As injections require the use of needles, pain is an obvious side effect of the treatment. Since Juvederm® is a relatively thick gel the smallest needles (32 gauge) cannot be used, however 30 gauge can be used for Juvederm® Ultra XC which is still a very small needle. Although local anesthetic can be placed prior to injection, this still requires a needle stick and the local anesthetic can sometimes be more uncomfortable than the Juvederm® injection. The vast majority of patients do very well with these injections.
Bruising and Infection
Inserting needles also can cause bleeding and bruising. To reduce theses risks, at is best to avoid taking medications that can thin your blood such as aspirin, Vitamin E and fish oil among other things for about two weeks before a treatment.
Infection is very rare with filler injections. The greatest risk would be injecting the product into an area where there is active acne. If you have pimples near where you want the injections, it is best to wait until they are completely gone to have a treatment.
If hyaluronic acid injections are placed too superficial, a bluish cyst-like lesion can appear. This can be treated with aspiration or drainage if it does not go away by itself in a few days. It is generally best to wait for a week or so to see if it will resolve without treatment unless it is obvious and difficult to cover up with makeup.
Lumps and Bumps
Some lumps may appear after a Juvederm® injection which are not usually visible. If you feel that your result feels a little lumpy, you can massage the area, which generally resolves the problem. These will almost always go away on their own and rarely require any form of treatment.
Probably the more severe potential adverse reaction to filler injections results from an intravascular injection. Small needles can get into small blood vessels and, as the gel is rather thick, it can occlude blood flow to the area supplied by the vessel. This can result in full thickness skin loss, which can happen on the forehead, brow, cheeks, nose or lips. In most cases, there is an unusual amount of pain and bruising or discoloration to the skin near the injection, which can appear a few minutes to several hours after the treatment. If this occurs, contact your physician immediately as the product can be dissolved with Vitrase® injections, which is an enzyme that dissolves hyaluronic acid; other treatments can also be done to limit damage to the skin.
Not all lines, wrinkles or folds will go away completely with filler injections such as Juvederm®. A lot depends on how deep the lines are and how much filler is used. Obviously, a small amount injected into a deep wrinkle or fold is very unlikely to get rid of it completely. Many times, it is better to start with a smaller amount and add to it over several months to gradually build up the area rather than to try and put in a large amount at one time.