Lip augmentation with soft organization fillers is an artistic and technical challenge. Not only does one need meticulous injection technique and skill, however an detailed understanding of lip anatomy and also lower challenge aesthetics is imperative because that optimal results. In addition, ideal knowledge of the filler assets themselves, consisting of the individual and unique attributes of each, skilled uses and also potential complications, is needed for safe and effective treatment.

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A current article described lip nodules and swelling that ended up being painful and noticeable soon after injection. This is why this may have actually happened and also why she was ideal to it is in concerned:

Consequences of Filler Injections

As stated in my previous posts, usual side impacts such as bruising, swelling, redness and also pain, room most common of the injection procedure itself quite than the product used. The usage of drugs prior come injection the predispose come bleeding, such together aspirin, NSAIDs, fish oil, Ginko and/or vitamin E, can increase the threat further. Fortunately, these complications are an ext irritating 보다 serious, and also can be easily managed with cool compresses, camouflage makeup and/or laser treatments (pulsed dye, Excel V).

Rare symptom are more frequently early out to bad technique, lack of experience, or simply frank negative luck. Symptom you have to be involved with after injectable filler treatment are reports of far-ranging pain or adjust in skin color past the typical pain and also redness or bruising indigenous injection. These symptoms have actually serious implications and should it is in evaluated immediately if report after treatment.

Choosing the best Filler


Choosing the right Filler

The lip is distinctive in its anatomy. Therapy in this area is less forgiving than other locations of the challenge primarily due to the enhanced vasculature, intricacy in shape and also dimension, wet and dry borders, as well as frequent, active nearby muscular movements. Pristine method and appropriate filler selection is required to limit complications and give optimal aesthetic improvements. The rheological principals of the filler chosen are much an ext or much less likely to reason acute complications such as nodules or ede as viewed in the presented case. Because that example:

Voluma has a much higher G prime then other forms of Juvederm and also has the volume to “lift” the lips much more than others, potentiating the capability to kind nodules, pain and also swelling.Particulate filler such together Restylane can give an ext structure to the lip, however may compromise the softness seen with other homogenous hyaluronic acid fillers such as Juvederm or Belotero.The hydrophilic nature that hyaluronic acid fillers calls for the practitioner to stop over therapy in order come prevent an extensive swelling and also unpredictable results leading to patient unhappiness.Semi-permanent fillers such together Radiesse, Artefill and/or Sculptra (biostimulant) have to not it is in injected right into this area, as the muscular movement can cause clumping the filler product and potentiate nodule formation, bring about permanent irregularity requiring surgical removal.

Techniques for Success

Since ede is immediate in locations of raised vascularity and can reason the regional anatomy to easily alter, optimal aesthetic outcomes of the lip are more an overwhelming to acquire if the procedure is no performed swiftly and precisely. Therefore, i teach a “10-second” rule, where selecting your injection site, performing the injection and deciding if you have to make edits, bring away a full of, at most, 10 seconds. Microcannulas border the amount of swelling and also bruising by gift blunt fairly than sharp, and being much more flexible than rigid, compared to needles. Through just a few access points, microcannulas can be provided contour and lift one area that would certainly otherwise need a number of serial puncture injections or threads. The absence of organization trauma by the dull nature of the product makes treatments basically pain cost-free and bloodless. My only caveat is the the capacity to “fine-tune” the lip shape, produce eversion and/or specify the vermillion or lip corners is much more restricted/difficult through cannulas compared with a sharp needle. Finally, that is important not come forget:

Treatment about the lip/mouth into the vermillion can improve lip lines and also give eversion and also lift.Treatment the the top cutaneous lip and pyriform aperture, and also the lower cutaneous lip and also chin fat pads, can provide the lip/mouth support that regularly decreases v age because of fat atrophy and also bony resorption beneath.To always check the within of the mouth for great dentition, as lack of teeth or periodontal an illness can it is in a reason for absence of lip/mouth shape, contour and support.

Post Treatment treatment Instructions

Post Treatment care Instructions

Meticulous technique, pressure and icing, and also homeopathic treatments, such as arnika, bromelain and vitamin K, can help to limit minor complications from filler injections. Patients have to be informed and instructed on suitable at-home care of the treated areas to limit the much more serious consequences such together necrosis and also infection, as well as migration and asymmetries. Manipulation that the treatment areas with massage need to be avoided for at the very least 24 come 48 hours after treatment. When filler rarely migrates, it has been report at far-off sites and also in different planes (superficially) from injection. This might be a result of the technique used, but also the an outcome of at-home management.

I have actually seen inflammation reactions, product migration, extreme swelling and extensive bruising from hot yoga, saunas, massage table or CPAP machine/mask pressure, and trauma to treatment locations in the early on post-treatment phase. Because that patients with far-reaching post-procedural swelling or potential angioedema, oral antihistamines (Zyrtec, Allegra), corticosteroids (prednisone), and/or diuretics (furosemide, hydrochlorothiazide) have actually been helpful in my practice.

Fixing an excellent Lips gone Bad

Fixing an excellent Lips gone Bad

The best treatment is avoidance by using an excellent technique, including very low volumes and strategic placement, having a thorough expertise of product characteristics, being well versed in the discrepancies in between individuals and lip anatomy, and also advising patient on proper at-home care:

Supply in-depth post-treatment instructions to each patient.Suggest avoidance the manipulation or trauma come treated areas for 24 to 48 hrs after treatment.Avoid intense exercise, too much temperatures and also applying chemistry or irritants to cure areas.

When in a situation where you have to treat patients:

Reverse extensive swelling or nodules through hyaluronidase injections, roughly 10 come 20 devices per 1 cm2 area.For considerable bruising, consider laser therapies (pulsed dye, Excel V) in the first 24 to 48 hours after treatment.If the patient reports extensive pain, blanching or duskiness, and/or mucosal change/sloughing, consider impending organization necrosis and follow developed guideline protocols because that treatment.

What deserve to We discover From This Post?

The most vital take-home message from this post, is come educate her patients top top the potential complications from filler injections and also supply them with an extensive at-home care guidelines. Lip nodules are a potential complication, most commonly occur from poor filler technique or inappropriately liked filler product, and also can be avoided.

Jason Emer, M.D.Jason Emer, M.D.

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, is a board-certified and fellowship-trained general, cosmetic and procedural dermatologist who is passionate about advancing safe and also effective treatments in the ar of cosmetics dermatology and laser surgery. Dr. Emer’s expertise and also interests encompass the full range of general dermatological conditions, novel therapeutics, cosmetic face and body treatments, consisting of aging skin, veins, body sculpting, fat harvesting and fat transfer.