Thank you for your question.
You submitted your question with a single photo.
And you describe in the details of your question that it has been two weeks since you underwent
lip fillers and that you have several bumps in your upper lips especially when you smile.
And the injector advised you to massage this area.
You are aware of potentially having this material dissolved but you are hesitant to go that
way because it takes awhile for you to recover from bruising and swelling and that you take
the time off when you have lip filler.
And you work in a job where you serve people.
So you are of course caught in a situation which is a bit challenging where you are concerned
about an appearance and you are of course concerned about any downtime related to any
corrective action.
Well, I can certainly share with you my thoughts on this situation based on the limitations
of your history in the photos in the absence of a physical examination.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Helping people with their lip aesthetics is something we do in our practice every day.
And I can certainly share with you that I have evolved in my approach to help my patients
with lips enhancements since it has been often that particular challenge of the desire to
have an improvement but at the same time, have a minimal amount of swelling and downtime
and do something in a way that can be consistent.
And so I’ll discuss my approach in a moment.
To begin with, the perception I have from looking at the multiple, what appears to be
islands of filler that are relatively superficially placed that it would be my conclusion that
the injectable filler of most likely a hyaluronic acid filler was placed by doing multiple injections
into the lip.
And that some of that material was released relatively superficially hence the causes
of the bumps.
You know with lip anatomy, generally speaking, enhancement of the volume of the lip in my
experience and in my approach in doing this type of work is to place the volume mostly
deep.
And anything that is superficial is limited to areas that are not in that pink area and
more along the lip border also known as the vermilion border.
Now that being said, you’re in a situation where the strategy and the approach probably
induced a certain amount of significant swelling which why of course you needed to take it
off.
I think that from the perspective that these bumps are probably going to get somewhat better
from just the massage as what your injector recommended but hyaluronic acid fillers at
a certain point will actually reach a certain equilibrium or balance and it might persist
until the body breaks it down.
And so you have to decide whether or not you’re comfortable with allowing that certain amount
to be present.
Generally speaking, when we do injectable fillers for our patients whether it’s for
lip or anywhere else, we see patients after two weeks and I can generally predict that
whatever I see after two weeks is basically going to be stable for a while and that for
the initial first week or so, there’s a certain degree of swelling that can affect
the picture.
When I do volume enhancement for lips, I generally use a technique using blunt cannulas.
And I have found that I have been able to significantly improve my outcomes using this
approach.
Essentially, I strategically place entry points and then I place the filler in a way that
minimizes the trauma and bruising and swelling.
Further, I find that I can have a lot of more control in getting the level of the lips that
I want enhanced and avoid some of these more superficial placements.
It’s not like it’s impossible and it certainly can happen but I would say that in my experience
that this technique has been very consistent.
You know when I read something like in your situation where you often have to take time
off to allow for swelling and other things to resolve, well that’s I think one of the
reasons why that motivated me to help my patients through evolving the technique because once
someone gets a nice result they like, well eventually the filler goes away and they naturally
want to do it again.
But if they have a not so great experience, they may be hesitant to do that.
So it’s important, with any aesthetic procedure that requires maintenance that you do everything
you can to minimize swelling, bruising and maximize predictability.
It doesn't mean that at the two week visit, sometimes patients want more volume and they
may ask for more volume.
Of course that’s fine or little enhancements which is also fine.
But I think that this is a situation where the material is kind of focused in different
little tiny islands.
Now, like I said, it is possible that with a little bit of massage and just natural movement
from smiling, talking and moving, you will be able to get resolution.
I would say, to address the question about the hyaluronidase and the use of an enzyme,
yes, you maybe get a little bit of some swelling but I would say that since the area is a little
bit small, a small amount of enzyme may go a long way.
So it might be a decision you choose to do maybe in a couple of weeks after it has settled
out.
And if you are still bothered by the appearance then you can address with the enzyme and maybe
allow for a day or so of swelling may be related to just the procedure.
Again, there’s a lot of nuance in the approach and the style, the touch and of course the
fact that lips are sensitive and can swell.
You know, even in the best hands and the most delicate approach and the most experienced
hands, a little bit of swelling is still going to be a normal part of the process.
So talk to your injector about this.
Maintain your dialogue and of course, I think it’s a good idea to just kind of document
for yourself like the photo you took to see if a week later, it looks pretty much the
same or two weeks later it looks the same.
At that point, it might be, the most practical thing is to dissolve some of this filler and
just let things not look as irregular.
It’s difficult to appreciate the three dimensional aspect of your appearance with a two dimensional
photo and that’s where a physical exam is obviously superior to just the photo.
So I hope that was helpful, I wish you the best of luck and thank you for your question.