How to massage lips after dermal filler to avoid lumps

Lumps of dermal filler in the lips can be a real cause for concern for patients; therefore, you must ensure you carry out a post-procedure massage after injecting to smooth the filler and mould it into place to avoid lumps. However, many aesthetic clinicians are concerned about how to approach massaging the lips safely and effectively.

In this blog, Dr Tim Pearce discusses the importance of post-procedural massage after lip filler and explains the technique required to effectively massage the lips to smooth out any lumps without destroying your expertly placed injections.

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Why do we need to massage lips after dermal filler?

Suppose you are not routinely massaging lips, and doing so using the proper technique, as part of a lip filler procedure. In that case, you are probably causing yourself lots of unnecessary work noted when patients who should otherwise be enjoying their new lips, return to you disgruntled, warns Dr Tim. Worse still, you may think you are a bad injector, when you are not, you simply need to ensure you add in a good post-procedure massage routine.

Even with the best injection technique, there are always going to be high-pressure spots – as you are injecting, the tissue will hold on to filler in some places or it will spread more easily in other places – and these form small irregularities in the tissue. This can be even more profound when using larger volumes of filler or injecting larger boluses in one place; larger deposits which may not spread or spread unevenly will cause irregular outcomes that are not apparent until you feel the lip.

Is there a right and wrong way to massage lips after dermal filler?

One of the common concerns that Dr Tim encounters when discussing lip massaging with training delegates is that the action of massaging could move the filler into an undesired place. And this is indeed the case, he notes, explaining that it is possible to ruin a good procedure by massaging in the wrong way.

To massage correctly, he employs a technique that he calls ‘smoothing’, which is a massage technique that smooths the filler gel without moving it. This technique enables you to add a level of sculpting to your procedures, as opposed to just blurring, shifting, or amalgamating the product ruining your beautifully placed injections. Technique is everything.

How hard should you massage dermal filler?

Dr Tim’s analogy is to imagine that you are looking for a pea in the dark, on a plate, and you must squash it when you find it. You would feel around first to find the pea, after which, as you find the centre of it, you would gradually increase the pressure until it popped.

Applying this analogy to dermal filler, you establish the area(s) where imperfections are presenting, narrowing in until you have the pulp of your finger over the lump or filler deposit that you want to blend in, and then gradually you increase the pressure while sensing what is happening with your fingertips, allowing that to guide your movements until it is blended into the tissue.

How long should you massage the lip post-dermal filler?

Time spent is not the primary factor when it comes to post-procedural massage after lip filler; the result you are aiming for is far more important, reassures Dr Tim.

Squeeze and massage the lip until it forms the desired shape and you have rid the area of the imperfection you could previously feel. This ought to be a relatively quick process; if you are spending more than 30 seconds massaging one spot, you are probably overdoing it.

Like all things, getting proficient comes with practice and experience and very much depends on how good you are at sensing the changes you are trying to create, with your fingertips, while you are massaging the lip.

What happens if you massage a lump, but it does not disappear or blend into the tissue?

There are several common reasons for this occurrence, but probably the most common is that you are not doing it hard enough.

Dr Tim explains that many over-empathic and cautious aesthetic injectors struggle to put their full strength into their fingertips to blend in a lump until they have a bit more experience. If this is the case, all you need to do is try squeezing a little bit harder, he reassures. However, if you have already tried squeezing harder and the lump persists, you should be aware of some additional types of lumps.

• Pre-existing lumps
  You will occasionally meet patients with a pre-existing imperfection in their lip, this may be due to past dermal filler treatment, but often it is something else like a little bit of scar tissue from a trauma or injury from many years ago which will not respond to massage. You may have felt this imperfection in the lip before you began injecting. 
• Bruise or haematoma
  Occasionally the action of the procedure can cause a bruise or haematoma that is resistant to being massaged away. Check out some top tips to reduce swelling and bruising when injecting lip fillers. 
• Filler reaction
  If you are massaging a much older lump – from a procedure performed weeks or months ago – it could be a reaction to the dermal filler product. These lumps do not massage away and cannot be blended into the lip because they now present as a ‘lump’ of white blood cells that have come to react to the dermal filler and include collagen deposition (scar tissue). 
• Post-haematoma scarring
  After a haematoma or large bruise has healed, it can leave a gristly-type lump of additional scar tissue. This will not be visible on the outside of the lip but can be felt as a rough-textured lump. If left, it should disappear by itself within a matter of weeks.

How can you tell if a lump is dermal filler or the patient’s tissue?

Discerning factors are related to the procedure history – where and when was the patient injected, how much dermal filler was injected etc. You should compare that knowledge with how the lump feels – does it feel soft and malleable, or does it feel hard or gristly and more like a firm type of tissue?

Therefore, the texture of the lump and the timing of the lump manifestation are both critical ways of establishing the aetiology or cause of the lump, affirms Dr Tim.

How can you correct superficial lumps of dermal filler in the lips?

There is another type of lump which you will often see when doing rather superficial injections which has become popular because you can achieve more vertical lift when the injections are closer to the connector tissue; they are also potentially safer because you are further away from the arteries. One of the downsides of this type of technique is that sometimes it results in filler that rises to the surface, through the layer of connective tissue, causing small lumps on the surface of the lip. This is common with both vertical and horizontal injection techniques and does need to be addressed immediately, or your patient will be dissatisfied.

The good news is that these lumps can be easily softened; Julie Horne RN has branded her technique, called ‘scratching’, which she performs with a fingernail, through a glove, allowing her to massage the lip using the edge of her fingernail to smooth over the little lumps. Dr Tim uses a similar technique but with the pulp of his finger and notes that a fingernail is a way of speeding up the process due to the additional pressure and a slightly sharper edge.

Massaging lips after filler: Dr Tim’s take-home message

If you are going to massage lips after the procedure, you must think about the shape(s) that you have been trying to create with the injections that you have placed. Massaging is about smoothing, with respect to the shape that you are trying to create, and not about ruining it or causing migration to undesirable areas like the white lip. Watch the video for a further demonstration.

For more insight from Dr Tim on lip fillers and lumps, read up on:

• Complications management: diagnosing lumps in lips after filler,
• How to avoid lip filler lumps and treat them when they happen,
• How to diagnose product related causes of lumps in lips,
• How to diagnose procedure related causes of lumps in lips, and
• How to diagnose medical related causes of lumps in lips.

Have you any top tips? Dr Tim is always keen to hear about the experiences of his followers; if you have any tips to share, case studies to discuss, or questions for him, you can find Dr Tim Pearce on Instagram.

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Aesthetics Mastery Show

Lip Filler Massage Technique.

Dr Tim says:

“Massaging the lips post procedure is key for smoothing out any filler lumps. Filler lumps can be a cause of concern for patients, so it’s important ensure you massage after injecting to smooth the filler and mould it into place. In this episode I address the concerns many injectors have about massaging, plus demonstrate my technique on a patient.”

Watch the full Aesthetics Mastery Show here.

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Dermal Filler & Lips eLearning Courses

If you want to increase your knowledge about safe and effective lip filler injectable treatments, Dr Tim Pearce offers a series of fabulous courses, from foundation and upwards:

• Dermal Fillers Foundation Course
• Dermal Filler Complications Mastery
• Elective Lip Reversal
• 8D Lip Design

In addition, browse our FREE downloadable resources.

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.

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