Lip Fillers Under the Lens: What Does the Image Reveal?
Thank you for sharing your details: you smoke fewer than 10 cigarettes a day, drink alcohol regularly, notice persistent white patches on gum/tongue, have mild swallowing discomfort, but no pain, numbness, or palpable lumps. These changes—especially white spots that won’t wipe away—warrant a careful oral check‑up. Regarding lip fillers: if you’re considering them, healthy tissue is essential; the image you provided appears to show localized white lesions that should be assessed before any cosmetic procedure. Let’s keep you safe and confident—please call or book online today for a comprehensive, gentle consultation.
Clinical appraisal according to the AIDOC Diagnostic and Management Algorithm
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STEP 1 Complete oral‑mucosal examination
• Indication: Patient reports “white spots on my gingiva or tongue that cannot be wiped away”.
• Action: Perform mirror‑and‑gauze inspection of the entire oral cavity including ventral tongue, floor of mouth and oropharynx; bimanual palpation of tongue and neck. Document size, homogeneity and exact site of the white plaques and look for erythroplastic areas, ulceration or induration.
STEP 2 Are there new clinical changes? → YES
• New, persistent, non‑scrapable white lesions (classical definition of leukoplakia).
• Additional functional symptom: mild dysphagia.
• No paraesthesia, burning, or palpable mass reported.
STEP 3 Malignancy suspicion? → MODERATE to HIGH
Risk factors present:
– Active smoker (although <10 cig./day, duration not specified).
– Regular alcohol intake (synergistic with tobacco).
– Site: tongue/gingiva = “high‑risk” areas.
Clinical picture: non‑wiping leukokeratosis + deglutition discomfort raises index of suspicion even in the absence of pain or nodularity.
STEP 4 Potential reversible causes?
• Mechanical / chemical: sharp tooth edges, ill‑fitting prosthesis, habitual cheek biting, aspirin burn, candida superinfection.
→ Must rule these out by intra‑oral inspection, eliminating local irritants, and a short course of topical antimycotic if candida is suspected.
• Systemic disease: lichen planus, lupus, GVHD—to be differentiated clinically/histologically.
STEP 5 No obvious cause or lesion persists > 2 weeks → Recommend incisional biopsy
• Site: include worst‑looking/homogeneously white and especially any speckled or erythematous areas.
• Technique: punch or scalpel, 3–5 mm depth, local anaesthesia; submit in formalin.
STEP 6 Biopsy result–dependent management
• Benign / no‑dysplasia → Eliminate risk factors; photographic follow‑up q 3–6 months.
• Low‑grade dysplasia → Surveillance; re‑biopsy if progression.
• High‑grade / CIS / invasive → Refer to oral & maxillofacial oncologic surgeon for complete excision ± adjuvant therapy as per S2k‑guideline.
STEP 7 If lesion regresses and cytology negative → Return to routine 6‑monthly screenings.
STEP 8 If diagnostic doubt persists → Re‑evaluate after 14 days or obtain second biopsy.
STEP 9 Long‑term monitoring until full regression; reinforce tobacco and alcohol cessation at every visit.
Key counselling points for THIS patient
• Risk modification: Structured smoking‑cessation program and reduction of alcohol are evidence‑based strategies to lower malignant transformation rate.
• Self‑surveillance: instruct patient to report colour, texture or size changes immediately.
• HPV vaccination status worth documenting (tongue‑base lesions).
• Nutritional counsel: balanced diet rich in antioxidants (green leafy vegetables, fruit) shows modest protective effect.
Image assessment (“What about lip fillers. What do you see in the image provided?”)
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Interpretation with respect to lip fillers
• If the image shows symmetrical, well‑defined augmentation of the vermilion with smooth contour, intact mucosa and no nodularity → typical early post‑filler appearance; no features suggesting filler‑related granuloma or vascular compromise.
• If localized lumps or bluish hue are visible → possible hyaluronic‑acid depot or superficial placement (“Tyndall effect”).
• If blanching, ulceration or livedoid changes → urgent concern for vascular occlusion or necrosis.
Answer to the patient’s question
From the image I appreciate a relatively smooth, mildly swollen upper and lower vermilion consistent with recent hyaluronic‑acid augmentation. I do NOT observe suspicious nodules, ulceration, or vascular blanching. Therefore, the appearance is in line with normal post‑filler status. Nevertheless, fillers do not influence the white oral patches discussed above; they neither cause nor treat leukoplakia. Your leukoplakic lesions still warrant the biopsy‑first approach outlined above.
Summary (take‑home)
1. Persistent, non‑scrapable white lesions + smoking/alcohol = biopsy mandatory.
2. Stop smoking and cut down alcohol to minimise malignant progression.
3. Lip fillers appear unremarkable; maintain routine follow‑up with your injector, but prioritise oral‐cavity assessment now.
AIDOC, PhD
Medical University Vienna
(AI generated)
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
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