When filler has gone wrong

Swelling in the first two weeks makes almost everybody think something has gone wrong. Lips especially look far bigger and often asymmetric for several days. Do not judge a result, or make decisions about correcting it, before two weeks have passed.

What should not wait: severe or increasing pain, blanching or white patches, skin turning dusky, blue or mottled, or any change in vision. Those can indicate a vascular occlusion, which is a medical emergency. Seek immediate medical attention and alert your injector; do not delay emergency care while trying to reach the clinic. Sudden vision loss, severe eye pain, breathing difficulty or tongue/throat swelling: call 999 immediately. Do not drive yourself.

Migration — product sitting outside where it was placed, most often as a shelf above the lip border. Overfilling, which reads as heaviness rather than fullness and shows worst in photographs. Lumps or nodules persisting beyond a few weeks. Asymmetry still present after full settling. Under-eye filler that has gone puffy or taken on a bluish cast.

None of that is your fault, and none of it means you have to live with it.

Hyaluronic acid filler — which is most of what is used in the UK — can be dissolved with hyaluronidase. That includes work done by someone else, and work done years ago. The area looks flat for a couple of weeks afterwards because the enzyme also breaks down some of your own hyaluronic acid, and that recovers.

The usual sequence is: dissolve, wait two to four weeks for the tissue to settle, then reassess and rebuild properly if you still want to. Adding more product on top of a bad result does not fix it.

Give the original practitioner the chance to put it right first — most will want to, and a good one will not charge you for a review. If you are not comfortable going back, or they will not engage, you are entitled to a second opinion and to raise a formal complaint. You do not need their permission for either.

I see corrections regularly and there is no judgement in it. Filler migrates, techniques and products have improved, and what was placed five years ago was not necessarily wrong at the time.

Not everything that looks wrong is an emergency, and one thing that can look mild is the most urgent problem in aesthetics. Work out which row you are in before deciding what to do.

An assessment before any decision to dissolve

Dissolving is a treatment, not a reset button. Hyaluronidase acts on your own tissue's hyaluronic acid as well as on the product, so an area can look flatter than its true baseline for a week or two afterwards. That is normal and it recovers — but it does mean dissolving something that would have settled on its own costs you money and a fortnight of looking worse than you started.

A good correction appointment therefore begins by establishing what is actually there: how long ago it was placed, where, how much, and whether the thing you are unhappy with is product or swelling.

A patch test where there is any doubt

Hyaluronidase is enzyme-derived and allergic reaction, while uncommon, is possible. Where there is any relevant allergy history, testing beforehand is reasonable practice rather than excessive caution.

A plan, not just a reversal

Dissolving returns you to a starting point. Whether you then re-treat, and with what, is a separate decision best made once the area has fully recovered — usually a fortnight later, when what you are looking at is your own face rather than an area mid-recovery.

Ask the clinic first, and in writing — a practitioner who is registered and insured has every reason to resolve it, and most do. If that fails, the route available to you depends entirely on who treated you.

• A nurse, doctor, dentist or pharmacist sits on a statutory register, and their regulator — the NMC, GMC, GDC or GPhC — takes complaints about fitness to practise.
• A practitioner on a voluntary register such as the JCCP or Save Face can be complained about to that register, which is one of the better arguments for checking a register before booking rather than after.
• A practitioner on no register at all is subject to no professional complaints route. Trading Standards covers the consumer side; your insurer or a solicitor covers the rest.
• A serious adverse reaction to a product can be reported through the MHRA Yellow Card scheme. It is the mechanism by which product-level problems get noticed at all.

That last point is the honest case for checking beforehand: it decides whether there is anybody to complain to.