Lip Filler Bruising or Necrosis: Recognizing Symptoms

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Lip fillers can enhance the appearance of your lips, but they come with potential complications such as bruising or, more seriously, necrosis. Bruising is common and typically harmless, presenting as discoloration that resolves within a week.

Necrosis, however, is a severe condition resulting from vascular occlusion, where blood flow is obstructed, leading to tissue death. It’s crucial to differentiate between the two: bruising is usually painless and improves over time, while necrosis involves intense pain, skin discoloration, and texture changes. Immediate medical attention and treatment with hyaluronidase can mitigate the effects of necrosis. Understanding these risks and the importance of prompt action can ensure the safety and success of lip filler treatments.

Immediate Post-Treatment Symptoms and Their Implications

After receiving lip fillers, it’s normal to experience certain symptoms. Recognizing what’s typical versus what’s concerning is key to a safe recovery.

Normal Post-Treatment Symptoms

Expected Pain and Swelling: Mild to moderate pain and swelling are typical after lip filler injections and are part of the body’s natural response to the treatment. The lips may feel tender to the touch, and the swelling can give them a fuller appearance temporarily. This swelling is due to the influx of fluids and inflammatory cells to the area as part of the healing process. Cold compresses and over-the-counter pain relievers can help manage these symptoms, which should peak within the first 48 hours and gradually diminish over the following days. It’s important to follow your practitioner’s aftercare instructions and to be aware that while some discomfort is expected, extreme pain is not normal and should prompt immediate consultation with your healthcare provider.

Typical Timeline for Bruising Resolution: Bruising from lip fillers generally follows a predictable healing process. Initially, the bruise will appear red or purple, indicating fresh bleeding under the skin. Over the next few days, hemoglobin, the molecule in blood that carries oxygen, breaks down into other compounds, changing the bruise’s color to blue or black. As the body continues to metabolize these compounds, the bruise will turn green, then yellow, before finally resolving back to the normal skin tone. This color transition is a positive sign of healing. The entire process typically takes about one to two weeks, with the most significant color changes occurring within the first five to seven days. Factors such as the individual’s skin type, the extent of the bruising, and overall health can affect this timeline. If a bruise persists beyond two weeks without significant improvement, it’s advisable to consult with your healthcare provider.

Alarming Symptoms Indicating Vascular Complications

Sudden Onset of Severe Pain: Severe pain that arises suddenly after lip filler injections is a red flag for potential vascular complications. This pain is often described as sharp, intense, and disproportionate to the expected discomfort from the procedure. It may indicate that the filler has obstructed a blood vessel, leading to vascular occlusion. Unlike the dull ache associated with normal bruising, this type of pain is a signal from the body that something is wrong, and it requires immediate attention. If you experience such pain, especially if it’s accompanied by other symptoms of vascular occlusion, contact your practitioner without delay.

Skin Discoloration and Texture Changes: Skin discoloration that deviates from the typical bruising pattern is a cause for concern. A pale, white, or mottled appearance can signify that the blood supply to the area has been compromised. As the condition progresses, the affected skin may turn a dusky purple or blue, indicating a lack of oxygen and impending tissue damage. Texture changes such as skin hardening or the presence of small, fluid-filled blisters are additional warning signs. These symptoms can escalate quickly, and prompt medical intervention is crucial to prevent permanent damage or necrosis.

Abnormal Swelling, Coldness to Touch, or Coldness in Lips: Swelling is expected after lip filler treatments, but when it’s excessive or accompanied by coldness to the touch, it may indicate a vascular complication. The lips feeling unusually cold is a sign that the blood flow has been restricted, either by a blockage within a vessel or external compression from the filler. This lack of proper circulation can lead to tissue damage if not addressed promptly. If you notice abnormal swelling or a cold sensation in your lips, it’s important to seek immediate medical attention to rule out vascular occlusion and prevent further complications.

Diagnosis and Emergency Response to Lip Filler Complications

Prompt and accurate diagnosis is key in managing lip filler complications. Recognizing the signs and understanding the urgency of different symptoms can make a significant difference in outcomes.

Clinical Assessment and Immediate Actions

Physical Examination and Capillary Refill Time: A thorough physical examination is the first step in diagnosing lip filler complications. One critical aspect of this examination is assessing the capillary refill time, which involves pressing on the lip to blanch the skin and then observing how quickly the color returns once pressure is released. A normal capillary refill time is typically less than two seconds. Delayed refill time can indicate compromised blood flow, suggesting vascular occlusion. Alongside visual inspection for discoloration and palpation for texture changes, capillary refill time is a simple yet effective diagnostic tool to help differentiate between normal post-procedure symptoms and potential emergencies.

Distinguishing Between Bruising, Infection, Allergy, and Vascular Occlusion: Differentiating between common side effects like bruising and more serious conditions such as infection, allergy, or vascular occlusion is crucial. Bruising is characterized by discoloration that follows a predictable healing pattern without severe pain. Infections may present with increased warmth, redness, and possibly fever. Allergic reactions can cause itching, redness, and swelling beyond the treatment area. Vascular occlusion, on the other hand, is marked by severe pain, skin blanching, or a dusky appearance, and requires immediate intervention. A detailed patient history and careful examination are essential for accurate diagnosis.

Contacting Your Practitioner and Importance of Timely Medical Advice: If you experience any concerning symptoms after lip filler injections, it is imperative to contact your practitioner immediately. Timely medical advice can prevent the progression of potential complications. Aesthetic practitioners are trained to recognize the signs of complications and can provide or direct you to the appropriate emergency response. Delay in seeking advice can lead to worsening of symptoms and more severe outcomes, including permanent tissue damage. Always ensure you have your practitioner’s contact information readily available post-treatment.

Treatment Protocols for Vascular Occlusion and Necrosis

Use of Hyaluronidase: Hyaluronidase is an enzyme that rapidly breaks down hyaluronic acid, the most common substance used in lip fillers. In the event of vascular occlusion, hyaluronidase can be injected into the affected area to dissolve the filler and restore blood flow, preventing tissue necrosis. The use of hyaluronidase is considered an emergency treatment and should be administered as soon as vascular occlusion is suspected. It is a critical tool and can significantly reduce the risk of long-term complications from lip filler treatments. Patients should be monitored closely after administration for signs of improvement and to determine if additional doses are necessary.

Additional Interventions for Severe Cases and Monitoring: In severe cases of vascular occlusion, where hyaluronidase and initial interventions are not sufficient, additional medical treatments may be necessary. These can include medications to improve blood flow, such as aspirin or nitroglycerin, and antibiotics if infection is a concern. Close monitoring for signs of improvement or worsening is critical. Follow-up appointments should be scheduled to assess the affected area’s recovery and to determine if further treatment is required. In some cases, referral to a specialist may be needed for advanced care. Continuous monitoring ensures that any changes in the patient’s condition are promptly addressed to minimize the risk of long-term damage.

Long-Term Management of Complications: Managing long-term complications from lip filler procedures requires a comprehensive approach. If tissue necrosis has occurred, wound care becomes very important to promote healing and prevent infection. Scarring and asymmetry are potential long-term issues that may require corrective procedures, such as surgical revision or further filler adjustments. Psychological support may also be beneficial, as dealing with complications can be emotionally taxing. A multidisciplinary team approach, including aesthetic practitioners, dermatologists, and plastic surgeons, can provide the necessary expertise for managing these complex cases.

Frequently Asked Questions

How can I tell if my bruising is normal or a sign of something more serious?

Normal bruising should improve gradually and follow a color transition from red/purple to yellow/green. If you experience severe pain, skin discoloration that does not follow the typical bruising pattern, or other alarming symptoms, it may be more serious.

What should I do if I suspect vascular occlusion after lip filler treatment?

Contact your practitioner immediately or seek emergency medical care if you suspect vascular occlusion, as it is a medical emergency that requires prompt treatment.

How long does it typically take for bruising from lip fillers to heal?

Bruising from lip fillers usually resolves within one to two weeks, with the most significant changes in color occurring within the first few days.

Can vascular occlusion be treated successfully if caught early?

Yes, if vascular occlusion is identified and treated early with interventions like hyaluronidase injections, the chances of successful treatment and avoiding serious complications are high.

What are the long-term effects of necrosis caused by lip fillers?

Long-term effects of necrosis can include permanent tissue damage, scarring, and potential disfigurement, which may require surgical correction or other treatments.

What qualifications should I look for in a practitioner for lip fillers?

Look for a practitioner with medical qualifications, specialized training in aesthetic procedures, and a deep understanding of facial anatomy and injection techniques.

Can vascular occlusion be treated if diagnosed late?

Treatment is more challenging and may not be as successful if vascular occlusion is diagnosed late, but interventions like hyaluronidase injections and supportive care are still critical to minimize damage.


Understanding the risks and knowing how to respond to complications are crucial aspects of lip filler treatments. While most side effects like bruising are benign and self-limiting, serious complications such as vascular occlusion and necrosis require immediate medical attention. Choosing a qualified practitioner and following best practices can significantly reduce risks. Being informed and vigilant about post-treatment symptoms empowers patients to seek timely care, ensuring the best possible outcomes for their aesthetic enhancements.

Was this article helpful?



Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.