I probably get asked about lumps more than anything else related to Botox or Fillers. Usually it’s lips, but here’s my short, simple advice on lumps, wherever they appear.

With lips, patients will often describe their lumps appearing days after the procedure. This is not due to the filler enlarging or growing. Check you aren’t leaving visible lumps post procedure before the patient leaves. Do this by feel as well as visually. Remember that lips swell when you insert a needle into them. This has little to do with the filler and is mostly related to the act of puncturing the skin and small blood vessels with a needle. This swelling hides from plain sight any lumps of filler left behind. As the swelling subsides over the coming days, the lumps are then revealed. Think rocks on the beach. When the tide goes out, the rocks are visible but the rocks were there all along and could be found below the surface.

If you have purposefully left a lump (a bolus of filler) anywhere that you can feel with your fingers (and if you are replacing volume this is often the standard method) it’s important to explain to the patient that this is your intention and that this is normal but that they shouldn’t see the “lumps”.

It’s also useful to provide an aftercare sheet (and if you’re using Flourish they will have ticked a box to say that they have downloaded and read the aftercare sheet) explaining again about lumps and what to do about them if they are present.

I definitely don’t recommend telling patients to massage their filler as this undoes the good work you’ve done – but lots of clinics do recommend this.

So, you have a lump, despite your best efforts to avoid one – what are your options? Everyone wants to jump in with hyalase (hyaluronidase). It is possible to do this. You can buy individual vials for around £39, and make these up with normal saline (here’s a protocol for that). Note that prices of hyaluronidae tend to vary depending on national shortages. Beware that if you do use hyalase, you may well end up with a loss of volume as the hyalase will indiscriminately dissolve hyaluronic acid; whether it is the filler that has been injected or the body’s natural hyaluronic acid. This should recover after two weeks BUT there is a risk : benfit consideration here, especially if the lump is very small or has been resolving already, but especially if the lump can only be seen whilst pulling an unusual pose.

What might be a better approach, particularly for small lumps, is to recommend that the patient applies firm pressure to the lump between their finger and thumb or pushing it against the underlying bone for 10 seconds, 10 times per day. This should, over the course of a week, shrink most lumps. If this doesn’t shrink a lump enough so that if becomes invisible, consider bringing the patient to your clinic in order to try simply lancing the lump and squeezing out the clear gel contained withint it. Check first for signs of infection (redness and / or tenderness) then hold it tightly between your finger and thumb and use a needle to put a small hole in it. And if that doesn’t work, you could reconsider the hyalase option.

Tell me your thoughts, especially if you think I’m wrong about any of this! [email protected]