How to avoid complications from dermal fillers

Dermal fillers were first introduced in the 1970s. Since then, innovations, particularly hyaluronic acid-based fillers, have resulted in continued growth and evolution.

Injectable fillers remain one of the most popular procedures in the world thanks to their effectiveness, versatility and the fact that social media has raised awareness and social acceptability. While it is human nature to assume that if something is ubiquitous, it is safe – it's important to recognize that just like any plastic surgery procedure, things can go wrong with any type of injectable.

The best way to avoid complications from dermal fillers is to see a highly trained injector, such as a board-certified plastic surgeon. Here is why vetting your injector carefully is in your best interest.

Social media and dermal fillers

Social media has affected the aesthetic industry in both good and bad ways. On the plus side, you can now conduct in-depth research online into the various procedures that may be right for your needs before ever stepping foot into a doctor's office. The web can also provide you with many before and after photos.

On the downside, you do not always know if these photos have been altered or if the person also had other procedures. Furthermore, an aesthetic procedure is never one-size-fits-all. What provided an excellent result for your favorite influencer may not be right for your anatomy.

This is why scheduling an in-person consultation is always a smart idea, even with something that may seem inconsequential. Dermal fillers have become so normalized that many patients tend to forget that it is still a medical procedure. Anyone with a medical degree can legally administer dermal fillers, depending on the state. However, your dentist is likely not going to have the same skill or artistic eye as someone who is trained in aesthetics.

Skilled injectors are the best protection against filler complications

The skill of your injector is your best protection against developing complications from a filler procedure. You want to choose someone with considerable experience, as he or she will have a deep knowledge of the various fillers currently on the market and the subtle pros and cons of each.

A safe, exemplary result is always going to come down to choosing the right filler for your individual anatomy and needs. Also, this experienced medical professional will know when and when not to perform a filler procedure.

Typically, most patients will require a combination of fillers to rejuvenate the face. A hyaluronic acid filler that is lighter in weight will be better for fine and superficial lines. At the same time, you may need something heavier for deeper wrinkles, nasolabial folds and loss of volume in the mid-face.

Filler can be injected through a needle or a blunt cannula, and a skilled injector will know which is best for each treatment area. Filler injections are one of the safest procedures out there, but no aesthetic procedure is completely risk-free.

Bruising and swelling are the most common complications

The most common complication from an injectable procedure is swelling. Some degree of swelling is inevitable. This is your body's natural response to any trauma. However, poor technique may result in more intense and unnecessary swelling.

Bruising may also occur, but it is much less likely in the hands of someone with considerable experience. Keeping your head elevated, minimizing activity just after an injection and topical treatments, such as vitamin K creams, arnica and aloe vera, may help reduce any residual bruising.

Cold compresses and ice can help reduce the signs of bruising and swelling. While both can be annoying, they tend to resolve on their own within a couple of weeks.

Moderate complications from dermal fillers

There are other moderate complications to consider with dermal fillers. These include:

• Allergic reaction
• Nodules (aka lumps and bumps)
• Tyndall effect

Allergies are rare as most fillers today are hyaluronic acid-based, and hyaluronic acid is a natural component of skin and soft tissue. Nodules, or unsightly lumps and bumps, result from poor technique and may occur due to inappropriate filler choice and/or improper placement. If too much filler is placed near or within a very deep line or close to an active muscle such as the perioral area, the filler may move and gather into a "ball," creating a non-aesthetic or uncomfortable result.

The Tyndall effect happens when too much hyaluronic acid filler is placed too superficially. Light that shines on your skin may then develop a bluish discoloration. This effect can happen when too much is asked of filler, and it is injected just under the skin's surface to break or smooth out lines. Areas under the eyes and around the lips are particularly prone to this issue.

To counteract the Tyndall effect or a nodule, hyaluronidase can be injected to break down or melt previously placed hyaluronic acid filler. The incidence of these complications is negligible in the hands of a skilled injector, such as a board-certified plastic surgeon who will also be well-versed in hyaluronidase injections.

Vascular complications from filler are dangerous

Most of the complications that can result from dermal fillers are manageable. However, there are two vascular complications that can be dangerous:

• Skin necrosis
• Vision loss

Necrosis occurs when the blood supply to your skin is cut off. Though very rare, this could happen during a filler injection procedure if the filler is accidentally:

• Injected into an artery or vein
• External pressure from the filler compresses the vein
• Direct trauma to the vessel wall

Symptoms, including significant, prolonged pain and "blanching," which is a whiteness in the treatment area, typically present within 24 hours. This sounds scary but is most often treatable. If necrosis occurs, your filler will need to be dissolved immediately with hyaluronidase. Early contact with your injector is recommended as necrosis is more easily treated sooner rather than later.

Vision loss is also a scary and potentially devastating complication of dermal fillers. Extremely rare, it occurs due to a retrograde flow of the filler into an artery or vein, resulting in an occlusion. It may occur when treating the tear trough area under your eyes, around the nose, nasolabial folds and the "11" lines between your brows, as filler can migrate. This requires immediate recognition and treatment with hyaluronidase and possibly other hospital-based treatments.

A skilled injector always plans for the possibility of these complications, so the best way to protect yourself against dermal filler complications is by researching your injector as intensely as you would a surgeon. You may wind up spending more to see a highly qualified injector. However, a safe result is well worth it.