Filler Complications: What’s Normal, What’s Not—and Exactly What To Do
- Sharon Suh
- Nov 11
- 5 min read
Featured answer (for quick readers):
Dermal fillers are fantastic tools when used conservatively and placed with intention. Still, even in expert hands, side effects and complications can happen. This guide answers the questions people actually ask, explains what to do in plain language, and shares how I handle safety and after-care at VIBEology Medspa in Prosper, TX.
Quick Triage: Green / Yellow / Red
Green (common & self-limiting)
Mild swelling, tenderness, or puffiness for 2–5 days
Bruising that appears day 1–3, fades by day 7–10
Tiny lumps that soften over 2–4 weeksWhat to do: cool compresses the first 24 hours, then light warmth after day 2; head-elevated sleep; arnica or bromelain if you like; skip strenuous workouts/sauna for 24–48 hours.
Yellow (needs a check-in)
Asymmetry after swelling subsides (after ~2 weeks)
Firm nodules that don’t soften by 3–4 weeks
Itching/hives or redness beyond the normal first 72 hoursWhat to do: message your provider; don’t massage aggressively; don’t “wait it out” beyond 2–4 weeks without being seen.
Red (urgent—same day)
Severe pain, blanching/whitening or mottled/purple “netlike” skin, cool skin, or color change that doesn’t pink back up
New vision changes, severe headache, dizziness, or drooping
Spreading redness, warmth, fever (possible infection)What to do right now: contact your injector immediately or go to urgent care/ER. This may be a vascular occlusion or other urgent issue. Time matters.
FAQ—Real Questions, Candid Answers
1) What’s normal swelling and how long does it last?
Lips/tear troughs: swelling can look dramatic for 48–72 hours; lips may look “too big” before they settle.
Cheeks/jawline: usually 24–72 hours of mild puffiness.
Bruising: common; most clear by day 7–10 (lips can take a bit longer).My tip: sleep elevated, avoid salty foods and alcohol for 24–48 hours, and skip hot yoga/sauna the first two days.
2) When should I be concerned?
If pain gets worse after the first day, skin looks white or dusky, or the area feels cold, that’s not normal.
If one side remains visibly larger or lumpy after the swelling window (2 weeks), it’s time for a check.
3) What exactly is a vascular occlusion?
It’s a blockage or compression of blood flow—rare, but the reason we take safety so seriously. Red flags: escalating pain, blanching, livedo (mottled/purple), prolonged capillary refill, cool skin. This is a same-day situation.
4) What do I do if I suspect a vascular issue?
Call immediately. Do not ice or massage aggressively unless instructed. You’ll likely be seen urgently for assessment and treatment (see how I manage this below).
5) Can fillers really affect vision?
Extremely rare—but yes, there are reported cases. Sudden vision changes, severe headache, or dizziness are an emergency. Call 911 or go to the ER, then notify your injector.
6) I feel small lumps—should I massage?
If I placed your filler, follow the specific after-care I gave you. Random, forceful massage can make things worse or move product. If a lump persists at 2–4 weeks, I’ll assess whether it’s swelling, product, scar tissue, or a nodule and treat accordingly.
7) What is the Tyndall effect (blue hue under the skin)?
A bluish tint can occur when hyaluronic acid (HA) filler sits too superficially, especially under thin skin (tear troughs). It’s not dangerous, but cosmetically annoying. It’s typically managed by dissolving a small amount with hyaluronidase and re-planning placement.
8) How do you treat asymmetry?
First, we let swelling resolve (about 2 weeks). Then I compare pre-treatment photos and anatomy. Options: a tiny “tweak” dose, or dissolving and resetting. The goal is harmony, not chasing millimeters on day 3.
9) What’s the difference between inflammation, infection, and biofilm nodules?
Inflammation: warmth/redness early on, usually self-limited.
Infection: increasing pain, warmth, fever, or pus—needs medical treatment.
Biofilm (delayed): firm nodules weeks to months later; handled with targeted meds and sometimes dissolving.Bottom line: don’t self-treat; come in so we can classify it correctly.
10) Do fillers migrate?
Migration can happen with high movement areas (lips) or overfilling. It looks like product where it shouldn’t be (e.g., above the lip border). Solution: often dissolve and re-approach with a better plan.
11) Cold sores after lip filler—what then?
Lip injections can trigger HSV if you carry the virus. If you have a history, tell me up front; I can coordinate prophylaxis. If a sore develops, we’ll treat quickly to shorten the course and protect your results.
12) Can all fillers be dissolved?
HA fillers: yes, with hyaluronidase (an enzyme that breaks down HA; also affects natural HA briefly, which your body replenishes).
Calcium hydroxyapatite (CaHA) or PLLA: not dissolvable; different strategies apply (targeted meds, dilution, time).
13) Will dissolving ruin my face?
No. Used correctly, hyaluronidase is a precision tool. It can soften or remove unwanted HA while preserving your features. Sometimes one conservative dissolving session followed by a careful refill gives the most natural outcome.
14) How do pros prevent complications?
Deep knowledge of anatomy and risk zones
Conservative dosing, small aliquots, slow injection, minimal pressure
Thoughtful choice of needle vs cannula by area
Meticulous sterile technique and thorough medical screening
Saying “not today” when the situation isn’t safe (illness, dental work, big event tomorrow, etc.) Treatment plan with clear aftercare and easy follow-up? Book a consultation and we’ll map your unique expressions, dose conservatively, and prioritize natural, confident results.
How We Manage Safety & Complications at VIBEology Medspa
Our philosophy: subtle > stuffed. Safety > speed. Long-term harmony > short-term “fullness.”
Before treatment
Detailed consult with medical history (blood thinners, autoimmune issues, HSV, recent dental work, pregnancy/breastfeeding, allergies).
Photos, lighting, and proportion analysis; we plan treatments in phases.
Pre-care instructions to lower bruising and swelling risk.
During treatment
Skin prep and sterile technique.
Layered approach with careful product selection and depth by area.
I pace dosage and pressure, continually reassessing capillary refill and comfort.
After treatment
Written/printed after-care, what’s normal vs not, and how to reach me.
Proactive check-ins (I encourage a 2-week review for most areas).
If anything feels off, I’d rather see you too early than too late.
If a complication occurs
Suspected vascular compromise: prompt in-clinic assessment; if indicated for HA fillers, targeted hyaluronidase to restore perfusion; supportive measures; close follow-up.
Infection or inflammatory nodules: culture/antibiotic pathway or anti-inflammatory plan as appropriate; may combine with dissolving for HA.
Aesthetic issues (lumps, Tyndall, migration, asymmetry): time window first, then precision dissolving or micro-tweaks.
Second opinions/“fix-its” from elsewhere: I’m happy to help; we’ll start with a calm, systematic assessment and a staged plan.
Prep Smart: Reduce Your Risk
For 3–5 days before: if medically appropriate, consider pausing non-essential blood-thinning supplements (fish oil, ginkgo, garlic, ginseng, vitamin E) and alcohol 24 hours before. Always follow your prescribing clinician’s advice if you’re on medical anticoagulants.
Avoid major dental work 1–2 weeks before/after lips or perioral filler.
After-Care Checklist
First 24 hours: cool compresses (10 min on/off), head-elevated sleep, gentle face, no makeup directly on entry points, no heavy workouts/sauna/hot tub.
Days 2–3: switch to light warmth if puffy; keep hydration up; avoid salty foods and alcohol.
Days 7–14: most swelling/bruising resolves; schedule your review if we planned one.
At any point: unusual pain, color change, new vision symptoms, fever, or spreading redness = urgent call.
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