Lumps in lips: How to diagnose product related causes
Dr Tim Pearce previously talked about diagnosing lumps in lips after filler treatment and how you must build a complete story – the patient background, the original treatment, the presenting symptoms of a complication, and the visual and physical examination of the lip – so you have a detailed narrative upon which to make your diagnosis.
There are three broad categories of lumps in lips following dermal filler treatment:
- Procedure related causes – lumps caused by the treatment itself, the delivery method and process of placing the dermal filler into the lip which causes trauma, or may introduce infection,
- Product or substance related causes – foreign bodies as well as the filler product can play a role in lump formation,
- Medical causes – these are not related to the treatment or the product, but lumps caused by an underlying medical condition.
In this blog, the second in a small series of three, Dr Tim Pearce will share some expert tips on product or substance related lumps in lips – those caused by the dermal filler product, or other substances and foreign bodies.
Shh…Dr Tim will soon be revealing a very exciting new ‘ultimate’ lip course that will cover EVERYTHING you need to know about injecting the lips. Sign up >> to be the first to know when it goes live!
What are product or substance related lumps in lips?
Product or substance related lumps are caused either by the dermal filler used (the product) or by other substances applied to the area which may include reactions to foreign bodies.
Substance-related lumps can be divided into are two types of reactions – acute or chronic.
How to diagnose product or substance related lumps in lips
Referring to the ‘story’ that aesthetic clinicians should be aiming to build when assessing and diagnosing lumps in lips – patient, procedure, symptoms, and signs – Dr Tim explains some examples of the primary stories that you may encounter when considering and diagnosing specific product or substance related complications that cause lumps in lips post filler treatment.
Diagnosing an acute substance-related reaction in the lip
With an acute reaction, the patient may appear to have a normal history, although they may report having had aesthetic or medical procedures in the past which caused excessive swelling. Similarly, they may highlight that, in general, they are often more inflammatory, for example, if you were to scratch their arm, they would quickly develop a red weal. Such a history of inflammation would make the patient more prone to inflammation following an injection related procedure which may help you to diagnose that they are not experiencing an infection, if there is excessive swelling, and it may also be self-limiting, unlike other types of reaction.
The nature of the procedure may also indicate a trauma related cause of inflammation, particularly if it was more traumatic than usual, or a
The patient may have reported bruising as a symptom soon after the procedure, which is inflammatory by nature as it triggers a healing response.
The most excessive part of swelling following lip filler normally occurs approximately six hours after the procedure, improving and resolving from that point onwards. However, if the patient is having a reaction, one sign to note is that inflammation (across the whole area) will persist for much longer, meaning that it is often much worse the following morning and for 24-48 hours later, if left untreated.
The development of swelling is therefore a means to prove whether the diagnose is due to trauma from treatment or a substance related reaction – timing is the key. If the normal and expected post-procedural swelling gets worse rather than resolving, this could indicate a product or substance related allergic reaction which requires treatment.
Diagnosing a chronic substance-related reaction in the lip
A chronic reaction tends to be very different because it can take a long period of time to evolve – 3, 6, 9, even 12+ months post procedure.
The patient may be laid back in their nature, not wishing to cause a fuss or be a burden, thus they have ignored or falsely reassured themselves that nothing is wrong and therefore have no sought help and assistance for a much longer time than a more anxious personality.
The procedure itself will often have little to do with the reactionary outcome if it is product related. However, there is a question over the introduction of other substances or foreign bodies which can cause a chronic reaction, such as make-up entering the tissue post treatment if aftercare advice is not followed by the patient.
Initial swelling and mild to moderate tenderness around the area of the lump, usually regarded by them as normal, but which persists, alongside mild redness will often be reported as symptoms by the patient. These will settle and what initially felt like a soft lump will turn into a hard lump over a period of months, resulting in something that is difficult to treat. On palpation, a firm, discreet lump with a solid or rubbery nature is a sign of a chronic reaction or nodule formation that is surrounded by collagen deposition.
Lip Filler Treatment & Complications
With all the conflicting advice out there about lip filler treatments – vertical or horizontal? needle or cannula? – it can be difficult to know how to inject to create the lips your patient desires.
If you are suffering from technique overwhelm, worrying about causing a vascular occlusion (VO), or panicking about injecting thin lips, then Dr Tim Pearce’s brand-new ultimate lip course is going to teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
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