This article has been medically reviewed for accuracy by Harrison, NY oculoplastic surgeon Dr. James R. Gordon on August 25, 2020.
Dermal filler is the most effective noninvasive procedure to plump lips, enhance cheekbones, soften lines and wrinkles, and more. But as with all cosmetic treatments, the injectable can come with some less-than-desirable side effects, namely, swelling. While post-filler swelling is completely normal and should even be expected, it’s never fun to watch as your face doubles in size—especially if you’re getting filler every three to six months. Fortunately, there are a few tricks that the experts have up their sleeves to help prevent or reduce swelling after fillers.
Why do filler injections cause swelling?
“Fillers cause swelling because the injection process disrupts the skin and soft tissue,” explains Dr. Heidi Waldorf, a board-certified dermatologist in Nanuet, New York. “Some fillers cause more swelling because they are hydrophilic and absorb more water from the surrounding tissue, others because they trigger a mild inflammatory response.” Anytime there is bruising or bleeding underneath the skin, swelling will follow. Hyaluronic acid, the active ingredient in most dermal fillers, is known to bind to large amounts of water, and because of this, they are associated with more significant swelling.
What sort of swelling can patients expect after getting filler?
“I advise my patients that some degree of swelling is expected after any injectable treatment,” says Dr. Stephen Weber, a board-certified plastic surgeon in Lone Tree, Colorado. “Fillers placed in the temples, chin, cheekbone, and nose are usually placed deeper, right on top of the underlying bone or cartilage, so most of the potential swelling is camouflaged by the overlying tissue, and very little swelling is evident.” Similarly, filler in the nasolabial folds and jawline can be injected using a blunt cannula, resulting in less tissue trauma and swelling than with a sharp needle, and hand injections also tend to swell very little because the tissue plane lacks significant blood supply.
Do the lips swell more than other regions of the face?
“The greatest amount of swelling is usually seen in the lip, due to the delicate nature and exceptional vascularity of the tissue,” says Dr. Weber. “This results in mild to moderate swelling in most cases, but it has significantly improved with the introduction of advanced filler products, such as Vollure and Volbella, as there is far less product-associated swelling.” The plastic surgeon always tells first-time lip filler patients that the expected amount of swelling will result in lips that “look slightly overfilled during the first one to two days and that this resolves by the third day.” Ironically, he says, once that swelling subsides, many lip filler patients wish it would return, because they love the pillowy appearance of the swollen lips.
How long does swelling last after fillers?
Though it can sometimes seem to last for ages, post-filler swelling often goes away within a few days. “Swelling is generally worst from 24 to 72 hours after treatment and then gradually subsides,” says Dr. Waldorf. “But depending on the degree, it can last a few days to two weeks.”
Do certain fillers cause more swelling than others?
“Fillers that have high concentrations of non-cross-linked hyaluronic acid tend to cause more significant swelling, as they are more hydrophilic and draw in more water,” Dr. Weber explains. “The original Juvéderm Ultra product, which has been largely replaced by more modern Vycross products, caused more significant swelling, particularly in the lips and under-eye regions, but modern filler products do not cause swelling to the same degree.” Dr. Waldorf concurs and says that in her experience, she’s noticed that Radiesse, Restylane Silk, and Juvéderm Ultra Plus are also the most prone to cause swelling.
Is there anything your doctor can do to avoid potential swelling?
There are many steps your doctor will take before and during injection, all designed to reduce swelling, but sometimes they can go even further. “During the injection, avoiding obvious vasculature (either visible vessels or vessels known to be anatomically relevant), changing needles frequently, and using a cannula, if appropriate, can be helpful,” says Dr. Waldorf. “And if immediate bleeding and swelling occur, holding firm pressure on the site for a few minutes and avoiding reinjection there can help keep it from excessively swelling.” She also notes that oral or topical arnica preparations and ice can help after injection, and when appropriate, adding a small amount of lidocaine with epinephrine to the filler will constrict local vessels and may reduce some bleeding and swelling. Additionally, the use of handheld devices, like Accuvein, a laser that locates veins that are invisible to the naked eye, can help avoid piercing of a blood vessel and the severe swelling that comes with it. Ultimately though, Dr. Waldorf says there’s no way to guarantee there will be no swelling or bruising.
What is the immediate aftercare for filler?
“Aftercare actually begins before the treatment,” Dr. Weber explains. “I advise patients to avoid aspirin and ibuprofen for two weeks, to minimize bruising and swelling.” Many injectors will also recommend taking an arnica supplement, but Dr. Weber says most of these products often contain less than one molecule of the herb in a football field–size sample, so he no longer suggests them. Arnica creams and gels, on the other hand, typically do contain the active ingredient and can be helpful before and after injection, to control swelling.
Aftercare is quite straightforward, Dr. Weber notes. “I advise patients to avoid exercise and alcohol for 24 hours,” he says. “They can resume ibuprofen immediately if they have some discomfort, and ice can minimize swelling and bruising, especially if implemented immediately and continued for the first 48 hours.” Patients should also avoid manipulating or traumatizing the treated area, even if it may be tempting to massage small irregularities, since these are usually localized areas of swelling rather than product buildup. “Manipulating these areas can actually create long-lasting asymmetries in the filler product,” Dr. Weber says.
How to reduce swelling after fillers
Traditional aftercare instructions are intended to reduce swelling, but if you’re experiencing substantial or long-lasting swelling after your fillers beyond what’s expected, you can up the ante on most of these steps. Continued use of ibuprofen and ice can help, as can avoiding strenuous exercise and alcohol for more than 24 hours. And if none of that helps, consult your doctor, who may be able to offer something more. “For the rare patients who tend toward excessive swelling,” says Dr. Waldorf, “I may prescribe one or two doses of oral prednisone, on the day of and day after injection.”
