Juvederm Gone Wrong!

Dr.Irwin- I had juvederm injected into the upper lip area to smooth lip lines that are hereditary. My first injections left the areas in approximately two weeks, and the second series left one area more plump that the right side leaving my face asymmetrical. I also had lots of injection problems with hematomas, purplish blistery knots, and swelling that lasts to this day. Continuing to this day (three months later) at this end of the day my lips swell leaving me very self conscious. Can you offer any advice on what the problems may have been, and what I can do to stop the swelling. I do not want to return to this physician (who is board certified in Dermatology). Please help if you can.

It helps me to know your age and how deep the lines are.  In general, I don’t like Juvederm for upper lip lines, unless they are quite deep for these exact reasons. It tends to be too full and it takes a lot of skill and experience to get it just right.  I do use it sometimes on the upper lip for my older patients who have more volume loss there and deeper lines.  Even then, we will often use a needle even smaller than an acupuncture needle (a 32 gauge). 

 I think you would be much happier with Cosmoplast, which is smoother with less tendency to be lumpy on the upper lip.  Bruising can still occur though.  It really helps to have a topical "caine" mix ointment applied for 30-40 minutes prior to injection.  It not only numbs, but also constricts the blood vessels to make bruising less likely.  We also use ice and often do dental blocks for comfort.

 If it’s still bothering you, it would be worthwhile to see if your doctor has hyaluronidase (an enzyme which melts Juvederm/Restylane).  If so, that can be injected which fixes the problem immediately.

Dr. Brandith Irwin, MD

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