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Plastic Surgery/permanent filler complications


QUESTION: Dear Dr Engler,

I got aquamid injected into my upper lip 10 years ago. After a couple of years the lip got hard, firm and swollen. Ever since the lip swelling would stay permanently. A couple of weeks ago my the swelling reached its peak. Family doctor prescribed Zitromax 500mg. I did a course of 6 day-therapy which somehow improved the condition but the lip is still enormously large.
Could you suggest anything to me? Shall I go for steroid injections (triamcinolone?).
I must also say that I had a surgery to remove the material from the lip but it did not improve the looks, nor was aquamid removed.
This problem is ruining my life because I am ashamed of how I look (enormously large upper lip, very artificial and bad looking)

Kind regards,

ANSWER: from Dr. Alan Engler

Hi Ann,

I'm obviously very sorry for what you're going through.

I wish I had a simple answer but I don't.  Permanent filler complications are extremely challenging, and may require multiple treatments.  I don't know that steroid injections will be enough of a solution but it is the simplest thing to try.  The fillers can cause granuloma formation, and THAT may respond to the steroids.

Otherwise, I'm afraid that the best recommendation is to see several board-certified plastic surgeons near you and see what their suggestions would be.

Sorry again,

I hope that this helps and good luck,

Dr. E

---------- FOLLOW-UP ----------

QUESTION: Dr Engler,

Thank you very much for prompt answer. I have seen a few plastic surgeons (board certified) and so far I am still looking for somebody who has experience treating filler induced complications and can help me somehow. I am ready to travel to a specialist who can help me.
If you know about a doctor who has experience treating permanent filler complications I would highly appreciate your recommendation!
Could you tell me if you think it is ok to take zitromax 500mg for a few weeks? This is what one doctor prescribed to me to reduce swelling and redness on my upper lip. But still I am afraid of the side effects of taking antibiotics in this large dosis over such a long time (14 days).

Kind regards and many thanks for taking your time to reply to my questions!

Hi Ann,

A 14 day course of the antibiotics should not cause any long term problems; I think it's pretty benign (although you could develop a yeast infection, etc).  However, it also doesn't address the long-term issue of the complication from the filler.  Unfortunately, I don't know of anyone I can recommend to you for this.  I'm not saying there isn't someone who can do it; just that I don't know of anyone.
Dr. E

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Alan M. Engler, MD, FACS


Dr. Engler has answered over 6500 questions on social media sites, including over 3500 on AllExperts alone. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, lipomas, skin cancers, cysts, etc. Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction." Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), the Dr. Keith Ablow Show and Jerseylicious. Videos of his appearances are available on YouTube (search for "DR. ENGLER"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is Follow Dr. Engler: @AlanEnglerMD


Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on,, as well as EyeScapes - Plastic Surgery of the Eyelids.

Dr. Engler graduated from Yale University (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York in the Departments of both Surgery (Plastic Surgery) and Medicine (Dermatology), and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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