Are Dermal Fillers Safe?
In our last article we looked at how fillers work, this time we’ll look at the safety of this treatment.
More important than anything else is to make sure you are being treated by a reputable practitioner who is fully aware of the possible complications and how to manage them - proper use of dermal fillers requires a deep understanding of the structure of the face and how the different products interact with our bodies.
When thinking about the safety of a procedure it’s useful to look at side effects which are relatively common but usually not long lasting or severe; and complications which are much rarer and can cause lasting harm if not recognised and managed properly.
Let’s talk through the common side effects and the important complications to be aware of. I think it’s really important people know what might happen before they decide to have a treatment like dermal fillers.
Dermal fillers are not permanent, likewise most side effects are temporary too. Some injections can be painful, feel like a bad sting, but this usually subsides in the time it takes the filler to be injected, it certainly shouldn’t last longer than a few minutes. Bleeding at the time of injection, swelling around the site, redness and bruising are all other common side effects. Sometimes the filler can be felt under the skin after being injected, this is quite normal and usually settles with massage.
There are a few serious complications to be aware of, thankfully these are very rare. Firstly you can have a reaction to the dermal filler. This is due to an ingredient in the filler. This may cause swelling and pain, and should settle with antihistamine treatment. Sometimes people can react more severely causing problems with their breathing and even affect the whole body, this most serious of reactions is called anaphylaxis. If you have ever had anaphylaxis or a severe allergic reaction, it is important to discuss this with your practitioner. It should be one of the questions you are asked at your pre-treatment consultation. If you ever have a consultation where this isn’t discussed you should think really carefully about going ahead with a treatment - if a practitioner doesn’t take the time to talk to you about this, you’d have to question how well set up they are to deal with it if it were to happen.
You need to be confident that your practitioner knows how to manage this complication. All practitioners should have an emergency anaphylaxis kit and - even more importantly - know how to manage a patient who develops anaphylaxis. This is one reason why choosing your practitioner is very important. It is vital to have somebody with the experience to be able to recognise and treat anaphylaxis if this rare but life threatening complication was to occur. One tip I would say is to ask your practitioner what they would do if you had a reaction, and ask to see their emergency kit - if they can’t tell you during your initial consultation they may not be experienced enough to manage it properly in the stressful (but thankfully rare) situation
Another rare but serious complication is necrosis. This is where the blood supply to tissue is blocked by the filler, this is called a vascular occlusion. In the case of dermal fillers, the overlying skin cells and surrounding soft tissue stops receiving blood. If left untreated, this tissue will die, necrosis is the medical name for this. There are two ways this can happen, one is if some filler is injected into the blood vessel and blocks the blood supply. The second way that the blood supply can be reduced is if the filler presses on the blood vessel, this is more likely if a large amount of filler is used. An experienced practitioner will know their anatomy so avoid the blood vessels and do several safety checks to reduce this risk as much as possible. They will also know how to recognise it if it were to occur. Again, this highlights how important it is to choose the right person to do your treatments - are they someone who deeply understands the anatomy and physiology involved? Do they talk you through what they’ll do to prevent this complication and what they’d do if it were to happen? Like with anaphylaxis, do they have an emergency reversal kit?
If a vascular occlusion was to happen, your practitioner should be able to detect this before you leave the clinic. With the use of a resolving injection called hyalase, they should be able to reverse the effects of the blocked vessel and preserve the tissue. If you ever leave the clinic and develop pain or discolouration to the skin, make sure you speak to your practitioner immediately - don’t wait till the next day. You should be given aftercare advice before leaving the clinic.
Another complication that is an unwanted but treatable is a flare up of herpes simplex (cold sore virus). This can happen even if you have never knowingly had cold sores. See your practitioner or GP if this was to occur.
Infection after an injection is rare, but can occur. Again your practitioner should take several steps to prevent this, and you should be given aftercare advice about how to avoid infection and how to recognise it so that you can get medical help quickly.
A couple of other complications to be aware of are visible fillers and nodules. If the filler is placed too close to the surface of the skin it can cause discolouration, this will resolve itself with time or can be reversed. Likewise with nodules, these are small bumps that can occur after 1-2 months of having the treatment, and less commonly more troublesome nodules can develop after a few months. When you have your initial consultation how much does your practitioner talk to you about these risks? Do they have the medical, anatomical and physiological knowledge to keep you safe and give you the best results? Next time I delve into this topic a bit more with some tips on how til choose a practitioner.