Thank you for your question.
You stated in your question you had 1mL of Juvederm placed on your lips yesterday and
you feel like your upper lip looks very large—you describe it as looking like a duck and you
are concerned about the results and whether it could be undone.
I think you submitted some very good photos to help me understand what your situation
is.
Well I can certainly assist you with this question.
I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic surgeon
and we do a lot of fillers in our practice.
I have been in practice in Manhattan and Long Island for over 20 years and we use a lot
of Juvederm.
And certainly, improving lip aesthetics is one of the most sought after procedures we
provide, because of the importance it is to have nice-looking lips.
So, to begin with, let’s just understand a little bit of the process, and I’ll tell
you what I do in my practice and hopefully, if this was comparable to what was done for
you, you’ll get a better sense of what to expect.
So, to begin with, I recognized for years that lips are very sensitive and they could
swell very significantly.
So, when I do lip enhancement, in my practice, I actually have the patient see what the lips
look like immediately after the completion of the injection.
So I place the injection and my assistants are often there to share their opinion and
give me some feedback as to what areas need augmentation, and what areas can be left alone.
And after I’m done with completing the procedure, I give the patient a mirror and I have them
look at it.
The reason I do that is that this is a small window before there is going to be two types
of swelling.
One is just reactive swelling.
Think about it, it’s just like eyes, if you bump your lip, it swells tremendously.
Then there is another swelling which is the material.
The material will absorb water.
A lot of times, that is responsible for a certain percentage of the swelling.
We routinely give the patients a little cold compress or a little ice to help minimize
the swelling on their lips, particularly if they are going back to work.
Now, lip aesthetics can be challenging—now this is going towards the question of the
duck-ish appearance of your lips.
An aesthetic lip, whether it is the Golden Ratio, the 1.6 : 1 ratio between the lower
lip and upper lip or the 1/3 : 2/3 ratio for the upper lip and the lower lip, these are
the ratios that are very, very important and we see too many celebrities and too many people
walking around Manhattan and Long Island looking like duck lips long after they had their injectables
done.
So, I think that one thing to be mindful of, and I know you acknowledged that in your question,
is that swelling is a big part of the response when people feel like lips are exaggerated.
So I always recommend that apply ice as much as you can tolerate and for the first couple
of hours, if the lips appear to swell.
A lot of times people swell that much, depends a lot on the individual, it depends on the
amount of manipulation there was during the time of the procedure.
One mL between the upper and lower lip is not a lot, but again it just depends on how
you respond.
If this is your first time getting this filler and you have no experience like this before,
then, this might be what you have to anticipate in the future.
I always tell a lot of our patients who come for the first time for injectables, that if
they have never had this type of injectable done, particularly in the lips, I always tell
them give yourself a day or so, just in case you swell and to a level where you do not
want to be seen by other people.
So maybe do it on a Friday and then allow yourself the weekend.
Because by the time Monday rolls around, typically it’s down well enough.
Now if for any reason you still are not happy with the results, there is an enzyme that
is used called hyaluronidase and this is an enzyme that will dissolve the material and
it can be done, but I would say, you should give it a little bit of time.
In our practice, we have our patients come back after two weeks, for any type of injectable
we do, just to see how things look.
Sometimes, it is an opportunity to augment or enhance.
Interesting thing with lips, and this goes back to the days before the injectables when
we would use mainly fat as a filler for lips, is that patients would be very scared in the
first couple of weeks after fat grafting procedures of the lips, and then three months later they
ask if they can get more fat put in.
And that is because of the reactive swelling, because the lips can really swell significantly.
So once again, expect that swelling is responsible and you should manage that in the first 24-48
hours.
Contact your doctor—your doctor may want to put you on an anti-inflammatory, if appropriate.
In addition, be mindful that it does often take 1-2 weeks for it to settle, so that you
have a better sense of what it will look like in the long term.
The long term being about the next 3-6 months, depending on your individual metabolism and
how the material responds in your situation.
That being said, I hope that was helpful and I wish the best of luck.
Thank you for your question.