What Potential Complications Are There?

There are many complications that can occur when receiving any type of dermal filler and it is important for not only your educator to be informed and aware of these, but also for you, too!

Swelling and Bruising:

These can be associated with any treatment. Since needles, cannulas, and manual manipulation are involved, sometimes these side effects can occur, even if we do our best to try to avoid any vessels. Things can be done to try to decrease these side effects as much as possible.

This includes following filler pre-care instructions such as avoiding Aspirin, Ibuprofen, Advil, St. John's Wort, oral Vitamin E, and non-steroidal anti-inflammatory drugs (NSAIDS) in the 24 hours prior to your treatment as they may promote the risk of bruising and bleeding in the injection area. Please let your injector know about any supplements you may be taking. If you are currently taking anti-coagulation medications (Warfarin, Coumadin, Heparin, Lovenox, Enoxaparin, Lepirudin, Refludan, Ticlopidine Ticlid, Clopidogrel, Plavix, Tirofiban, Aggrastat, Eptifibatide, Integrilin), discuss the use of these medications with your healthcare provider prior to your treatment. You may or may not be a candidate for treatment with cosmetic dermal fillers. Please don’t drink 24 hours prior to receiving filler or any other injectable.

Make sure you plan your treatment for a time when you have a few days where swelling, bruising, or other side effects will not impact your social or work obligations. All filler clients do receive a care-package with arnica tablets and creams to utilize. Please take as directed on the box.

Cold Sore (Oral) Herpes Simplex Activation:

Because your body experiences some trauma and the introduction of a foreign body, an immune response is activated. This can also make it possible for cold sores to becomes active. If you are prone to cold sores (oral herpes simplex), take your prescribed medication (Famvir, Famciclovir, Valtrex, Valacyclovir, Acyclovir) as prescribed in the 24 hours or more prior to your treatment, and continue to take as prescribed afterwards.

Side note, your injector will not inject you if you have an active cold sore. this could potentially cause your virus to become systemic and turn into viral meningitis. Do not take chances with this!

Infection: Infection can happen despite our best intentions. Hand hygiene is the first step to preventing infection. Make sure your injector always cleans their hands, wears gloves, changes gloves throughout (especially when going in your mouth), and ask about cleaning and infection prevention. An oral mouthwash prior to fillers near the mouth can help with infection control. Two agents should be used to ensure that the area is as free from contaminants as possible. Do not touch the area after your treatment.

Be aware that any dental procedures, surgeries, vaccines, or other activities or medication which lower immunity should be reconsidered for 14-30 days prior to or after treatment with dermal fillers.

Allergic Reaction:

A true allergic reaction to dermal filler is unlikely as hyaluronic acid (HA) is found in our body. Reactions can occur however and are thought to be related to the HA source or other manufacturing differences. Sometimes your body can have an immediate reaction simply to something foreign being introduced, these reactions can occur within minutes sometimes. This can include erythema (redness), swelling, itching, and pain. In this type of reaction, oral antihistamines and steroids can be given.

Sometimes a delayed reaction can occur up to three days later. These reactions are not usually managed well with antihistamines. They usually need steroid treatment. If a reaction cannot be controlled, sometimes dissolving the filler is the only option. An allergy spot test should be performed before receiving hyaluronidase to dissolve filler.

Infection and Biofilms:

Generally infection is rare, but can occur. Usually infection happens within two weeks and can be characterized by swelling, drainage, redness, heat, and/or abscess at the injection site. Systemic reactions can also occur and include fatigue, fever, leukocytosis (elevated white blood cells), and chills. Delayed infections can occur, but these are generally thought to be related to an already present infection or other underlying issue. Generally oral antibiotics work to clear these infections, but viral and fungal infections can also occur.

Biofilms can occur in the body. This is where the bacteria have a protective film, essentially shielding them from the immune system or the antibiotics. These can remain dormant in the body until conditions are idea and then become active again. They can be hard to treat., although oral ciprofloxacin over 4-6 weeks can help treat. This is another reason why it is important to make sure that dental procedures or other surgeries are not scheduled too closely to the filler procedure as these types of things can set up an environment for a biofilm.

Nodules. Immediate and Delayed:

Nodules can occur immediately after receiving filler and are usually related to small boluses that were not distributed or massaged through well. These can usually be easily remedied with some massage.

Sometimes nodules occur one month to a year later! These are very rare and are thought to be related to a delayed inflammatory response or a biofilm. These may need oral antibiotics, steroids, or hyaluronidase to dissolve the filler.

Vascular Occlusion (VO):

This is one of the scarier potential complications of a dermal filler procedure and it is one that both you and your injector should be well educated about. Make sure your injector has a plan for a potential VO. They don’t happen often, but preparation can help ensure a positive outcome.

A VO occurs when a blood vessel becomes blocked during the dermal filler procedure. This can happen due to the vessel being blocked by the space the filler is taking up and sometimes can be relieved by massaging the offending area of blockage. Other times, the blood vessel can be penetrated by the needle or more rarely, the microcannula and the filler can go directly into the blood stream. This is in turn can lead to more severe complications such as tissue necrosis, blindness, and even stroke! A very tiny amount of filler (0.04ml) can occlude the orbital artery causing blindness.

A VO can be scary, but it can also be rectified quickly and efficiently by a well-prepared injector. Heat should be applied immediately to help open open blood flow, aspirin should be given if appropriate for the patient to help thin the blood to increase blood flow, hyaluronidase should always be available on site to flood the suspected path of occlusion to dissolve the filler. This mean your injector needs to know the anatomy and landmarks of different blood vessels and how they potentially meet each other.

Occasionally, the path of vessels can lead the ones supplying parts of the eye and can cause blindness. This can be rectified and is exceedingly rare.

Sometimes signs of a VO can occur days or weeks later and can be mistaken for, or brushed off as another complication such as a cold sore or infection. Generally, any time there is prolonged pain, blanching, blister formation (other than cold sores), mottling of the skin, or the tissue looks like it is becoming purple or black, VO needs to be at least considered. This can be confirmed with an ultrasound.