Persistent bumps (lips) and problems years after Restylane or another HA.

Hi Dr.Irwin, I need help desperately please! I read a post to you from Dawn on March 24, 2013 regarding restalyne injections in her lips 7 years prior that resulted in large hard bumps on or above her upper lip which are extremely noticeable. I have the exact same problem and it's been 5 years since the injection of restalyne. In my case it was definitely restalyne and I did have the hydrolauranic(not sure of the name but the one they use to fix this) injection done but it seemed to work at first but over the years the problem continued to get worse. One day there was a tiny hole on the far side above upper lip and when I squeezed it a white gel like substance would come out. At times the substance would be very thick and other times runny but for days it continued to ooze out of this hole. This hole is still there and several times it oozed out what I think is the restalyne still somehow stuck in these lumps. My upper lip is a mess. Besides the lumps, it is red, you can't really see my upper lip line anymore and I have developed two more holes that won't go away. I would really like to send you a pic so you can see what I am saying. I don't know who to see or if anything can be done to fix this mess. Please help me.

Dear Jennifer, I hope you don’t mind my answering here because you’re not identifiable and I think others are having this problem also. To my knowledge, this can happen in three different situations. Two of these you seem sure aren’t the problem, but I’d like to address them anyway to help other people.


If you have persistent bumps or inflammation (lasting longer than 6-12 months) after a hyaluronic acid product like Restylane or Juvederm, here’s what to consider:

1)  The product wasn’t what you thought it was. Look for the boxes in the room when you get your injections – the boxes should say clearly what’s on them. Also, even better each syringe has its own individual sticker with the lot # on it and the product name. These are supposed to be in your chart note. We take these off the syringe and affix them right to each person’s note. If there’s ever a problem, we know exactly which syringe was used.


2)  You now have an infection. These are referred to now as biofilms and are usually low to medium grade but persistent infection during and/or after the HA filler placement. These can continue after the HA filler goes away. These need to be cultured first but often won’t show up as a positive culture because the organisms may be unusual or because it’s difficult to get a good sample. These need to be treated with antibiotics sometimes for more than several weeks. Have your doctor do some research on this complication for you (if they are not familiar with it) and use one of the recommended antibiotics.


3)  Cheap HAs in Europe, Asia, South America etc. There are currently being made and injected cheap, poor quality, sometimes contaminated HA filler products that are substandard and can cause all kinds of reactions including allergic and infectious ones. Even though they are more expensive, try to get the better quality Restylane family, Juvederm family or products by Merck (Belotero and others in Europe) injected to control for this. This is not a problem in the U.S. because they are not available. It is sometimes a problem in Canada.


Hope this helps,  Dr. I


Learn more about Filler Mistakes and How to Fix Them.

Dr. Brandith Irwin, MD

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