48hours later im starting to freak out ..im still swollen in my left side but i can still easily see she misplaced the product plus giving my left side much more volume..it looks deformed as it is placed over my cheekbone leaving an unatural gap to the temples ..i will wait another 24hours but then should i correct the right with more product? or dissolve only my left side and do it again? My doctor said it was because i had damaged tissue ..but i think it was her first time with voluma.
After Juvaderm Voluma in my Cheekbones, Swollen and Uneven Face
Doctor Answers 19
Don't Freak Out -- Ask Questions!!
Asking the right question might get you the response that will make you realize that a problem is not so severe, is fixable, or just happens to be within the range of normal.
Having said that, the first place to start is with your doctor. Express how you feel. You can even ask if it was their first time, but that doesn't mean that is the problem. My first patients did exceedingly well.
If you feel unsure or uncomfortable with the responses, get another opinion (or two) until you are comfortable with what is happening.
Whatever you do, don't rush into "fixing" what might not be a problem.
In other words, don't bleed until you're cut...LOL
There is some swelling with Voluma and sometimes it does get misplaced, even at times by patients "playing with it"
Get the facts before you act or react.
Start with your own doctor.
Move on if you feel the need.
Voluma injections require an artistic eye.
Uneven and Bumpy: Will my Juvederm Voluma Improve 48 hours following the injections?
Juvederm Voluma is an excellent product for building deficient cheeks and mid-face areas and should ultimately be smooth. I prefer to take care not to over-inject during the first session. You can always come back for another session in a month or so if necxessary.
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Juvederm Voluma is Excellent for Cheek, Mid-Face & Chin Augmentation, and the nonsurgical Ten Minute Necklift
Although Juvederma Voluma is not yet available in the United States in my Upper East Side N.Y. practice, I have a great deal of experience with it in my private clinic in Israel where it has been available for the past couple of years. Unfortunately, as with so many products that have received prior approvals for use in humans by their FDA equivalents in Canada, Mexico, Europe and Israel, Voluma will very likely (hopefully) receive its FDA approval for use in the States within the next year.
Voluma is an excellent product, more robust than the current volumizing fillers, such as Perlane L or Juvederm Ultra XC, and has the advantage over Radiesse in that it can be dissolved, as can all other hyaluronic acid-based injectables, by hyaluronidase. It is excellent for areas that require real volumization, such as the cheekbone area, the mid-cheek, jawline and chin. I also prefer it over all others for my nonsurgical neck rejuvenation, the Ten Minute Necklift.
Swelling and distortion of the treated areas is very common with all hyaluronic acid products, but particularly so with Voluma. What I explain to my patients immediately after treatment (before the swelling and the bruising take full effect--which can happen in the next day or so) is that "what you see right now in the mirror is what you get again when all the dust settles," i.e. when all the swelling, bruising and redness completely resolve. I make sure to alert all patients that swelling can be uneven, so that one side can swell far more than the other, but that such distortions will resolve spontaneously in a few days. I absolutely do not retreat before three or four weeks have elapsed to be sure that no asymmetry is due to persistent tissue swelling that has been slow to resolve. And I certainly would not even consider dissolving any of the material prior to that time, as well, although, to date, I have never as yet needed to use hyaluronidase for Voluma.
Swelling After Voluma
Swelling after Voluma can be a result of the following factors
-Deep bruise- Not all bruises are at the surface and this localized swelling can take weeks to dissipate
-Injection technique- Injections of the product can create depositions which can create lumps if not properly transitioned. Since Voluma is not hydrophilic (does not tend to absorb water), Voluma tends to be a what you see is what you get type of filler.
Consult your treating physician for the best course of action.
Swollen and Uneven After Voluma
Voluma and Side Effects
Voluma is a great injection but results like all facial injections are dependent on the injector. If it looks uneven I would definitely return to your treating physician. If you feel that the physician is inexperienced please consult a board certified dermatologist. Voluma can be dissolved with hyaluronidase so try not to worry and have the situation corrected.
Uneven results after Voluma can be due to a few different reasons
Uneven results after 4 weeks is often due to physicians not being aware of pre existing facial asymmetries. Treating both sides of the face equally in these situations will only further accentuate these asymmetries. I find that taking good pre treatment photos, having them up during the treatment so that I can refer back to them as needed is very helpful as once swelling sets in it can be difficult to make the proper judgment as to where product is needed. I like to use Vectra 3D photography.
Other delayed causes can be due to an inexperienced injector placing too much product in one cheek. In this situation, Wydase can be used to melt the Voluma but this may result in total loss of the results and having to start over.
You made a good point about possibly needing to fill your temples to balance out the cheeks. The temples are often hollowed out making us look older. Filling only the cheeks will make the cheek volume look overfilled as there is not balance between the temples and cheeks. Filling the temples at the same time will restore smooth facial curves and natural contours.
Ran Y. Rubinstein, MD
200 Stony Brook Court, Newburgh, New York
Board Certified Facial Plastic Surgeon
Clinical Professor New York Presbyterian Hospital
National Education Faculty (physician trainer) for:
Allergan (Juvederm, Voluma), Valient (Scultpra, Restylane),
Cynosure (Cellulaze, Precision Laser Lift) & Solta (Fraxel, Thermage)
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.