Let's talk about fillers

Dermal fillers are becoming more and more popular as a cosmetic injectable. They can help you achieve fuller looking lips, erase deep lines and plump up your cheeks. Fillers can even be used in nose shaping, chin augmentation and jaw definition.

However, unlike botox, fillers can have permanent side effects that can be dangerous. You should be fully informed about the risks of each procedure before proceeding.

Jocelyn pillow face meme
More and more filler to reduce wrinkles does not make a balanced face.

There are 3 main types of fillers: temporary fillers, permanent fillers and biostimulators. Temporary fillers comprise of hyaluronic acids. These are temporary as the hyaluroic acid gel is slowly absorbed by the surrounding tissue and disappears in a process called iso-volumetric degradation. Permanent fillers either consist of silicon or permanent hydrogels. These cannot be degraded or absorbed by the surrounding tissue. Generally speaking, permanent fillers = permanent problems. The third type of filler, called biostimulators, work by inducing expansion of dermal tissue, such as stimulating collagen production. However, the effects are temporary.

You may already be familiar with the common side effects of fillers, such as pain, swelling and risk of infection. We will discuss the dangerous complications here. These are mainly associated with adverse effects from filler being unintentionally injected into a blood vessel. Take a look at the illustration below showing the main blood vessels in your face. You should also note that every human will have anatomical variations of this. A facial artery in one person will not follow the exact path as that in another person. So even if your injector has memorized the course of a particular vessel, it won't follow the same course in everybody and a slight variance could result in filler entering into your blood vessel.

Gold Coast dysport
Arteries and veins of the face. Can your injector name each vessel they are trying to avoid when injecting filler into your face?

So what happens if filler is accidentally injected into a blood vessel? The filler will act like a blood clot - similar to what happens when you have a heart attack (blocked artery to your heart) or an ischemic stroke (blocked artery in your brain). Except this will occur to a localised area on your face. We won't show any gory photos in this post, but if you search "filler complications necrosis" on Google Images, you will get a better understanding about how serious these complications are. There is also this example of a Florida woman who was left looking disfigured after botched dermal fillers in her forehead.

Lip filler complication
Lower lip ischemia following injection of lip fillers. (1)

Perhaps the most dangerous risk is blindness. When injecting filler near the eye (including for deep frown lines or forehead lines), if any filler makes its way to the ophthalmic artery, you risk getting blind (2).

Hyaluronidase can be used to dissolve filler if it is suspected that it has gotten into your blood vessel. However, if left too late, it will lead to permanent, irreversible damage.

In summary, with Botox, the complications are generally mild and temporary, resolving in 3 months or so. With fillers, the complications range from mild to severe and can even lead to blindness. Has your injector made you aware of all the possible risks? Are you confident in their skills and training? Have you checked their qualifications on AHPRA? Do they know which blood vessels to avoid getting filler into?

1. DeLorenzi C. Complications of injectable fillers, part I. Aesthetic Surg J. 2013;33(4):561-575.
2. Tangsirichaipong A. Blindness after facial contour augmentation with injectable silicone. J Med Assoc Thailand. 2009;92(suppl 3):S85-S87.

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