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Dr Tim Pearce
Recently, Dr Tim Pearce welcomed his apprentice winner, Nurse Charlotte to a podcast to discuss her concerns about injection trauma as a relatively new aesthetic practitioner. He reflected on his experience of swelling and bruising caused to patients by lip filler injections.
In this blog, we share the key points from their conversation and Dr Tim reveals some insight into the causes of swelling, and gives his expert advice on how to minimise trauma when performing lip filler injections, offering newer aesthetic injectors some valuable tips.
Do you feel anxious about causing complications? Many clinicians feel so overwhelmed with the thought of causing a vascular occlusion that it stops them growing their aesthetics business. Dr Tim is currently hosting a webinar series to help you overcome your fear of complications so that you can uplevel your knowledge, and increase your CPD-certified learning to build a successful aesthetics business. Sign up here >>
How to tell your patients that their lips will swell after lip filler treatment?
Nurse Charlotte was acutely aware that swelling was a significant issue for many patients. She wants to reduce it when she performs lip filler treatments, fearing that her patients will leave her clinic with overly swollen lips. She asked Dr Tim how she can reduce that risk and avoid the worry of an upset patient.
Firstly, Dr Tim noted that preparation is key – and by that he meant preparing the patient. He would tell the patient that their lips are going to swell, and by how much, as part of the consultation process. To do this, it is useful for them to know the dynamics of what to expect. Swelling is likely to peak approximately six hours after treatment, starting to fade at this point. However, sometimes, it can be a little worse the following morning, before improving again. 80 to 90% of people will have returned to normal (at least to look at) within five days, but may still feel the sensation of being a little swollen.
How can you reduce swelling for patients having lip filler treatment?
Dr Tim shared his top tips for reducing swelling when injecting the lips.
Tip 1: Do not perform unnecessary injections
There is no requirement to carry out forty vertical injections to achieve a lip augmentation, warned Dr Tim. If you have a patient who is particularly worried about swelling, then you can vary your injection technique to accommodate, rather than following trends.
One technique is to enter the lip with the needle through one entry point and carry out three injections or product depositions; you can therefore address most of the top lip with only four injections. This technique will reduce swelling and be considerably reduced compared to a multiple entry technique. Every time you insert the needle, you are entering and tearing through tissue cells and the blood causes swelling; hence, the more injections you perform, the more swelling results.
Tip 2: Focus on precision
Dr Tim recalled causing a lot of bruising when he first started practising facial aesthetics, but with a little experience under his belt, this stopped and the reason behind it was precision.
He explained that one of the earliest skills you need to develop as an aesthetic injector is the resolution for your anatomy. A new injector cannot tell when the needle is two millimetres deeper in the tissue, but an experienced injector can; hence, the rookie will go in through tissue that is more vascular and cause more trauma, but outwardly the injection looks the same. When you are injecting, Dr Tim advises ‘getting in the zone’ and thinking hard about where you are trying to be with your needle, which plane of the tissue are you entering. Over time, this focus on precision will have an impact on the number of bruises that you create.
For example, if you want to be in the lip, you should be just under the mucosa, and ideally not in the middle of the lip (depending on where you are trying to inject) because all the blood vessels are within three to five millimetres. Dr Tim explained that large hematomas are caused by going through an artery and typically this is from being too deep with the injection.
Be precise, inject slowly and gently and you will minimise bruise formation.
Tip 3: Stabilise your injections
Maintain your stability when injecting; from your wrist, the only thing that should be moving is your fingers. Inject slowly and with a steady hand all the way through and you will have less swelling, Dr Tim reiterated.
For more on how to assume a good position when injecting – being stable, balanced and without motion, read Dr Tim’s Injection Techniques 101: good injection techniques for dermal fillers.
Tip 4: Treat swelling prophylactically
Dr Tim pointed out that you can treat swelling straight after the procedure, by pre-emptively giving the patient ibuprofen. He noted that some clinicians believe it increases bruising because it thins the blood, but he disputes this and believes this mostly applies to aspirin. Moreover, different patients just seem to bruise differently, irrespective of ibuprofen or anti-coagulant use, so it is still warranted as a helpful option.
Will post-treatment massaging cause lip filler migration?
Nurse Charlotte explained that as well as the risk of bruising and swelling, she is concerned that massaging the area will move the lip filler, leading to an overfilled or migrated appearance above the lip border.
Dr Tim advised thinking about the technique as a sculpting movement, rather than massage – imagine the lip is made out of plasticine and you are shaping it. When doing this himself, he feels along the inside of the lip, very gently and in a way that would not move the product, He is feeling for any irregular lumps or bumps. If one is located, he gradually increases the pressure on it, slowly, and in a way that would put the filler product where he wants it to be located, typically guarding the vermilion border and gently smoothing it into place, rather than using massaging or crushing movements which would also increase swelling.
Although, he warned to be aware that sometimes what you are feeling for filler, it can be a hematoma, particularly if the patient has come back to see you the next day with a lump. If the lump is tender, it is best to leave it as it will be swelling and inflammation and not the filler. If there is no tenderness, then it is likely to be product, and you can gently massage or sculpt it.
If you are concerned about ‘lumps in lips’, then read Dr Tim’s three-part blog series looking at how to diagnose procedure related causes, how to diagnose product related causes, and how to diagnose medical related causes.
You can find Dr Tim Pearce on Instagram if you have further questions about lip filler injections or have your own tips to share for reducing trauma when injecting fillers.
You can also follow aesthetic nurse Charlotte on Instagram at Refined Aesthetics.
Aesthetics Mastery Show
Reduce Swelling and Bruising When Injecting – Top Tips To Reduce Trauma
In this episode, Dr. Tim shares his expert advice on the potential swelling and bruising that lip filler injections, with tips on how new injectors in particular can minimise these effects. Watch the full Aesthetics Mastery Show here.
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Lip Fillers & Filler Complications eLearning Courses
If you want to increase your confidence by learning how to handle complications, Dr Tim Pearce offers a series of comprehensive courses that are highly rated by our delegates:
All courses give certificates on completion.
In addition, browse our FREE downloadable resources on complications.
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.
