Restylane and Juvederm Bumps - What Causes Them?

Hi Wrinkles,
With hyaluronic acid fillers like Restylane and Juviderm, lumps and bumps should be minimal. If present after the treatment, they should be massaged out, certainly they should be gone within 24 hours. When injected properly, your wrinkles should be less noticeable, and not replaced with bumps. Thicker skin is more forgiving, but even in thin skin, the technique can be altered to avoid bumps. Avoid taking aspirin products, Motrin, Advil, or any other blood thinning products for 7 to 10 days prior to your injections to minimize your chances of bruising.
Depending on the individual (and their willingness to pay for product) anywhere from one to three syringes should do the job. I have recently heard of a physician in NYC using 10- 12 syringes to re-inflate faces. Your name needs to be something like Madonna, or you need to be in the venture capital/CEO line of work to be able to afford that treatment.
Good luck with your wrinkles being gone. Be well.
Dr. P

Juvederm is an excellent filler for facial wrinkles.  Bumps are caused by the technique of injection.  Of course even with the best technique you can have bumps.  Make sure that the person injecting the Juvederm is a board certified plastic surgeon. Nurse injectors just do not have enough skill, training, education, or expertise to inject fillers.

Hyaluronic acid can cause bumps initially when injected for several reasons:-injection technique- deposition technique can involve the use of placing droplets which may settle down over a period of weeks-bruising- early bruises can cause the product to swell and create lumps-clumping of product- too much product placed too close together can clump together-improper viscosity- too viscous a product can create a more palpable bump, in particular thinner skinned patient

We never want to see bumps, but bumps can sometimes serve a useful purpose.  Sometimes, a small bolus of filler under the skin "tacks" the skin up and helps it to drape better.  These bumps act as scaffolding under the skin.  Sometimes, especially initially, the patient can feel them.  But, we never want to be able to see them.Bumps that we can see are the result of filler that has been placed too unevenly and too superficially.  Sometimes the bumps will resolve on their own; sometimes they can be massaged away; sometimes they have to be dissolved, unfortunately. 

It’s not unusual for small bumps to occur following Juvederm
injections. These bumps occur at the
site of the injection and are related to the injection technique. When Juvederm is injected close to the surface
of the skin these bumps commonly occur. They can be prevented by avoiding superficial injections. Once they occur, they can be treated with
massage. In most cases, a response is
generated within a week of this maneuver.The
volume of filler utilized in any particular case depends on the patient’s
physical findings and aesthetic goals. In the majority of cases, 1 to 2 syringes will be necessary.If
you’re concerned about this problem you should consult your physician. Your physician should be able to make an appropriate
recommendation.

Bumps tend to be due to swelling or bruising from the injection itself. If it is bruising that forms, I would recommend using arnica gel, which is a herbal remedy that can help to minimize swelling and bruising after your treatment. I would also recommend that your physician apply ice prior to your treatment to help minimize your risk of swelling.It is difficult to say how many cc's on average is required, since everyone is different.

While the bumps you speak of are noted by consumers somewhat often on this site, we have noticed that most of the issue occur around the lips and under the eyes. This is because proper injections in these areas of the face require proper experience and training.
To lessen the risk of experiencing bumps after Restylane or Juvederm injections:

Search for a practitioner that has injections as a primary part of their practice, not secondary.
Make sure that if you are having under eye injections you search for an injector that injects "under the muscle". So many of the bad outcomes under the eyes on the site are for those physicians that are injecting the under eye area superficially over the muscle.
When getting lip injections, make sure to start with less rather than more. Many patients are surprised by swelling and how far .4 cc or 1cc will go. You can always get more, but it's more difficult to move backward.
Make sure that you talk to your practitioner about hyaluronidase, which is an enzyme used to reverse the effects of Restylane and Juvederm. It's amazing how many injectors do not know how to use it or even that it exists. Scary!

Bumps from Restylane or Juvederm are temporary if they occur (few to several days) and they are not easily seen. They’re very small and makeup can hide them. Some only have the slight redness for less than one day. Long term bumps are very unusual. It can occur as a reaction to the filler or if the product gets injected too superficially. Usually one to two syringes are needed, rarely three, depending on the length and depth of the lines. Most patients do very well and the results are natural –looking.

The most likely cause of bumps after injection is that the filler is a bit too superficial (it was not injected deep enough). Usually this will resolve with time and massage, but it can happen with any filler. Experienced injectors will know how to minimize this risk, but even in the best of hands the risk exists. That being said, it is an uncommon problem in most cases. But this brings up an excellent point-- it is important to know the experience and the training of the individual who you choose to perform your procedure. The right surgeon can not only perform the procedures properly, but inform you of all of your options, not just the injectable ones. This is by far the best way to avoid a disappointing reslut, so that you have the procedure that is right for you, performed by an individual who is skilled and able to offer you multiple options.

Although rare, lumps are a risk of any filler treatment.  Areas where the skin is thicker such as the cheeks and smile lines are less prone to lumps in comparison to areas where the skin is thinner such as the lips and undereye.  Restylane and Juvederm are both hyaluronic acid fillers.  The benefit of using any hyaluronic acid fillers vs. fillers such as sculptra and radiesse is that they can  be reversed or dissolved in 1- 2 days using an enzyme called hyaluronidase if a lump were to develop.  
In our practice we only use hyaluronic acid based fillers.  
-Dr. Sunanda Chugh, NYC