How to avoid lip filler lumps and treat them when they happen

The development of lumps and bumps in the lips following a lip filler enhancement or augmentation procedure is a frequently reported side effect. Understanding how to diagnose the cause is not always straightforward because their occurrence can be multifactorial.

In this blog, Dr Tim Pearce will discuss the common causes of lumps and bumps post-lip filler treatment, including infection, reactions to the product, swelling, or insufficient massaging during the procedure, alongside how to resolve them. He will also share some preventive measures to help you avoid encountering this issue in the first place.

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What commonly causes lumps and bumps after lip filler treatment?

Lumps in the lips after a lip augmentation procedure with dermal fillers are relatively common, explains Dr Tim, because lumps can be caused by many different things.

• The procedure – the simple act of putting a needle into the lip tissue can cause a small bruise or hematoma that causes a lump. It can be tender when you touch it, which also helps to differentiate it from other types of lumps and will usually get better on its own.
• The filler product – dermal filler product lumps are caused by inadequate injection technique which leaves a bolus of hyaluronic acid gel that the patient can either see or feel, and it bothers them. This is a simple lump to resolve by massaging until it softens and fades into the tissue. Such non-inflammatory lesions may also go on their own with time as swelling subsides and the newly placed filler integrates into the tissue.
• Inflammation – infection or a reaction to the dermal filler product can cause lumps which require a medical response because they are by nature inflammatory lesions. If the patient has a lump that grows over time, particularly if it is asymmetrical and has redness surrounding it, then it could be the start of an infection, an already established infection, or an allergic reaction which typically involves the rest of the lip swelling up and appearing very lumpy as the product reacts with the immune system.

How can you avoid causing lumps and bumps with lip fillers?

To avoid causing non-inflammatory lesions, which are typically lumps of filler product, the primary mitigation is to make sure that you do a gentle check for any lumps or bumps that you can feel after you have completed the injection procedure. If you leave a large bolus of filler, it tends to attract moisture and will become firmer over the next few days. However, if you massage the lumps before the patient leaves your clinic – smoothing and not moving the product – with a gentle squeeze that respects the shape of the lip that you are trying to create, it will gently integrate the filler into the lip tissue, rather than simply squashing it. This action should decrease the amount of follow-up appointments because of patients complaining about non-inflammatory lumps in their lips.

To avoid causing inflammatory lesions, we must consider injection techniques and best clinical practice.

• Aim to keep the lip area as clean as possible while you are injecting.
• Do not apply make-up, particularly make-up that is not sterile, immediately after the procedure, and advise your patient to avoid doing this too, because anything that seals in a pathogen (bacteria etc.) might become a problem and result in infection.
• You can also decrease the risk of infection somewhat by reducing the number of needle entry points when injecting because each insertion is a potential entry point for bacteria.
• Schedule lip procedures in isolation, i.e., on days when you are not doing other procedures, particularly dental procedures. The more bacteria that enter the bloodstream around the patient’s head, the more likely some of those bacteria may settle onto an area of dermal filler resulting in lumps and bumps caused by bacterial-induced inflammation which are the hardest type to treat.

How to treat lumps and bumps after lip filler treatment?

This very much depends on the type of lump that you are faced with, concludes Dr Tim. You can either give it more time to resolve if you think it is simply post-procedural swelling. You can massage it if you think it is a product placement problem or a large bolus that has failed to integrate into the tissue. Or you can medically treat if you believe the lumps or bumps are related to infection or an allergic reaction.

As an aesthetic clinician, once you can deal with all types of lumps, you should develop a sequence or protocol upon which you can apply interventions sensibly, doing the minimal intervention necessary to restore most patients to a happy state within the first or second follow-up visit. You will find the more you think about this topic, and the more you improve your injection technique and your post-procedural massage, the number of adverse occurrences of lumps in lips should reduce over time. Although they will never reach zero because it is a common side effect.

What do you do if the lumps do not resolve?

If you have employed all other interventions – time, massage, medical treatment – and the lump or lumps are still unresolved, the final course of action is to dissolve the hyaluronic acid dermal filler within the lips using hyaluronidase.

Dr Tim advises that you try to avoid doing this until you know it is the best option, after trying all other options. For example, he warns against immediately choosing to dissolve the lip filler two or three days after a procedure, even if you have a patient who hates having a lump and is insistent on dissolving. You must allow time for natural resolution first (remember, this is not an emergency) because lumps can be related to haematomas and swelling which will resolve given enough time. If you dissolve at this early point, there is no guarantee that the reversing action will rid the patient of the lump, and you might just cause a different type of lump. Always work your way through the interventions first, step-by-step.

For more detailed information and advice on lip filler-related lumps and bumps, read these additional blogs from Dr Tim:

• Complications management: diagnosing lumps in lips after filler
• Lumps in lips: how to diagnose procedure related causes
• Lumps in lips: how to diagnose product related causes
• Lumps in lips: how to diagnose medical related causes

Dr Tim is always keen to hear about the experiences of his followers. So, if you have any questions, case studies, or discussion points for him, you can find Dr Tim Pearce on Instagram

Aesthetics Mastery Show

Get rid of lip filler bumps. How to avoid lip filler lumps.

Dr Tim says:

“One frequently reported side effect following a lip filler procedure is the development of bumps in the lips. However, understanding and addressing lip filler bumps is not a straightforward matter, as their occurrence can stem from various factors. These may include reactions to the product, swelling, or even insufficient massaging during the procedure. In this episode, I discuss how to diagnose and treat lip filler bumps. Additionally, I discuss preventive measures to avoid encountering this issue in the first place.”

Watch the full Aesthetics Mastery Show here.

The video has received over 5k views and a variety of feedback from clients and injectors, including the following comments:

@Dandelion_flight

“I had one or two lumps too after my lip filler. I had to see my injector a few times where she gave it some very hard and uncomfortable massages. They did somehow smooth out eventually and does not bother me anymore.”

@ilkertr8980

“Does the type of lip filler biphasic or monophasic, dense or hard etc, have any effect on filler bumbs tendency?”

@Hyliea

“I recently got mine done for the first time and the bottom was fine but the top had bumps and developed a blister. I wonder if it was technique related? She said she would redo it for another 400. I didnt want to go back though. It kinda seems like the top was overfilled and I ended it dissolving at another clinic and a lot of it was placed superficially.”

@lesleyjackson2750

“This was fantastic information to know thank you”

@Babygirl16457

“Is it possible to get bumps, little dots / lumps surfacing from filler due to scar tissues in lips . I had my lips done before that was overfilled . She dissolved it and refilled it and then dissolved a few times after that try to remove all fillers . When she dissolved them she was rubbing them so hard . Such a bad experience from that person that did my lips. Then I went to see someone else she tried to dissolve the rest and refilled them she did a better job but she mentioned certain spot may be due to scar tissues caused by what my lips went trough .”

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Dermal Filler & Lips eLearning Courses

If you want to increase your knowledge about safe and effective dermal filler injectable treatments, Dr Tim Pearce offers a series of fabulous courses. The foundation level is a popular starting point, with many delegates continuing to complications courses focused around safety, including how to minimise the risk and how to handle things if the worst occurs:

• Dermal Fillers Foundation Course
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• Elective Lip Reversal
• 8D Lip Design

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In addition, browse our FREE downloadable resources.

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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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