Vascular occlusion is the complication that matters and it is time-critical. Lumps and swelling are not — here is how to tell them apart and what we refuse to inject.
The labial arteries run close to the injection planes in the lip. If filler enters or compresses one, the tissue it supplies loses its blood supply — this is vascular occlusion, and it announces itself with disproportionate pain, blanching that goes white then mottled, and a dusky colour over the following hours. Treated with hyaluronidase within a few hours it usually resolves completely. Left overnight it can leave permanent tissue loss.
Hyaluronic acid filler can be dissolved with an injection of hyaluronidase in minutes — for an emergency, for a lump, or simply because you dislike the shape. Permanent products, polyacrylamide gels and industrial silicone cannot be dissolved and are removed surgically, often with scarring. Lips are mobile, thin-skinned tissue that changes over decades, and permanent material in them ages badly. There is no case in which we would inject a permanent filler into a lip.
Lips swell more than any other filler site. Expect maximum swelling at twenty-four to forty-eight hours, often asymmetrical, settling over five to seven days. Small firm areas at one week are usually product that has not yet integrated and respond to gentle massage. What is not normal: pain that increases after day one, white or grey skin, or a tender lump appearing weeks later — that last one may be a delayed inflammatory reaction and needs to be seen, not massaged.
A first session is 0.5–1 ml — one syringe or less — from €250 a syringe, lasting nine to fifteen months in most patients. The migrated, shelf-like upper lip you notice in photographs comes from repeated top-ups before the previous product has resorbed, not from one large treatment. We will dissolve and restart rather than layer over old filler, and we will decline to add more once the lip has reached what its skin envelope can hold.
Yes. Hyaluronidase dissolves hyaluronic acid filler within twenty-four to forty-eight hours. Swelling from the dissolving injection settles over a week and the lip returns to its natural shape.
Flying itself is fine, but you will swell more in a cabin. Book injections for after your flight home, not the morning of departure — and never within forty-eight hours of an important event.