Possible Risks, Complications & Side Effects to Dermal Fillers

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Some Common injection-related reactions might occur. These reactions include redness, swelling, pain, erythema itching, bruising, asymmetry, migraine and tenderness at the treatment site. These reactions are generally described as mild to moderate and typically resolve spontaneously a few days after treatment. These reactions are normal and are to be expected.

Other types of reaction are rare, but approximately one in every 10,000 patients treated with a dermal filler has experienced localised allergic reactions after one or more injection treatments. These have usually consisted of swelling and firmness at the treatment site, sometimes affecting the surrounding tissues. Redness, tenderness and rarely acne-like formations have also been reported. These reactions have either started a few days after injection or after a delay of several weeks. They have been described as mild to moderate and self-limiting, with an average duration of two weeks. In rare instances, such reactions or lump formations like granulomas have persisted for a number of months.

On very rare occasions (less than one in 15,000) prolonged firmness, abscess formation or greyish discolouration at the treatment site has occurred. These reactions can develop weeks to months following the injections and may persist for several months but normally resolve with time. Even more rarely, the formation of a scab and sloughing (shedding) of tissue at the treatment site has been noted, which could result in a shallow scar.

Delayed potential complications

• Orange-brown staining- Injection of the tear trough or periorbital region with dermal filler may be associated with bruising and subsequent deposition of hemosiderin, giving an orange-brown or rusty, stained appearance to the skin that may take months to resolve on its own. Ice application pre-procedure, discontinuation of anticoagulants at least seven days before injection, and a smooth, gentle technique may help avoid this complication.

• Post-inflammatory hyperpigmentation- This is often seen in darker skin types due to bruising and hematoma. It can last for a long period and may be difficult to treat.

• Puffiness- Overcorrection with HA products in the periorbital area may also cause a puffy, oedematous appearance of the lower eyelids because of the hydrophilic nature of the filler. Oedema may seem to fluctuate in patients with allergic predispositions or in response to dietary intake of salt.

• Infection- Though extremely rare, they can present as single or multiple erythematous and fluctuant nodules that are best treated with antibiotics active against frequent skin bacteria including staphylococcus epidermidis or propionibacterium acnes. Filler injections should not be performed if there is an infection in adjacent sites.

• The Tyndall effect- HA when injected too superficially can cause a bluish discolouration under the skin, this discolouration is due to the Tyndall effect where the blue light spectrum is scattered by colloid particles more strongly.

• Nodules- These can occur with superficial; infections. These can be treated with local massage, aspiration or incision and drainage of the product. Hyaluronidase can be used to dissolve a nodule or a focus of overcorrection in the case of HA-based fillers. However, a preliminary skin test is necessary to rule out any allergies to hyaluronidase.

• Blindness- Although extremely rare, this may be an under-reported complication. According to researchers, blindness occurs due to migration of a filler embolus in a retrograde manner via an arteriole to an antegrade flow through the central retinal artery. This complication can be avoided by using blunt cannulas with minimal pressure and quantities of filler at a time.