Facial injections can come with complications. Here’s what you need to know.
Most people are familiar with Botox, but fewer people know about soft tissue or dermal fillers.
Beyond wrinkles, the loss of tissue and fat under the skin makes the face look older and more gaunt with the passage of time. Fillers replace this tissue loss and give the face a rounder and, theoretically, more youthful appearance.
The problem with temporary fillers, much like with Botox, is that repeat treatments are necessary. Hyaluronic acid, which has largely replaced collagen as a filler, typically lasts between six and 12 months.
That said, there are many types of fillers on the market. Some are better for lip augmentation, while some are better for wrinkles or minimizing the appearance of acne scars. Some last for months, others for years. But temporary fillers like calcium hydroxylapatite microspheres, poly-L-lactic acid, and platelet-rich fibrin matrices all share one common feature: They all eventually get broken down by the body.
Which is why people invented permanent fillers. Polymethylmethacrylate microspheres, hydrogel polymers, liquid injectable silicone, and autologous fat injections remain in the body indefinitely and would in theory require a single treatment, which would result in significant cost savings. But they have become less popular over time for a number of reasons, not the least of which is concerns over short- and long-term safety.
Side-effects of fillers can be divided into early complications that happen within the first two weeks of treatment and late complications that can appear up to a year later. Most people, regardless of which type of filler they choose, will have common early side-effects like bruising, swelling and redness around the injection site, which can be mitigated somewhat by ice and will disappear with time.
Late complications include the formation of nodules and granulomas under the skin, which create an aesthetically unpleasant appearance. Fillers can also migrate with time, which impacts the desired result. If too much filler is injected during the treatment, you can over-correct the esthetic defect you were trying to fix and end up with a result that is equally undesirable.
Deeper injections near arteries in the face pose the greatest risk, as does an increased volume of filler being injected. Judicious care and a good knowledge of arterial anatomy on the part of the medical operator probably make the biggest difference, but there has been some concern that permanent fillers increase the risk to some degree. Most cases have been associated with the permanent autologous fat type of filler, though they have occurred with temporary fillers too.
Whether permanent fillers are more dangerous than temporary fillers in the hands of skilled operators is unclear. The largest disadvantage of permanent fillers is that they are not reversible. If one uses hyaluronic acid, probably the most common temporary filler in use, a complication like a misplaced or excessive injection can be reversed with an enzyme that breaks down the filler. Permanent fillers have no such option. They may require surgery to remove or be impossible to correct.
Also, temporary fillers give patients and physicians the flexibility to reassess, correct and shift treatment plans over time as the shape of the face and patient expectations change with age.
The risk of complications, regardless which filler type is used, is greatly reduced in the hands of skilled medical professionals. Recent years have seen a crackdown on the industry because cases of botched cosmetic procedures by untrained and unlicensed individuals are sadly not uncommon. Permanent fillers can be used provided patients understand the drawbacks. The main one being that permanent fillers are very permanent.