When hyaluronic acid fillers are the culprit of necrosis, injecting with hyaluronidase might relieve the problem before complications even occur (Refer to the Aesthetic Complications Expert Group document on Hyaluronidase).
Tissue death (necrosis)
Although very rare, this is one of the most severe complications that can occur as a result of dermal fillers. Necrosis can occur immediately or a few hours after treatment.
Answer: Skin necrosis is rare after injection of filler
Signs of skin necrosis include changes in skin color (a blue, dusky, or dark hue in that area), pain, and “breakdown” of the skin.
SYMPTOMS OF NECROSIS INCLUDE:
Severe pain: which may initially be dulled if anesthetic cream has been applied to the lips. Prolonged blanching: when the affected area looks very pale, white or dusky due to the reduction in blood supply.
Treatment can slow the progress of avascular necrosis, but there is no cure. Most people who have avascular necrosis eventually have surgery, including joint replacement. People who have avascular necrosis can also develop severe osteoarthritis.
Answer: Not likely necrosis
As others have stated, usually necrosis happens very quickly. It looks more like a bruise which can take a while to resolve in the lips.
What does skin necrosis look like? There are two main types of necrotic tissue present in wounds. One is a dry, thick, leathery tissue usually a tan, brown, or black color. The other is often yellow, tan, green, or brown and might be moist, loose, and stringy in appearance.
Necrosis is the death of the cells in your body tissues. Necrosis can occur due to injuries, infections or diseases. Lack of blood flow to your tissues and extreme environmental conditions can also cause necrosis. While dead body tissue can be removed, it can't be brought back to good health.
There have been cases reported that occurred 12-24 hours after being injected but almost always it occurs immediately. If no treatment is initiated to improve the vascular flow, the skin will start to appear dusky, a bluish tint, with fine reticulations (lace like) to areas WELL BEYOND THE SITE OF INJECTION.
It is important to note that while necrosis is a very real and serious complication of dermal filler treatments, actual occurrences are quite rare. Reports suggest that for all dermal filler treatments, only 1 in 100,000 result in a necrosis.
Background: Skin necrosis is considered the most serious complication of hyaluronic acid dermal filler injection procedures.
It looks like bruising – but then you remember – skin necrosis, following a period of vascular occlusion, can also look like a bruise.
Once necrosis starts, it cannot be reversed. But, the earlier the diagnosis, the sooner you can take steps to prevent the necrosis from spreading. Skin necrosis can be caused by hematomas or seromas: collections of blood or fluid that form under the skin.
“Necrotic tissue is dead, non-functioning, non-dividing and can no longer utilize oxygen and nutrients for normal cellular function,” Wolheim said. “It cannot become live tissue again.”
A necrotizing infection causes patches of tissue to die. These infections are the result of bacteria invading the skin or the tissues under the skin. If untreated, they can cause death in a matter of hours.
Some people have no symptoms in the early stages of avascular necrosis. As the condition worsens, affected joints might hurt only when putting weight on them. Eventually, you might feel the pain even when you're lying down. Pain can be mild or severe.
Necrosis (from Ancient Greek νέκρωσις (nékrōsis) 'death') is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated digestion of cell components.
Wounds that have necrotic tissue present will not heal, therefore one of the above methods will be required to remove the devitalized tissue. Removal of necrotic tissue will decrease wound bacterial bioburden and will allow healthy tissue to grow in its place.
Autolytic Debridement
This debridement is a natural process by which endogenous phagocytic cells and proteolytic enzymes break down necrotic tissue. It is a highly selective process whereby only necrotic tissue will be affected in the debridement.
Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. It happens most commonly in the ends of a long bone. Avascular necrosis may be the result of injury, use of medicines, or alcohol.
The skin may look pale at first but quickly becomes red or bronze and warm to the touch and sometimes swollen. Later, the skin turns violet, often with the development of large fluid-filled blisters (bullae).
Delayed hypersensitivity reactions are characterized by induration, erythema, and edema and are mediated by T lymphocytes rather than antibodies. They typically occur 48–72 hours after injection but may be seen as late as several weeks postinjection and may persist for many months.
Skin necrosis is considered the most serious complication of hyaluronic acid dermal filler injection procedures.
Answer: Signs of necrosis
Luckily if treated in time, this is reversible and should not cause any permanent damage.