Lip Fillers Gone Wrong: Risks, Complications, and Prevention

The rise of injectables, such as dermal fillers and neurotoxin injections, have made shaping the lips easier than ever before. Unfortunately, that doesn’t mean that the procedure is without risks. If you’re contemplating non-surgical lip augmentation, it’s vital to be educated about the possible complications that may arise.

How Can Lip Fillers Go Wrong?

The popularity of lip fillers on social media leads many to assume the procedure is straightforward and safe. When performed by a plastic surgeon or dermatologist, the procedure is likely to result in excellent results without long-term or unsightly side effects. 

However, there is always a risk that dermal fillers may result in less-than-ideal outcomes. “Even with precise, meticulous injection technique, some patients will develop excess swelling or bruising because the lips are well vascularized–that’s why they are red,” explains Dr. Steven Goldman MD, an injectables expert at the Derm Collective.

What Are Some Common Complications That Can Arise?

“The most common issues with lip injections are bruising, asymmetry, bumpiness, and prolonged swelling,” points out Dr. Goldman. Here’s what you should know about these issues:

Bumpiness: Lumps and bumps after fillers typically subside within 72 hours. However, in some cases, small, hard lumps may be visibly apparent on the lips for weeks or months if the injections have been made too superficially.

Unevenness or asymmetry: Poor injection technique may cause the top lip to appear plumper than the lower lip. Sometimes asymmetry can also be caused by the way the filler settles.

Overfilled lips (also known as duck lips): Excess filler can cause the lips to overly protrude, like a duck’s beak. Overfilled lips can become stiff, rendering it challenging to make expressions with the lips.

Soft fillers, such as hyaluronic acid fillers, are best suited to lip augmentation. Restylane Silk is used to help erase vertical lip lines and plump lips, while Juvederm Ultra XC plumps lips. The use of an incorrect filler can create a less-than-ideal outcome.

Bruising: Bruising is, unfortunately, a prevalent side effect of lip fillers and happens when the larger blood vessels in the lips are punctured. Usually, bruises will run their course and fade within one to two weeks. If you have significant pain with your bruises, or irregular bruising outside the lips, get your lips checked out.

Swelling: Lip tissue is extremely vascular, and therefore sensitive. Some swelling after the procedure should be expected for five days. Intermittent icing can manage swelling. Talk to your injector if swelling lingers longer.

What Are Rarer Complications That Can Arise?

In addition to the more common complications, there are also some more severe, rarer risks that can happen. “As with all filler injections of any kind, there have been rare episodes of blindness and skin necrosis (patches of skin dying),” reflects Dr. Goldman. “Blindness and skin necrosis are rare events, however, because filler must get into a blood vessel and migrate. Even non-surgical cosmetic procedures carry some risk.” 

Some rarer risks you should be aware of:

Overstretching of lip tissue: Those who use lip fillers regularly and have a preference for an inflated pout may find their lip tissue starts to stretch and sag over time.

Infection: Although unlikely, infections can occur. In most cases, they can be treated with a course of antibiotics if identified early. Fillers can also trigger cold sores among those who are prone.

Skin necrosis: Necrosis can happen if the filler is injected directly into the blood vessel. The supply of blood flow then becomes blocked, which can cause tissue death.

Blindness: If a filler is inadvertently injected into a blood vessel, blindness can occur. Although this is an extremely rare occurrence, it can happen.

How Can Problems with Lip Fillers Be Prevented?

Prevention is always the best cure. There are strategies that you can take before your procedure to minimize the likelihood of some complications. 

“You can reduce bruising by using ice packs during injections, stopping medications like aspirin, ibuprofen, and other non-steroidal anti-inflammatories two weeks or so prior to treatment. Stopping supplements like fish oil and vitamin E, which can increase bleeding, can also reduce bruising,” advises Dr. Goldman.

Arnica Montana may also offer mild benefits in reducing swelling and bruising following injections. Pre and post-procedural diet may also play a part. “Eating pineapple and foods rich in antioxidants before the injection, and avoiding alcohol after the injection may help as well,” he states.

These tips may also help lead to a more successful outcome:

Ask for recommendations

If you’re new to fillers, ensure you find a reputable cosmetic doctor specializing in lip fillers. Medical professionals have a nuanced understanding of the vasculature of the lips and know safe procedure. Avoid beauticians as they do not have adequate medical training.

Follow a “less is more” approach

Ask your injector to talk you through the kind of filler they will be using, and why. The best injectors will take a conservative approach to lip fillers.

Opt for hyaluronic acid fillers

Fillers can be divided into hyaluronic acid (HA) fillers and non-hyaluronic acid fillers. Hyaluronic acid lip fillers are recognized to be safer, with fewer risks of long-term side effects than other kinds of fillers, and the potential to be dissolved if necessary. While they may not last as long as other filler options, they represent a safer method of experimenting with lip fillers for first-time patients.

Follow all pre and post-procedural instructions

Your injector will provide you with clear instructions regarding the care of your lips, like sleeping with your head elevated to encourage swelling to subside. Following these instructions is critical to avoiding unwanted outcomes. 

If things go wrong, there is a remedy

Fortunately, hyaluronic acid fillers can be reversed if you are unsatisfied with the outcome. “Most injections are performed with hyaluronic acid fillers, including Restylane and Juvederm,” explains Dr. Goldman. “These fillers may be dissolved with an enzyme called hyaluronidase, so if there is an asymmetry or a lump, it can be reduced.” It’s best to wait for two weeks or more to allow the swelling to resolve and the filler to settle before opting for hyaluronidase.