Fillers: what can go wrong?

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We can’t quite believe that we haven’t blogged on this subject yet!  For those of you considering having a filler but who are nervous as to what the side effects are read on!

We cannot stress enough how wonderful fillers truly are.  These quick, easy and relatively painless injections are truly a miracle treatment and in the right hands can take years off your face in only a few minutes and for a very reasonable price.  However there are some negative effects that can come from these procedures, and unlike with Botox, some of them can be permanently disfiguring!

What are these horrifying side effects you ask?  Some doctors may fear putting you off the procedure by informing you of what can go wrong, however we believe that having an informed patient is far better than having an uninformed patient, and that you should be part of the team when it comes to treating your face!  Here are the scariest things that can go wrong when you opt for a dermal filler injection:

Allergic reactions.  While it is nigh on impossible to be allergic to Hyaluronic Acid fillers, if you are allergic to local anaesthetic this is something you need to notify your doctor of before you have any injections.  This doesn’t mean you can’t have a filler, it just means you need to have one that isn’t mixed with local.

What to do about it: if you don’t know you’re allergic and get a reaction to the filler you should notify your doctor as soon as you start seeing or feeling anything strange.  This can range from difficulty breathing to nausea to disproportionate swelling or redness.  All of those are not normal so speak to your doctor if you experience any of them!  If you are so allergic that you go into anaphylactic shock this is obviously a life-threatening situation and this is one of those instances where if you have allowed your beautician or someone unqualified to inject you, you will REALLY regret not having gone to a real doctor…if you live to tell the tale.

Bruising and swelling.  Any time a needle goes into your body, even if the needle is being held by the High Priestess of Vascular Anatomy herself, there is a chance you may bruise or swell.  Your doctor cannot see each capillary in your face, so rather expect a bruise than try to convince your doctor not to bruise you.  Sometimes they happen, sometimes they don’t.

What to do about it:  You can ice, you can use arnica, you can use your grannies remedy, you can use concealer, you can use foundation, you can put a paper bag over your head or you can stay at home until the bruise is gone.  A bruise is a bruise and it will be there for as long as it wants to be there for.  Your doctor cannot erase it so you need to find a way to live with it until its gone.

Lumps and bumps.  A filler is a gel-like substance injected under your skin.  As soon as the needle carrying the filler enters your skin your tissues begin to react by swelling (even if the swelling is not visible to you, there will be inflammation) and this distorts your anatomy a little.  Your doctor should always try to ensure that your filler is smooth and perfect before you leave her/his office, but as the swelling settles you may notice that there is a small lump or bump that shows in certain lighting that appears abnormal.

What to do about it: To sort this out all you have to do is go back to your doctor, who will carefully massage the filler until it looks smooth.  You could do the massaging yourself, but with your untrained hands you may massage too much and flatten the filler completely leaving you with a negligible result.  Lumps and bumps are best treated within the first 2 weeks after injection, so wait 3 or 4 days after your treatment for the swelling to settle and then if there is something not right go back to your doctor.

Asymmetry.  Your doctor really should assess your face carefully before, during and after your treatment to ensure that the filler maintains your natural symmetry or improves your symmetry.  However, we are all right or left-handed and also right- or left-faced, we all sleep on one side preferentially and we are all born asymmetrical so a few days after your treatment you may find that one side of the treated area has more volume than the other, or that your face looks skew.  You shouldn’t ignore this or hope that it will become symmetrical on its own.

What to do about it:  Go back to your doctor who should top up the offending side free of charge.

Avascular necrosis.  This is the scary one.  It is possible for your doctor (and even more possible if you choose an injector who hasn’t spent 6 years learning anatomy in medical school) to accidentally inject filler into an artery in your face.  The filler is a gel which is thicker than blood, and so if this happens the filler blocks the artery so that blood can no longer flow through this artery and oxygen and nutrients cannot be delivered to the area that the particular affected artery was feeding.  If your skin is starved of oxygen and nutrients…it dies.  If the filler is injected into the artery that feeds your retina you will go blind.  This is obviously devastating and can mean permanent disfigurement and necessitate lengthy treatment and even skin grafts!

Okay calm down, the incidence of this is at the moment reported at 9 in 10, 000.  These statistics are very hard to pin down because of improper regulation of these kinds of products, and the vast number of companies that manufacture and sell these products so the best thing for you to do if you are considering a filler is to go to a properly trained medical doctor who is using FDA approved products only.

On the bright side, the effect is not immediate and you do have time to rectify the situation if you are vigilant and disregard the idea that your doctor doesn’t want to be bothered by you at 2am.

What to do about it:  If you are unlucky enough to be one of the 9 in 10, 000 people who this happens to you will feel disproportionate pain during your injection.  The pain may be in the spot where the needle is, but it may also feel like its spreading to another area of your face, and it will be SORE.  DO NOT BE BRAVE!  SAY OWWW!!!  Once you have notified your doctor that you think something untoward has happened s/he will stop injecting and examine you.  If s/he deems it safe to continue the injections you shouldn’t have cause for much further concern, but you should still be extra vigilant.  If something dodgy has happened your doctor will explain this to you and then proceed to warm the area and apply a nitroglycerin paste, or to inject Hyalase, which is a substance that almost immediately dissolves HA filler.  This will allow the blood to flow normally again and you won’t have any long term side effects.

If you don’t notice anything odd at the time of injection but then after you’ve gone home notice that there is a colour change in any area of your face from pink to white after the injections you need to report this to your doctor as soon as you see it.  This may only happen a few hours after the injections, and you should not be shy to tell your doctor this news at 10pm or 2am or on a Saturday or during Sunday lunch or during the rugby or any time of the day or night.  Having your skin turn white is not normal and you need to get it seen by a doctor as soon as possible.  If you notify your doctor soon enough the filler can be dissolved and there will be no long term ill effects for you at all, but if you ignore this you run the very real risk of having your skin literally die and fall off your face.

The next thing you may notice is further discolouration of the affected skin to blue or purple or black.  This is not a good sign.  Basically this is when it is too late and you are going to develop sores that take a long time to heal and may require skin-grafting or reconstructive surgery especially if the affected skin is on your nose.  Not good.

How can this be prevented?  The first step towards preventing this kind of thing from happening to you is choosing your injector carefully.  Just because someone is old doesn’t mean they are qualified, and just because someone is good looking doesn’t mean they know how to use fillers correctly.  We believe you should only trust doctors with evidence of adequate training that spend a significant amount of time in their practice injecting fillers.  It’s not rude to ask your doctor how long they’ve been injecting for or where they trained or how many filler injections they’ve given.

Doctors who have adequate training will be aware of where major vascular structures are in your face, and will use techniques that will minimize the risk of coming into contact with an artery.  Some of those techniques include avoiding high risk areas altogether, making the decision between using a cannula (essentially a blunt needle) or a sharp needle to inject with, and pulling back on the syringe to check whether blood flows into the syringe before pushing the filler into the area to be filled.

Even if your doctor has done all of those things though, there is still a risk that your anatomy isn’t exactly “textbook” or that for any other reason an artery is still affected, and this is where it becomes even more important that you are being injected by a doctor who knows how to deal with emergency situations and who has a protocol to deal with such events.  Your friend/beautician/massage therapist/hairdresser most likely doesn’t have a relationship with a Plastic Surgeon or Ophthalmologist who they can call if something goes wrong, nor do they have access to the drugs that can rectify these situations…so don’t be a doofus, you only have one face, entrust it to someone who is qualified for the job!

We cannot stress enough that despite all of these horrible effects, side effects are actually very rare in experienced hands, especially the worse of the lot.  Fillers are actually incredibly safe, effective, and forgiving, and their low cost and temporary nature makes them wonderful for experimenting with!  We do plenty of filler injections each week and absolutely love working with Hyaluronic Acid products, so don’t let the bad effects put you off!  Having said that one should always be armed with knowledge and information is power, so educate yourself on the negative effects of any procedure you intend undergoing before you sign up for anything!

If you haven’t been completely put off fillers and would like to find out more about what they can do for you, give us a call on (021) 6833048 extension 1, or send us an email on

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