Aside from Botulinum Toxin, dermal fillers are one of the most commonly performed aesthetic procedures. Most dermal fillers are hyaluronic acid-based (HA) and are temporary solutions for face contour correction.
HA fillers degrade over time (1-2 years) and are eventually completely eliminated from the body. When clients desire a longer lasting filler, they opt for semi-permanent fillers (last 3-5 years).
The main advantage of using HA fillers will be the reversibility. Errors made when using HA fillers can be “erased” by using an enzyme, whereas semi-permanent filler users will have to wait it out.
Potential complications from dermal filler use include:
- Filler migration
- Granuloma formation
- *Vascular compromise
Vascular compromise occurs when filler material gets accidentally injected into blood vessels. Due to the viscous nature of fillers, the affected blood vessel becomes blocked immediately.
This cuts of blood supply to the tissue and if intervention is delayed, the tissue will die. This manifests as darkened / gangrenous skin at the affected area, that will eventually heal with scarring. Filler material may also get pushed into blood vessels supplying the eyes / brain, resulting in blindness / stroke.
- Foreign body reaction
There are also clients encountered who had “filler” injection done for their face / breasts / buttocks >10 years ago. Unfortunately, most of them are not aware that they were injected with liquid silicone which are permanent fillers.
Liquid silicone was once a popular choice as filler until reports of side effects started pouring in, causing it to be sidelined. The implanted silicone commonly induces an inflammatory reaction within the tissue.
As silicone do not degrade, the inflammatory process is persistent and ultimately leads to a lot of scarring in tissues surrounding the implant. Silicone also integrates into tissues, making surgical removal and clearance very difficult.
Implanted liquid silicone is also known to migrate to other parts of the face, causing disfigurement. Even if the silicone stays put, thinning skin from aging will eventually reveal “islands” of silicone deposits, which is unsightly.
Swelling and bruising is common after filler injection especially when needles are used as opposed to cannula. They may take up to 2 weeks to resolve. Topical and oral medication may be offered to speed up the recovery process.
Infection / granuloma is rare after filler injections and can be prevented by performing the procedure using sterile techniques. To prevent overfilling or filler migration, the practitioner must always adhere to the adage “less is more” when injecting fillers. They must stop “chasing the lines” and instead assess the client’s face as a whole and focus on sculpturing.
To lessen the risks of vascular compromise during filler injection, the physician must be first well-versed with the facial anatomy. Injectables in aesthetic medicine is a vast field and requires constant training and refining in knowledge and injection techniques. In the event that a vascular compromise does occur, emergency measures are invoked immediately to minimize further tissue injury.