How to Manage Complications with Dermal Fillers

Injectable soft tissue fillers have become popular in the past few years for facial rejuvenation. Several factors have helped to increase the use of these procedures, including their minimally invasive application.

However, dermal filler complications can (and do) occur. This is especially true if you choose a new injector for your treatment. There is good news. Most complications are minor and can be treated. More serious complications with dermal fillers are rare, but untreated can result in disfiguring permanent damage.

How Pre-injection Planning Can Reduce the Potential of Dermal Filler Complications

The best way to reduce dermal filler complications is with proper planning. Finding an injector who understands facial anatomy and the unique characteristics of the filer being used is essential. It’s also necessary for doctors who are providing this treatment to manage patient expectations. This is a crucial element in pretreatment preparation.

Anatomy Considerations

Different parts of the face have unique thicknesses. This is a factor that impacts the proper injection depth. Also, areas like the glabellar region have limited collateral circulation. As a result, these areas are at a higher risk of vascular compromise if excess injection volume is administered.

Filler Used

The proper placement and depth of the filler depending on what product is used. It also impacts the end results. The following depths apply to different fillers:

• Medium hyaluronic acid products. This includes Perlane, Juvederm, and Restylane and should be injected deeper into the dermis.
• Calcium hydroxyapatite or Radiesse. This needs to be injected at the dermal-subcutaneous border.
• Poly-L-lactic acid or Sculptra. This product must be injected into the fat under the dermis.

If an injection of the dermal filler is placed too superficially, it can produce an uneven surface or nodules. Because of this, it is usually best to go a little deeper to get the desired results.

Patient Expectations

Before seeking treatment, the physician needs to clarify the goals the patient has and their expectations for the procedure, and the results that a patient expects to get. The patient should also be allowed to identify any treatment areas using a mirror. Standardized pre- and post-procedure photos should be taken for proper documentation.

Informed Consent

Proper consent should be given. During this, you need to learn about the possible side effects, with the most common being tenderness, bruising, and swelling. You should also learn about all the details for post-op care.

Preoperative Screening

If you are considering dermal fillers, you need first to be screened for any medical problems that may impact the results achieved. This includes any pathologic or pharmacologic clotting disorders, history of seizures, or prior vagal episodes.

Potential Early Onset Complications with Dermal Fillers

The earliest complications will be those that occur within the first two weeks. These are called early-onset complications and include the following:

Minor Complications

While most of the minor complications can be avoided if the proper injection technique and filler selection is used, even seasoned injectors can cause swelling and bruising, which a patient may consider embarrassing.

Because of this, your doctor should explain the minor complications and how they can impact you. Your doctor may recommend that you avoid scheduling injections within two weeks before a special or important social event.

Swelling and Bruising

This issue can be limited by ensuring the visible vessels are avoided during the injection process. The doctor should ensure that the skin is pulled taut and that the room is properly lit. they should have an assistant present to watch for any signs of ecchymosis.

Once your session is complete, you must apply an ice pack for around 15 minutes. You don’t necessarily have to stop taking blood thinners if you receive proper counseling before the procedure related to the increased possibility of bruising.

If this issue does develop, it can be reduced by using vascular lasers or intense pulsed light that will target the red wavelength.

Swelling can occur because of the injection and the increased volume provided by the filler. Also, some fillers are more likely to cause swelling than others.

Discomfort

Tenderness and discomfort may be felt at the injection site. This can be a huge source of patient anxiety, so you should discuss mitigation options with your doctor. They have some methods and products that will help reduce the discomfort you experience.

If you begin to have more pain or even a headache after a filler injection, you can use acetaminophen, but avoid aspirin and NSAIDs for at least one week. These can result in even more bruising.

More Serious Complications

Sometimes, more serious issues can arise. In these cases, the patient’s appearance may worsen. This is something that needs to be addressed immediately.

An advantage of using hyaluronic acid fillers is that they can be dissolved by hyaluronidase. This is a substance that can be used several times if required.

Nodules

While you should be able to palpate the filler after an injection is complete, your doctor should watch for any signs of tender, painful, or red nodules. These indicate an infection and need to be cultured (in many cases). You should also be given antibiotics and rechecked in two days.

Vascular Compromise

The most serious complication that can occur right after the injection (or soon after it) is vascular compromise. The most at-risk treatment region is the glabellar region. Both venous obstruction and arterial embolization are rare; however, your doctor should be prepared if this happens.

Symptoms can range from a dull persistent ache to extreme pain. If you notice any of these issues, be sure to talk to your doctor immediately.

Delayed Onset Complications

If complications occur after two weeks after the injections, they are called delayed-onset complications. Some of these include:

Minor Complications

Common complications that occur in this category include visible material or residual palpable material, hypersensitivity reactions, nodules, and blanching.

Nodules, Blanching, and Bumps

If the material used for the injection is placed superficially or too much is used, it may result in visible bumps or a bluish or blanching discoloration of the nearby area.

Sometimes, the bumps will appear bluish because of the differential light scattering. This is called the Tyndall effect. If you have the infraorbital area treated, you may experience this issue. Sometimes, the discoloration can go beyond the filler area.

Even if you can’t see the issue, the material can be seen as palpable lumps. This is more common if the medium-weight fillers have been injected into the dermis and papillary epidermis. Some of the areas that are at the most risk for this problem include the perioral and periorbital lines, tear troughs, lips, nasal dorsum, or nasojugal folds.

To help prevent this from happening, you should inject it only in the mid-dermis or deeper.

Hypersensitivity Reactions

This type of reaction is rare. Also, the FDA does not require any testing for allergies for the approved fillers. If this type of reaction occurs, you must go to a rheumatologist or allergist for the best results.

Migration

This is most common with nonbiodegradable fillers. Cases of migration may lead to discomfort.

Getting Treatment for Issues with Dermal Fillers

When it comes to issues with your dermal fillers, there are a few problems that may arise. You should speak to your doctor if you are concerned about the situation. There may be options for issues with hylenex and you can look into reversing Dermal Fillers, reversing Juvederm Injections, or reversing Restylane Injections. If you are experiencing any issues with your dermal filler, including discomfort, migration, and more, contact Glow Aesthetic Center in Encino CA and meet with an experienced practitioner who will go over your goals and concerns and will help correct your prior filler injections!