Thank you for your question!
You’re asking, based on some confusion as to why there are differing doctor’s opinions
about how to handles lumps and bumps on the lips after Juvederm.
And why is there is such a range of answers from conservative observation and stating
that this is a normal process while others recommend seeking medical attention immediately.
Well, I can certainly give you my perspective.
As a specialist, I’m a board certified cosmetic surgeon and fellowship trained oculofacial
plastic and reconstructive surgeon.
I practice in Manhattan and Long Island and I’ve been using fillers for over 20 years
in practice starting with the original Zyderm and Zyplast made by collagen.
So Restylane and Juvederm and all the other hyaluronic acid fillers are something that
I provide in my practice and certainly, there is a lot of confusion out there as to what
to do and when but I can give some simple basic rules of how evaluate patients in our
practice and how we monitor whether or not interventions are necessary.
To begin with, as far as lips are concerned for example, I believe very much on a natural
look.
In fact, the majority of people who come to us who want lip augmentation begin their request
by saying “I don’t want duck lips.”
Or they’ll refer to celebrities or people they know on reality shows or whatever who
have very large lips.
That’s of course because the lips are very much a critical part of facial harmony.
And when lips look disproportionate or unnatural they naturally draw a lot of attention.
In terms of management, let’s start with the first part.
In the evaluation and the artistry of using a filler, you know a filler is like a material
but it is the sculptor, the doctor who has vision as to what that lip should look like
and how to employ that filler.
So I believe very much more on a very natural and there is a golden ratio for lips where
there’s a proportion of 1:1.6 for the upper lip to the lower lip or a one third to two
thirds rule that in my experience, I’ve found is to be very useful.
Now, when this type of correction is done to try to add volume, you know when you’re
treating the lips, you’re not just treating one area.
There’s the volume in the upper lip and volume in the lower lip, there’s the border
of the upper and lower lips, there’s the corners, there are a lot of places at different
levels of the tissue in which fillers can be applied.
So when we’re talking about the volume in the lip, that’s what I refer to as the ratio
and then how it fits the face.
When you enter the lip with a needle to place this volume, there is going to be a certain
amount of short-term reactive swelling.
That reactive swelling can camouflage the presence of a little bit of additional material
causing a small elevation or a bump.
Now, I explain to my patients that if there is any evidence of an elevation or a bump
early that it can be normal as long as it’s not too obvious and it is normal for the movement
of the lips and the activity to help kind of internal massage the material into place.
What I usually do is have patients come and see me again in two weeks to see how things
look.
There’s always possibility of the need for enhancement maybe adding a little bit of volume
in one place or another.
Usually, not much is necessary but it gives me a sense of how it looks.
If looks natural, it looks good, if the patient is satisfied.
There’s a lot of value in having people come back after two weeks doing an injectable.
Times of concern is when there is pain, there’s inflammation, possibly infection.
There can be times when the material can be present and become hard.
So there are certainly appropriate reasons when a physician can be concerned and would
recommend a more urgent visit.
So, I always tell patients that choosing the right doctor is not about buying a syringe
of a filler.
You know, unfortunately, the commoditization of fillers has made people seek cheaper prices
for various levels of injectables including physicians and non-physicians.
And at the same time, there is often a compromise in the quality of the follow-up care.
And injectables are invasive procedures and I think there is often a diminishing of the
seriousness of an injectable filler but people think that surgery is invasive and I would
propose that placement of an injectable filler is comparable because you are now violating
or going through the barrier of the skin and you are placing a foreign material under the
skin.
So I look at it, as a surgeon, as being equivalent to surgery.
So, I’m always accessible to patients and they can always find me if they need attention.
So I would say that the close relationship of the doctor who performs the injectable
and the doctor being able to examine you determines whether or not something is more urgent or
less urgent.
So it’s understandable that when someone posts photos and has a certain history, it
is often natural for physicians to then respond by saying “Seek medical attention.”
But in general, in the short term, in the first two weeks, if there’s subtle irregularities
which are not disfiguring or drawing too much attention and there are no other symptoms
that can be unusual and again, it’s based on the description to the doctor of hardness,
inflammation or possible infection, then usually waiting is appropriate.
It comes down to relationships and knowing the patients.
With my patients, my injectable patients, we see them for a long time because this is
the kind of thing that requires maintenance.
So we get to know them, get to know their anatomy, get to know what they like and that
is critically important.
I find that when people come to me for corrections and very often, they have gone in a kind of
fragmented way, going from one place to another place.
They went to a friend or they went with another friend where they found a deal or there was
a party or something of that nature.
So that hopefully gives you a certain understanding that essentially there are some things that
can happen short term and long term that do require medical attention but as a general
rule, volume correction does require about two weeks in the lip area for example which
can allow for normalization without urgent intervention.
So I hope that was helpful, I wish you the best of luck and thank you for your question!