Q: About Juvederm Filler

What our experts say:

With regards to the question about the Juvederm:  The depression in the left check is probably an illusion because  of the filler placed nearby.  There would be no way for Juvederm to cause a loss of volume unless the area became infected after the injection.  Additional Juvederm to the area that appears depressed would likely be helpful.  As the Juvederm is resorbed, the check will go back to its pre-injection status.  This will occur over a 9-12 month period.

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Dr. Brent Smith

Facial Plastic Surgeon

Littleton, Colorado

It is difficult to understand exactly what is going on in this case, but it is possible that there is improvement in the area of the nasolabial fold where the filler was injected, but it now appears that there is a depression in the nearby tissue where filler was not placed.  It is not usual for patients to report a contour depression in the skin in the area of injection unless the patient has developed scar tissue which is pulling the skin inwards.  A good follow-up appointment with your provider is required so this area can be carefully examined.  If the filler needs to be removed, there is an injection that can be performed which can help remove the Juvederm and restore the pre-injection appearance.

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Dr. Cory Yeh

Facial Plastic Surgeon

Laguna Woods, California

It may appear like a loss of volume only because the point of injections is probably swollen and distorting the anatomy.  Once the swelling subsides (in 2 weeks), this should normalize.

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Dr. Davis Nguyen

Facial Plastic Surgeon

Beverly Hills, California

It is important when placing filler to improve the appearance of the nasolabial folds that cheek volume loss is also corrected.  Much of the depth of the nasolabial fold that we experience as we age is due to volume loss in the cheek, side of face, and under eye which allows the cheek to fall downward thereby deepening the nasolabial fold.  When volume loss in the upper and upper-lateral cheek is corrected first, the resulting lift in the cheek reduces the amount of correction required for the nasolabial fold.  When just the nasolabial fold is addressed with filler the result is often not the desired effect and can lead to an unnatural looking area around the mouth.  Because there is fullness in the nasolabial fold created by the filler, but then none in the cheek, relatively it can look like a new volume deficiency has been created.

In cases where an undesirable outcome from a filler injection persists after the initial swelling has resolved, correction is usually possibly.  If the problem is from too much filler, filler placed too superficially or in the wrong location Vitrase can be injected to dissolve the filler, if the filler is a hyaluronic acid filler such as Juvederm, Perlane or Restylane.  In some cases the best correction may actually require more filler to be placed in adjacent areas to improve the overall contour and appearance.  An expert injector should be familiar with the use of Vitrase and methods of correcting post filling issues.  Expert injectors invariably wind up correcting problems arising from less experienced injectors.

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Drs. Kelly V. Bomer & James Bouzoukis

Facial Plastic Surgeon

Scottsdale, Arizona