How to Manage Bumps and Lumps from Cosmetic Fillers

How to Manage Bumps and Lumps from Cosmetic Fillers

Thank you for your question! You’re asking, based on some confusion as
to why there are differing doctor’s opinions about how to handles lumps and bumps on the
lips after Juvederm. And why is there is such a range of answers from conservative observation
and stating that this is a normal process while others recommend seeking medical attention
immediately. Well, I can certainly give you my perspective.
As a specialist, I’m a board certified cosmetic surgeon and fellowship trained oculofacial
plastic and reconstructive surgeon. I practice in Manhattan and Long Island and I’ve been
using fillers for over 20 years in practice starting with the original Zyderm and Zyplast
made by collagen. So Restylane and Juvederm and all the other hyaluronic acid fillers
are something that I provide in my practice and certainly, there is a lot of confusion
out there as to what to do and when but I can give some simple basic rules of how evaluate
patients in our practice and how we monitor whether or not interventions are necessary. To begin with, as far as lips are concerned
for example, I believe very much on a natural look. In fact, the majority of people who
come to us who want lip augmentation begin their request by saying “I don’t want
duck lips.” Or they’ll refer to celebrities or people they know on reality shows or whatever
who have very large lips. That’s of course because the lips are very much a critical
part of facial harmony. And when lips look disproportionate or unnatural they naturally
draw a lot of attention. In terms of management, let’s start with
the first part. In the evaluation and the artistry of using a filler, you know a filler
is like a material but it is the sculptor, the doctor who has vision as to what that
lip should look like and how to employ that filler. So I believe very much more on a very
natural and there is a golden ratio for lips where there’s a proportion of 1:1.6 for
the upper lip to the lower lip or a one third to two thirds rule that in my experience,
I’ve found is to be very useful. Now, when this type of correction is done to try to
add volume, you know when you’re treating the lips, you’re not just treating one area.
There’s the volume in the upper lip and volume in the lower lip, there’s the border
of the upper and lower lips, there’s the corners, there are a lot of places at different
levels of the tissue in which fillers can be applied. So when we’re talking about
the volume in the lip, that’s what I refer to as the ratio and then how it fits the face. When you enter the lip with a needle to place
this volume, there is going to be a certain amount of short-term reactive swelling. That
reactive swelling can camouflage the presence of a little bit of additional material causing
a small elevation or a bump. Now, I explain to my patients that if there is any evidence
of an elevation or a bump early that it can be normal as long as it’s not too obvious
and it is normal for the movement of the lips and the activity to help kind of internal
massage the material into place. What I usually do is have patients come and see me again
in two weeks to see how things look. There’s always possibility of the need for enhancement
maybe adding a little bit of volume in one place or another. Usually, not much is necessary
but it gives me a sense of how it looks. If looks natural, it looks good, if the patient
is satisfied. There’s a lot of value in having people come back after two weeks doing
an injectable. Times of concern is when there is pain, there’s inflammation, possibly
infection. There can be times when the material can be present and become hard. So there are
certainly appropriate reasons when a physician can be concerned and would recommend a more
urgent visit. So, I always tell patients that choosing the
right doctor is not about buying a syringe of a filler. You know, unfortunately, the
commoditization of fillers has made people seek cheaper prices for various levels of
injectables including physicians and non-physicians. And at the same time, there is often a compromise
in the quality of the follow-up care. And injectables are invasive procedures and I
think there is often a diminishing of the seriousness of an injectable filler but people
think that surgery is invasive and I would propose that placement of an injectable filler
is comparable because you are now violating or going through the barrier of the skin and
you are placing a foreign material under the skin. So I look at it, as a surgeon, as being
equivalent to surgery. So, I’m always accessible to patients and they can always find me if
they need attention. So I would say that the close relationship of the doctor who performs
the injectable and the doctor being able to examine you determines whether or not something
is more urgent or less urgent. So it’s understandable that when someone
posts photos and has a certain history, it is often natural for physicians to then respond
by saying “Seek medical attention.” But in general, in the short term, in the first
two weeks, if there’s subtle irregularities which are not disfiguring or drawing too much
attention and there are no other symptoms that can be unusual and again, it’s based
on the description to the doctor of hardness, inflammation or possible infection, then usually
waiting is appropriate. It comes down to relationships and knowing
the patients. With my patients, my injectable patients, we see them for a long time because
this is the kind of thing that requires maintenance. So we get to know them, get to know their
anatomy, get to know what they like and that is critically important. I find that when
people come to me for corrections and very often, they have gone in a kind of fragmented
way, going from one place to another place. They went to a friend or they went with another
friend where they found a deal or there was a party or something of that nature. So that hopefully gives you a certain understanding
that essentially there are some things that can happen short term and long term that do
require medical attention but as a general rule, volume correction does require about
two weeks in the lip area for example which can allow for normalization without urgent
intervention. So I hope that was helpful, I wish you the
best of luck and thank you for your question!


  • floyd zepplin says:

    i just got juvederm voluma in my lips yesterday and i have some pretty bad and noticeable lumps

  • Mia M says:

    I love your videos! So educational:). Thank you!

  • notyourbae 19 says:

    love your videos so informational thank you! how quick after getting your lips done should you start massaging? i dont want any lumps

  • Natalia Pilichiewicz says:

    Hello dear
    i had teoysal deep lines in my lips…AFter like 3 weeks I have noticed some bumps..It has been a month now and i would like to massage it but i am scared to make it worse? after this time will it even help? Please help!!!

  • Callisto000 says:

    Thank you for the videos, very informative!
    I had my very first lip injection (only in the upper lip) one day ago and have a soft localized bump appear on one side pretty much immediately after the procedure. My upper lip in general has not gotten inflamed and has minimal bruises (barely seen). I was wondering whether i should try and massage it a bit or just leave it be and wait till my checkup visit to the doctor next week. Like I said, its a soft bump not a hard one so I don't know whether its simply a very localized inflammation or the filler just concentrating in that one spot.

  • juju bone says:

    I think poorly trained doctors give u bumps. I've gone to places where they have not given me any bumps and my lips came out symmetrical

  • truestar070 says:

    I had my lips done two days ago and I don't like it. How long does it take for the filler to get dissolved?

  • Just Me says:

    How does the filler stay only in the area that is injected? How does it not migrate to other areas of the body?

  • Elizabeth Caroline says:

    I wish you lived near me! Would love to come to you to get it done, plus you are cute to boot!

  • Elizabeth Caroline says:

    Should you always feel "bumps" after injection? I had mine done last week and can clearly feel and see the bumps. Should there never be any "bumps" in your lips afterwards then?

  • Rio says:

    A very interesting and informative video, thank you for creating it!

  • şevin hun says:

    Hello just came by your video and want to ask a question. I got Juvederm ultra 3 injected to under eye area three days ago. A swelling and bluish discoloration occured after a few hours through the tear line. Today the swelling is likely to diminish but there is a visible lump and a very tiny nodule can be palpated. My doctor suggested doing a soft massage but I am very concerned if something will go wrong. What is your medical opinion about massaging under eye area? Thank you…

  • Muriel Morales says:

    Thank you very much for the video! So educational. I just got Voluma on my nose 2
    Days ago and i feel a bumb in the middle area of the nose (like over the lip close to the nose). People don't see the bump but i feel it, it's kind of uncomfortable and it hurts a bit, but just a bit, like inflamation. My nose looks perfect but i feel this wierd kind of sphere. Should i call my doctor? Should I wait a little longer cause it could be just inflamation? Thank you very much and sorry for my english, im from chile haha. ☺️

  • Punanamous Me says:

    I had Juvaderm removed (under eyes). Now there's a bluish/white haze in it's place.

  • The Foreigner says:

    Dr. Prasad I would say you are like the Picasso of (oculo)Plastic Surgery, but I am more of a Van Gough guy. Bravo! Dali was pretty good too.

  • May Harb says:

    I did hyalas twice to dissolve lip filler but i still feel my upper lip especially the philtrum area bumping up

  • uruba nisar says:

    I feel lumps under my skin after my nasolabial fillers. It’s been 2 days. Is this normal?

  • Beauty Obsessed says:

    Such good info

  • claudiazuma says:

    I had juvederm fillers around my mouth. Specifically marionette lines a week ago. I see Two bumps besides each injection site making my lines look hollow and deep. Can that be corrected with time?

  • Susan Antoniades says:

    Dr Prassad hi I watched your video with interest as I had some hyaluronic injections nearly two years ago which have left me with several hard lumps. I have had them repeatedly treated with hyaluronidase but they haven't dissolved. Is it possible to have them surgically removed and if so how to I go about it?

  • Angelina Judd says:

    I got the white bump on the bottom of my lip in the corner the bad or good

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