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Filler – when well-intentioned aesthetic treatments backfire

A few fewer wrinkles here, lips a little fuller there and the pronounced frown line is also significantly reduced. Dermal fillers are injected quickly, and what about the antidote in an emergency?

Avoid doing procedures that have the potential to produce side effects that you cannot treat, advises Dr. Laurence Imhoff from the dermatological clinic at the University Hospital Zurich. This also applies to something as simple as filler injections .

In the MAUDE database of the US Food and Drug Administration (FDA), around 3800 complications related to dermal fillers were registered by August 2014. 1 This is the most extensive database of side effects and complications caused by medical devices that currently exists, emphasized the speaker. Unfortunately, exact figures are not available.

44% of the entries are related to hyaluronic acid preparations, 40% to poly-L-lactic acid fillers and 15% to calcium hydroxylapatite fillers. Less than 1% concerned therapy with polymethyl methacrylate fillers. Lumps, infections, allergic reactions, ischemia and swellings were common, but autoimmune reactions, changes in vision and strokes were also rare. Complications with temporary side effects are comparatively minor, because they usually go away over time. With permanent side effects, the risk of liability is greater.

Pain, purpura, necrosis, blindness

Possibly more often than previously thought fillers cause vascular occlusion , explained Dr. Imhoff. Immediately after the treatment, depending on the type of vessel, the region becomes pale or retiform purpura occurs, and pain is also typical. If countermeasures are not taken early, for example with large amounts of hyaluronidase, necrosis and permanent damage follow.

In a survey of 52 internationally renowned doctors, according to Dr. Imhoff almost two thirds said they had experienced something like this once or several times. The often combined injection of filler and local anesthetic is problematic in this context , because the analgesic can, among other things, mask the pain.

It is even worse if patients go blind as a result of the filler treatment. One review found blindness , pain, ophthalmoplegia, and ptosis top the list of documented ocular filler complications. 2 Most of those affected were treated with the nasal region (56%), glabella (27%) or forehead (19%), more rarely the nasolabial fold (15%). In isolated cases, blindness even occurred after injections of the lips or the chin. Hyaluronic acid fillers seem to be the most common cause with a share of 81.3%.

Loss of vision and pain occur quickly after the injection; some patients (44% in the study) also show skin changes. Only in every fifth case did the symptoms regress completely, in another 16% at least partially. Often there is no improvement at all, warned the speaker.

Pathogenetically, a vascular complication from the derma fillers is suspected behind the blindness . Either with intravascular injection or compression by injection near the vessel. Other frequent vascular complications are erythema, pus vesicles and (incipient) skin necrosis. It is important not to confuse these symptoms with a bacterial or viral infection, as this can result in skin and tissue damage with scarring or granuloma formation.

Have hyaluronidase to hand just in case

According to Dr. Imhoff, every dermatologist who offers filler treatment should be prepared for such emergencies with hyaluronidase and, ideally, nitro paste . If the result of a treatment is bad or if there are side effects, the patient should not be left in the lurch, she emphasized. If in doubt, it helps to consult with a more experienced colleague.

Risk of encapsulation and migration of the implants

Even if lip augmentation with implants is the only one that promises a lasting result, it still carries some risks. These are particularly high when synthetic implants are used. The implants can migrate, i.e. change their position within the lip. This change in position is often the result of a rejection reaction of the body and of course strongly falsifies the visual and aesthetic result of lip augmentation. In addition, as a result of a rejection reaction, the implant can encapsulate itself and cause ugly bumps.

In both cases it is not always easy to remove the displaced or encapsulated implants. The attending physician must be careful not to make large incisions, especially on the lips, in order to avoid scarring on the lips.

There is less risk of such complications with soft silicone implants. With implants made from the body’s own materials, the risk of a rejection reaction is virtually eliminated.

For this reason, patients who want permanent lip augmentation and therefore opt for implants are always well advised to opt for implants made from their own material. To do this, the doctor removes a strip of dermis from the groin or buttocks, which is then inserted into the lip.

First injection, then implants

Patients who are thinking of enlarging their lips can use the non-permanent effect of lip enlargement by injecting filling materials to their advantage. Such a treatment is a good way to test whether the result achieved really corresponds to the desired result. If the patient is not satisfied with the fuller lips after the treatment, the volume of the lips will decrease by itself after a few months. If, on the other hand, the treatment by injecting autologous fat or hyaluronic acid brings the desired effect and the patient is satisfied with the result, they can still opt for lip augmentation with implants after a few months.


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