Dermal Filler Problems & How to Fix Them

When I wrote my article on Botox Mistakes and How to Fix Them, I had no idea how popular it would be.  So I thought I would cover dermal filler problems, too.

It makes sense to do a piece on Juvederm and Restylane mistakes or problems, just in case some of you have had filler results that you’re not that happy with. Some of these tips are things you can do to help ensure good results, and some are things your dermatologist may need to do.

Dermal Filler Problems

Here are five problems you may encounter or hear from your friends:

  1. Too much bruising or bruises;
  2. Asymmetry (the face or parts of it look lop-sided);
  3. Over-filled or puffy looking;
  4. Under-filled (you don’t look any different than before);
  5. Lumps or bumps
  6. The one serious complication – a blocked blood vessel (very rare).

Too Much Bruising

The injection of any face fillers will often cause at least a little bruising or some red spots. With a little knowledge on your part and a good doctor or nurse injector, bruising can be minimized.

Bruising after Juvederm or Restylane cannot be cured or fixed, other than to cover it with make-up. So the goal with bruising is to prevent it in the first place. So here are the tips on how to avoid Juvederm bruises that we provide to our patients at Madison Skin & Laser Center, our dermatology practice in Seattle:

  • No aspirin, Aleve, or Ibuprofin 1 week prior to your appointment (Tylenol is fine)
  • Do not take Vitamin E 1 week prior to injections.  Your multivitamin is okay.
  • Stop alcohol 2 days prior to injections.
  • No garlic 2 days prior to injections.
  • Eat pineapple 2-3 times 1-2 days prior to injections.  Bromelain supplements can be taken but can have some serious side effects.
  • Take Arnica one day prior or morning of injections.  You can find it at certain drugstores and often at Whole Foods.

Asymmetry, or a Lop-Sided Face

We all have some normal and natural asymmetry to our faces. I think that’s part of what makes us individual and beautiful. Some of us have a lot and some have very little asymmetry. If a filler like Juvederm is done well, the uneven face should be slightly corrected or left as is. But it should definitely not be worse. So, if you’re Juvederm or Restylane filler looks lop-sided, look at a recent photo first!

Then, take a deep breath or two, and if it’s not too noticeable, just wait a week. Bruises can cause a temporary bump or asymmetry and will go away in a week or 10 days. Sometimes that bruise is deep and not visible on the surface of the skin.

Now, if the asymmetry is still there after a week or so, or is excessive, you may need to fix it. For this, please call your doctor. They should get you in within a day or two. Make an appointment and explain your concern. Depending on your goals, the doctor can either inject more filler (needed if one side is under-filled) or use an enzyme (hyluronadase), 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 Juvederm 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, call your dermatologist. You may need a little enzyme (hyluronadase) injected to reduce the fullness.

Under-filled or Not Enough Result

Feeling under-filled or that the result is not enough aren’t really dermal filler problems or mistakes in the true sense of the word. 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

There have been some rare reports of small lumps or bumps with Juvederm and Restylane. 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 ten days. If the lump or bump is still noticeable, see your doctor. The most common fix for this is, again, hyluronadase 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 Juvederm or Restylane. How rare? Estimates are 1 out of 10,000+ patients.

But here’s what to know just in case. Small bruises are common; 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 turn dark purple or there’s 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.

As with all cosmetic treatments, you should find an experienced injector in a reputable medical practice.

For more information, see Dr. Irwin’s other filler resources:

Guide to Juvederm, Restlyane, and Fillers


See Dr. Irwin’s expert answers to other reader’s questions on dermal filler problems or mistakes and how to fix them:
If I had a problem with a Juvederm injection, is it okay to use hyaluronidase to fix it?
I have a  lump in my lip from Juvederm!
Help! A Restylane problem!
I had injections of Restylane in my chin and now have white bumps inside my mouth. Should I worry – it has been 4 weeks?
More problems with fillers under the eye area.
Is there a good makeup that can cover up bruises from injection?
A serious problem after Radiesse.