Dermal Fillers: How to Prevent Complications?
Common filler complications include redness, swelling, and bruising. These reactions are normal physiological responses to injecting a foreign substance. Although a nuisance, these will heal with time.
However, there are more uncommon and unexpected filler complications that can arise.
Allergic/Hypersensitivity Complications:
Occurs when injected filler activates an immune response.
Time-limited reaction and is treated with a cold compress, antihistamines (Allegra/Benadryl), and oral steroids (if needed).
More serious reactions like anaphylaxis are rare and are treated in an emergent setting.
Be sure to provide a thorough history of skin conditions, allergies, systemic disease, current medications, and previous procedures.
Patients with a history of active autoimmune conditions (i.e. Lupus, Rheumatoid Arthritis, Mixed Connective Tissue Diseases, and Hashimoto’s Thyroiditis), and multiple, severe allergies and/or history of anaphylaxis are contraindicated and treatments should be withheld until cleared with your primary or specialist physicians.
Vascular Complications:
Occurs when filler is injected into a blood vessel or compresses the area impacting blood flow.
Usually immediate, although the onset of vascular occlusions can be delayed up to 24 hours.
Any suspicion of pain, skin blanching, or mottled skin appearance warrants immediate attention and is treated with a warm compress, aspirin, Hyaluronidase injections, and massaging of the affected area. This must be performed as soon as a vascular occlusion is suspected.
Infectious Complications:
Occurs when bacteria infiltrate the areas where your dermal fillers were injected.
Any injection with a needle or cannula breaches the skin barrier, thus posing a risk of infection and the development of a biofilm. Biofilms are dense communities of bacteria that secrete a sticky matrix that allows them to adhere to living structures. They can cause a local infection or abscess, a systemic infection, or a granulomatous inflammatory response.
Treatment with antibiotics and hyaluronidase (if needed).
Patients should arrive at their appointments with a clean face and avoid touching treatment areas to avoid contamination. If you have pets, keep them from licking your face.
Late Onset Complications:
Can occur due to viral or flu-like illness, inflammatory (i.e. prolonged mechanical irritation), or biofilm-related causes (bacteria from a distant site (i.e. dental cleaning)).
Nodules usually arise after 4 weeks to more than 1 year post-treatment.
Patients are advised to avoid any vaccinations or dental cleanings/procedures for at least 1 month pre- and post-filler treatments to lower the risk of late-onset nodules.
Inexperienced Practitioner Complications:
Lack of Knowledge of Product Characteristics: each company has a proprietary modification process, which allows a portfolio of filler consistencies with varied characteristics such as viscosity, gel firmness, lifting ability, tissue integration, and stretch. Placing an inappropriate product in a treatment area can result in unnatural results, abnormal facial proportions, unnatural facial expressions, and filler migration.
Lack of Knowledge of Facial Anatomy and Depth of Placement: knowledge of applied facial anatomy and placement depth is of paramount importance and serves as the foundation for avoiding complications. Your provider should fully understand the appropriate depth and plane of injection at different sites of treatment. Unduly superficial placement may lead to adverse events such as surface irregularities, the Tyndall effect, and filler migration.
Lack of Procedural Planning/Aseptic Technique: ensuring a clean workspace and that all supplies are in hand before initiating treatment prevents breaching of a clean workspace. The skin should be cleansed, degreased, and disinfected. Any way to help reduce breaks in the aseptic field and the risk of contamination is necessary in preventing infections.