October 24, 2022

We have looked at how to effectively consult and consent a patient for elective lip filler reversal and the types of patients who seek reversal treatment, including how they feel about elective lip filler reversal.

In this blog, Dr Tim Pearce will discuss the common indications for elective dermal filler reversal in the lips, and how to go about assessing where to inject to perform a reversal procedure.

If you are unsure where to start with elective filler reversal treatment – how to effectively discuss it with your patients, carry out the procedure, including how much hyaluronidase to use, and when you can re-treat the lips, or if you are worried about whether you can legally correct someone else’s work, then sign up for Dr Tim Pearce’s elective lip reversal eLearning online course. It includes 15 in-depth learning modules and 5 bonus FAQ videos covering all the core knowledge and skills you will need to embark on elective lip filler reversal.

Non-urgent complications

When it comes to indications for elective lip filler reversal, the broad term of non-urgent complications covers reactions and infections that must be reversed, but, unlike a vascular occlusion, there is not the same level of urgency or high-dose hyaluronidase requirement.

Over treatment

Over treatment is a common reason for elective lip filler reversal, due to an aesthetic dissatisfaction with the outcome of treatment, or a lump or bump caused by poor or incorrect injection technique.

Oedema or swelling

As an indication for elective lip filler reversal, oedema is particularly relevant when you have swelling around the vermillion border, often referred to as ‘migration’, but usually this is a misnomer, and it is in fact oedema and not from filler spread. This can happen more often with older filler.

Migration or diffusion

Dr Tim Pearce CannulaTrue migration or diffusion are very rare, even though the terminology is often misappropriated. It is very unusual for filler to travel or migrate from one compartment to another, but it can happen and is an indication for elective reversal. Most commonly, this can occur with movement, such as repeated contraction of the orbicularis oris which can squeeze filler material out of the pink lip and into the white lip, causing a swelling around the mouth that is more noticeable when the lip is downlit.

Migration of filler can occur elsewhere in the face, e.g., the nose where product spreads and the nose widens over time, or the chin where definition is lost and the lower face becomes rounder; true migration in the cheeks, temples and foreheads is also possible.

Where to inject when performing an elective lip filler reversal

Assuming your patient has an indication that is suitable to treat, has been appropriately consulted and consented to ensure they are also psychologically suitable, you can move on to assessing where to inject.

Start by having a look at their face, taking in the whole face and not just the lip area. Ask your patient to pull various ‘faces’ so you can see their face both when still and when moving. You may notice pockets of filler in the white lip, even though the patient was not treated in the area, which only show under certain movements, so assessment under motion is essential.

Different filler products can feel different, depending on the time frame since treatment or based on what is manifesting with the patient. If it is a reaction to the filler, the area will often feel firm or harder to the touch, even in older filler. If there is no longer an active reaction, you may feel lumps, bumps, or nodules. Older filler can also feel oedematous and spongey, but outwardly, the lip does not appear natural, even though you might think you cannot ‘feel’ the filler.

When assessing where to inject, Dr Tim’s advice is to look, feel, move, and if you have access to an ultrasound scanner, you can consider using that to review the problem, although, it is not necessary in most practice. Consider reading, should I buy an ultrasound scanner for my aesthetic clinic?

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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.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.

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