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Dermal Fillers: Risks and Management of Complications
Dermal filler treatment

The global demand for injectable is projected to grow by more than double over the next decade. Despite understanding the risks, the demand for dermal fillers continues to grow globally. 

The truth is that dermal fillers are generally safe. Although complications are very rare, they still present a real risk to people receiving dermal filler treatments. 

Before you decide to undergo a dermal filler treatment with your doctor, you need to first understand the various complications that may arise from the procedure.

Your doctor may or may not paint the complete picture before performing the treatment. Therefore, it is important to fully understand the risks so that you can weigh the benefits versus the risks and decide if you want to proceed.

In this article, Dr. Siew Tuck Wah, Medical Director of Radium Medical Aesthetics delve into the details of explaining the various complications one may face with dermal filler treatments. 

Possible complications from dermal fillers

Bruising from dermal filler treatment

The most minor and common side effects are temporary. These include bruising, swelling and redness at the site of the injection. These usually go away very fast, although they may take a longer time to heal if you are consuming certain blood-thinning medication or suffer from some illnesses that may cause severe bruising or bleeding. Steps can be taken before and after the treatment to ensure that you recover quickly.

Many of the complications people suffer from are related to the doctor’s technique. Such technique-related complications include lumpiness and overfilling.

Lumpiness occurs when the filler is injected too superficially or when the wrong type of dermal filler is used. In particular, the undereye area is prone to such problems due to the thin skin around the eyes.

On the other hand, overfilling is a common issue we often see in some celebrities and socialites where the cheeks become too puffy. 

Infection from dermal filler treatment

Infection Is a rarer, but more serious complication which can occur if skin not properly cleansed during procedure. Infection can occur soon after or even months later – when a biofilm is slowly formed by the bacteria surrounding the filler.

Another less common complication of dermal filler treatment is the formation of lumps which occur much later, known as delayed onset nodules. In this scenario, nodules appear weeks or even months after. The cause of this is a delayed type of  hypersensitivity reaction. Incidence of such complication is about 0.02 to 4%, depending on the type of fillers used and the area it was injected.

The worst complication that can happen by far, is when the filler inadvertently enters an artery during the injection. The fillers block the blood supply to a certain part of the skin on the face and necrosis or skin death occurs. This is followed by scarring. 

Blindness from dermal filler treatment

In another scenario, when the filler enters the artery which supplies the eye, blindness may occur. Blindness is extremely rare and it only happens when fillers are injected into the nose and forehead.

Are these complications reversible?

Fortunately, most filler complications are reversible or temporary. Bruising and swelling will usually resolve on its own after 3 to 5 days. Severe complications such as blindness and necrosis may occur, although occurrences are rare.

Lumps caused by overfilling can be dissolved by hyaluronidase. However, this can only be done if the filler is a hyaluronic acid filler such as Restylane or Juvederm. Semi-permanent fillers such as Radiesse and Ellanse cannot be dissolved.

For these reasons, you should only go to an experienced doctor if you are interested in undergoing semi-permanent fillers.

Infections can be treated with the right antibiotics and draining of abscess will be performed, if required. Delayed nodules can be treated by steroids. 

There have been significant advancements in the treatment of skin necrosis caused by fillers. In the past, when vascular occlusion occurs, it is catastrophic and it means months of treatment and possibly scarring. Today, we can reverse the impending necrosis with a protocol known as high dose pulsed hyaluronidase. 

Unfortunately when blindness occurs, it is often irreversible, even with the most timely and appropriate treatments.

How can we reduce the risks of these filler-related complications?

A properly trained medical professional will know how to reduce the risk of filler injections through thorough knowledge of facial anatomy and proper safe technique. For example, when an experienced doctor knows where the arteries are on the face, we are able to avoid them. 

A properly trained injector who fully understands the rheological properties of dermal fillers will significantly lower the risk of causing lumpiness on the face. 

dermal fillers

Is it still safe to undergo a dermal filler treatment then?

Every medical procedure carries risks. Your doctor needs to take time to explain all these risks to you. If he or she brushes aside the side effects and tells you that everything will be fine, you need to think twice about undergoing the treatment with him/ her. Only have the procedure done by a trained medical professional and never in a salon by a beautician. 

It is important to weigh the risks and benefits of the procedure. Fillers should only be done when there is a need to. Despite all the risks, dermal filler injections are an integral part of anti-ageing treatments. When performed correctly and safely, they can significantly improve your appearance and turn back the clock on ageing skin.

The most important thing is to choose an experience doctor who knows how to minimise the complications, and who knows how to treat the complications if they arise. 

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