We often tell patients that “Filler is not for the faint of heart.” By that we mean that you have to have the stamina or willingness to sometimes deal with less than optimal temporary issues in order to hopefully achieve a more beautiful outcome in the end. Here is a guide to dealing with five of the most common issues. If you are not sure if you need to be seen, we recommend that you email us a “selfie” along with a description of your concern. And we will advise you from there.
Too Much Bruising
The injection of any face fillers will often cause at least a little bruising or some red spots. First and foremost you need to avoid any medication that might increase your risk of bruising for 1 week prior to your appointment, such as ibuprofen, Advil, or aspirin. Please read this article for a more thorough discussion of what you can do to minimize bruising: “How to Avoid Bruising with Fillers and Botox.”
Asymmetry, or a Lop-Sided Face
We all have some normal and natural asymmetry to our faces. It is often said that the two sides of our face “are sister, not twins.”
Often asymmetries give a face “character,” but sometimes we use filler and Botox to soften asymmetries. If you feel that you look very lopsided, first compare your face to a recent photo and make sure that you did not have the asymmetry to begin with. Then, take a deep breath or two, and if it’s not too noticeable, just wait a week (or two!). Bruises can cause a temporary bump or asymmetry and it will go away in a week or 10 days. Sometimes that bruise is deep and not visible on the surface of the skin, but the area may feel tender.
Now, if the asymmetry is still there after a week or so, or is excessive, please call for a “filler follow-up appointment”. Depending on your goals, either more filler can be injected (needed if one side is underfilled) or an enzyme (hyaluronidase) can be injected, to reduce or dissolve the bump or fullness.
Over-Filled or Too Puffy
The same principles above apply to this problem. Wait a week or so because often the problem will resolve on its own. There is often some puffiness right after a treatment that goes down within 7-10 days.
Remember sometimes bruises from filler can be deep and you may not see them on the surface. They might just feel a little tender and cause some puffiness.
If you still feel over-filled and are not sure if you need to be seen, we recommend that you e-mail us a “selfie,” with a description of your concern. Then we can determine if a “filler follow-up appointment” is needed you may need a little enzyme (hyaluronidase) injected to reduce the fullness.
Under-filled or Not Enough Result
In my experience, most patients prefer to start with a conservative treatment to see how they will react to a new product. It’s a good idea to go slowly in the beginning. Many doctors will under-fill just slightly on that first treatment but tell you to please wait a week or two and come back for 1 more syringe if it’s not quite enough.
Lump or Bumps
These are usually small bruises underneath the filler. But the bruises can feel like a small lump or bump. The best way to fix these lumps or bumps is wait 10 days. If the lump or bump is still noticeable, call for an appointment. The most common fix for this is, again, hyaluronidase to remove enough filler so that the lump or bump goes away.
The One Serious Complication – a blocked blood vessel (very rare)
This is fortunately a very, very rare side effect of filler injection. How rare? Estimates are 1 out of 10,000+ patients. But here’s what to know just in case. Small bruises are common or even an occasional large bruise is fairly common. The two areas at risk are around the base of the nose and the area where your frown lines are. If those areas turn dark purple or there’s a blotchy red rash that extends out from the purple area onto the nose, upper lip or forehead, call your doctor right away, and don’t wait until Monday if it’s the weekend. This needs to be treated right away to avoid a scar.
