Why does lip filler carry its own specific risks?
The lips are among the most mobile parts of the face and have one of the richest blood supplies. They move constantly when you talk, eat and smile, which can create conditions in which filler spreads, forms lumps or shifts position. The upper and lower lip arteries run inside the lip, around the muscle layer. The depth and course of these vessels vary from person to person.
The lips are one of the areas most often treated with filler, and a large share of reported complications also come from this area. Literature reviews show that the most frequently reported problem related to lip filler is nodules (lumps), and that filler migration, discolouration and cold sore flare-ups are also among the lip-related problems. Because some complications are never published or reported, their true frequency is not exactly known.
For the basics of the procedure, see our article “Hyaluronic Acid Filler”, and for general problems with all types of filler, see “Filler Complications”.
How much swelling is normal after lip filler?
Because of their loose tissue and rich network of blood vessels, the lips swell more than other areas of the face. In the first days your lips may look much fuller than you expected, sometimes slightly asymmetrical and tight. This swelling is usually most noticeable in the first days and then gradually goes down. You generally need to wait a few weeks to judge the final result.
Small bruises at the injection points, tenderness to the touch and mild numbness in the first hours are also common. For how these develop and how to reduce them, see our article “Bruising and Swelling”.
The following, however, differ from the expected swelling and mean you should consult a physician: swelling that increases as the days go by, pain that gets steadily worse, warmth in the lip, discharge or fever. Swelling of the lips, tongue or throat that increases rapidly within minutes, together with difficulty breathing, may be an allergic emergency.
Why do lumps and firmness develop in the lip?
Small firm areas or bead-like bumps that can be felt in the lip are among the most common problems after filler. They can have different causes:
- Product collecting in one spot: usually noticed in the first days or weeks and most often not painful. Some of it may become less noticeable as the swelling goes down.
- Placement that is too superficial: product placed just under the thin lining of the lip can be felt and can sometimes be seen as a fine ridge or a bluish shadow.
- Delayed inflammatory reaction: swelling, redness and tenderness that appear weeks or months later, sometimes after an infection, a vaccination or dental treatment.
- Infection: a painful, red, warm and steadily growing swelling, sometimes with discharge and fever.
Only the physician examining you can tell the cause of a lump. A firm area that is not painful and gets smaller over time can often be monitored. A swelling that is growing, painful, red or appears late, however, should be assessed. Unless your physician specifically recommends it, do not massage or squeeze a lump.
Overfilling and asymmetry: why do the lips not look natural?
Lips that look disproportionately large, protrude forwards or have an overly upturned upper lip, the look sometimes called duck lips, are most often the result of too much product being injected in a single session or of product building up over time through repeated treatments. In some people, a new treatment carried out without noticing that the previous filler has not fully broken down can also contribute to this build-up.
Mild asymmetry in the first days may be due to swelling and can resolve on its own. If marked asymmetry or overfilling is still present after a few weeks, your physician will discuss the options with you. With hyaluronic acid fillers, some or all of the excess product can be dissolved with the enzyme hyaluronidase.
Can filler move above the lip border?
Yes, this is not rare. Filler can spread beyond the border of the red part of the lip into the skin of the upper lip, that is, towards the moustache area. In this case a slight bulge or band appears above the lip, becoming more visible especially when you smile; English-language sources refer to this appearance as a filler moustache. Migration of filler towards the inside of the mouth or to the corners of the mouth has also been reported.
Although the causes of migration are not fully known, a large amount of product, superficial placement, frequently repeated treatments and the constant movement of the lips are among the contributing factors. Migration is sometimes noticed only over months or years. With hyaluronic acid fillers, the physician may suggest dissolving the displaced product with hyaluronidase. If new filler is being considered after dissolving, your physician will decide on the timing.
Marked swelling of the lips in the first days is usually to be expected. However, if you notice blanching, a purplish net-like pattern or steadily increasing pain on or around the lips, contact the physician who treated you without waiting.
Dr. Hamza GemiciMedical Director, DoktorClub · Aesthetic Medicine Physician
Can lip filler trigger cold sores?
Cold sores occur when a virus that lies dormant in the skin and nerve cells becomes active again. Injections in and around the lips can trigger this virus in people who have had cold sores before. Symptoms usually appear in the days after the procedure as tingling and burning in the lip, followed by small fluid-filled blisters.
If you have a history of cold sores, be sure to mention it before the procedure. For people who get cold sores often, your physician may consider preventive treatment before the procedure. If there is an active cold sore on the lip, the procedure is usually postponed. If you think a cold sore has appeared after the procedure, see your physician; do not take prescription medicines on your own and do not burst the blisters. For how to tell a cold sore from an infection and how they are treated, see our article “Infection after Aesthetic Treatments”.
Blisters and crusting on the lip are not always a cold sore. Small blisters and darkening colour can also appear in the hours after a vascular occlusion. If the blisters come with whitening, a purplish colour or severe pain, contact your physician immediately.
What happens if a lip artery is blocked? When is it an emergency?
Filler entering one of the lip arteries or pressing on a vessel from outside is a rare but serious complication. The lip tissue supplied by the blocked vessel cannot get enough blood; without timely treatment, tissue loss and scarring can develop in the lip or the surrounding skin. Loss of vision after lip treatments has been reported extremely rarely; the main lip-specific risk is the disruption of the blood supply to the tissue.
Symptoms usually start during or immediately after the procedure, but are sometimes noticed hours later. Because the local anaesthetic can mask pain for a while, it is important to check the colour of your lips in the mirror during the first hours. For detailed information and what to do step by step, read our article “After Fillers: When Is It an Emergency?”.
Contact the physician who performed the treatment immediately (if you cannot reach them, go to the nearest emergency department)
- Whitening or marked paleness of the lip or the skin of the upper lip
- A purplish-bluish colour spreading like a net on the lip, around the lip or towards the side of the nose
- Sudden, severe or steadily increasing pain, clearly different from the expected tenderness
- Part of the lip being cold compared with its surroundings
- Colour that darkens, small blisters or crusting over the following hours
Call 112 (or your local emergency number) without delay or go to the nearest emergency department
- Blurred vision, loss of vision, double vision or severe pain in the eye
- Speech problems, facial drooping, weakness in an arm or leg
- Shortness of breath, difficulty swallowing; rapidly increasing swelling of the lips, tongue or throat
Can you be allergic to lip filler?
A serious allergic reaction to filler products or to the local anaesthetic they contain is rare. Mild redness and itching may occur. Swelling of the lips, tongue or face that increases rapidly within minutes, shortness of breath, widespread hives or feeling faint, however, is an emergency. It is not always easy to tell early allergic swelling from the usual swelling after the procedure; if the swelling is increasing rapidly, do not wait. For details, see our article “Allergic Reactions in Aesthetic Treatments”.
Normal, see your physician, or an emergency?
| May be considered normal (keep an eye on it) | Consult your physician | Emergency |
|---|---|---|
| Marked swelling in the first days that then goes down | Swelling that increases as the days go by, warmth, discharge | Rapidly increasing swelling of the lips, tongue or throat, shortness of breath: 112 |
| Bruising at the injection points with well-defined edges that fades over time | A bluish shadow or bump that lasts for weeks | Whitening or a purplish colour spreading like a net: physician or emergency department immediately |
| Small firm areas that decrease as the swelling goes down | A lump that is growing, painful or appears late | Sudden, severe and steadily increasing pain: physician or emergency department immediately |
| Mild asymmetry in the first days | Asymmetry persisting after a few weeks, a bulge above the lip border | Problems with vision or speech, loss of strength: 112 |
| Mild tingling or numbness (first hours) | Tingling followed by fluid-filled blisters (suspected cold sore) | Blisters together with whitening, darkening colour, severe pain: physician immediately |
What are the treatment options? What can your physician do?
Treatment depends on the type of problem, on whether the product is hyaluronic acid and on when the symptoms started. Your physician will first examine you and ask which product was used and when. They may then suggest one or more of the following:
- Waiting and monitoring: most early swelling, small irregularities and mild asymmetry resolve on their own.
- Dissolving the filler: with hyaluronic acid fillers, the physician can use the enzyme hyaluronidase in the case of a lump, overfilling, migration above the lip border or vascular occlusion. This enzyme only dissolves hyaluronic acid.
- Medication: treatments the physician considers appropriate when an infection, a cold sore or an inflammatory reaction is suspected. These require a prescription and follow-up.
- Procedures: draining an abscess if one has formed; with fillers other than hyaluronic acid, sometimes a surgical assessment.
- Referral: if needed, to relevant specialties such as dermatology, plastic surgery or ear, nose and throat (ENT).
Hyaluronidase is also a medicine and can rarely cause an allergy; if you are allergic to bee or wasp stings, say so. There may be temporary swelling after dissolving, and sometimes more than one treatment is needed. Lip problems caused by fillers that do not dissolve in the body or that stay for a very long time are harder to treat.
What can you do at home, and what should you avoid?
- Follow the aftercare instructions your physician gives you; avoid pressing on your lips in the first days.
- Check the colour of your lips in the mirror in the first hours and record any changes with the date and a photo.
- Keep the product type and treatment date with you; show them if you see another physician.
- Whenever you are unsure, call the physician who performed the treatment.
Do not do the following:
- Unless your physician specifically recommends it, do not massage or squeeze a lump or swelling.
- Do not apply heat without consulting your physician.
- Do not burst cold sore blisters; do not use antibiotics, steroid creams or other prescription medicines on your own.
- Do not buy products such as filler dissolvers or lip filler pens online and use them on yourself.
- Do not have new filler injected into the same area somewhere else to fix the problem.
How can lip filler complications be prevented?
To reduce the risk:
- Have the treatment done by a physician who knows lip anatomy well and is experienced in managing complications, in a licensed healthcare facility.
- Ask whether the product to be used is hyaluronic acid; ask for the product information in writing.
- Find out whether hyaluronidase enzyme and emergency facilities are available where the treatment is done.
- Mention cold sores, allergies, autoimmune diseases, the medicines you take and any previous lip fillers.
- Do not ask for too much volume in a single session; if needed, discuss a gradual approach.
- Do not have repeated treatments before the effect of the previous filler has been fully assessed.
- If there is an active cold sore, wound or infection on or around the lips, discuss postponing the procedure.
- Stay away from products of unknown origin, treatments with needle-free pressure devices and procedures carried out outside healthcare facilities.
Questions to ask your physician
- Is the product you will use hyaluronic acid? Can I have the product information in writing?
- Are hyaluronidase enzyme and emergency facilities available here?
- How long might the swelling in my lips last, and when should I call you?
- I have a history of cold sores; do we need to take any precautions before the procedure?
- Could filler I had before still be in my lips? How do you assess this?
- What do you pay attention to so that the filler does not move above the lip border?
- What can be done if the result is too full or a lump forms?
- I am allergic to bee stings; would this be a problem if hyaluronidase is needed?
- How can I reach you if there is a problem outside working hours?
Frequently asked questions
How many days does swelling last after lip filler?
Swelling is usually most noticeable in the first days and then gradually goes down; how long it lasts depends on the person, the product and the amount injected. You generally need to wait a few weeks to judge the final result. If the swelling increases as the days go by, or there is warmth or discharge, see your physician.
Do lumps from lip filler go away?
Some of the small firm areas felt in the first days may decrease as the swelling goes down. Lumps that do not disappear after several weeks, or that grow or are painful, should be assessed. With hyaluronic acid fillers, the physician can dissolve the product with hyaluronidase if needed; do not massage it yourself.
Can lip filler move into the moustache area?
Yes, filler can spread beyond the lip border into the skin of the upper lip and create a slight bulge above the lip. Large amounts and frequently repeated treatments may increase the risk. With hyaluronic acid fillers, the physician may suggest dissolving the displaced product.
Can lip filler cause cold sores?
In people who have had cold sores before, injections around the lips can trigger them. Mention your history of cold sores before the procedure; your physician may consider preventive treatment. If a cold sore appears after the procedure, see your physician and do not burst the blisters.
My lip turned white after lip filler; what should I do?
Whitening of the lip, a purplish colour spreading like a net or severe pain may be signs of vascular occlusion, and you should not wait. Contact the physician who performed the treatment immediately; if you cannot reach them, go to the nearest emergency department and say that you have had filler. If you have problems with vision or speech, call 112.
Can lip filler that is too full be dissolved?
With hyaluronic acid fillers, the physician can dissolve some or all of the excess product with the enzyme hyaluronidase. There may be temporary swelling after dissolving, and sometimes more than one treatment is needed. Fillers that do not dissolve in the body cannot be removed this way.
Can lip filler swell up months later?
Rarely, swelling, redness or a lump may appear in the lip weeks or months later, sometimes after an infection, a vaccination or dental treatment. It needs to be assessed. If you have a fever and rapidly increasing redness, see a physician without delay.
Sources
- Evaluating safety in hyaluronic acid lip injections (Safran T, Swift A, Cotofana S, Nikolis A). Expert Opin Drug Saf 20(12):1473–1486 — Expert Opinion on Drug Safety, 2021
- Evaluation of Current Literature on Complications Secondary to Lip Augmentation Following Dermal Filler Injection (Diwan Z et al.). J Clin Aesthet Dermatol 16(7):26–33 — Journal of Clinical and Aesthetic Dermatology, 2023
- Guideline for the Management Herpes Simplex 1 and Cosmetic Interventions (Vaghela D et al.). J Clin Aesthet Dermatol 14(6 Suppl 1):S11–S14 — Journal of Clinical and Aesthetic Dermatology, 2021
- Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol (Murray G, Convery C, Walker L, Davies E). J Clin Aesthet Dermatol 14(8):E69–E75 — Journal of Clinical and Aesthetic Dermatology, 2021
- Dermal Filler Do’s and Don’ts for Wrinkles, Lips and More — U.S. Food and Drug Administration (FDA), 2023
Medical Aesthetics Expert Board
This article has been reviewed by the DoktorClub Medical Aesthetics Expert Board.
