve over time, it's best to see your injector. I tell patients to please not massage Juvederm themselves. Often when patients do this, it's they themselves who move the Juvederm around and cause lumps and bumps. Return to your injector for an evaluation at this point. Yes, the lump will resolve, but a tiny bit of hyaluronidase into the lump will also resolve it immediately too. Don't massage anymore on your own.

Wavy, Bumpy Bottom of Top Lip After Filler - What Has Gone Wrong? (photo)

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