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Side Effects of Dermal Fillers: What You Need to Know

by Joel B. Herron, MD

The use of injectable dermal fillers for facial rejuvenation and reduction of lines and wrinkles is increasingly popular. As a result, more physicians and offices are offering these services, but it’s important to know that not all providers are prepared to handle potential side effects of dermal fillers.

What are the side effects of dermal fillers?

Fortunately, the risk of filler injection side effects remains low and most complications are minor and transient. These often include:

  1. Bruising

  2. Swelling

  3. Unevenness

These are things that will improve within a short period of time or with minimal intervention. However, although very rare, more serious side effects are possible.

What are serious side effects of dermal fillers?

Some of the most concerning side effects of dermal fillers include arterial occlusion, particularly central retinal artery occlusion. If filler is inadvertently injected into an artery, the viscous nature of the filler can result in blockage of that artery, which can lead to necrosis or ulceration of the skin. When the filler goes into the artery supplying the retina, the result can be permanent blindness.

Anyone performing filler injection should be well-versed in the rare but potential complications and be prepared to handle them immediately. In the unfortunate cases of blindness, there may be less than 15 minutes of time in which to attempt to reverse the complication.

Not All Providers Can Handle Serious Side Effects of Dermal Fillers

I recently had a conversation with a “master injector” from a local med spa, which operates with little medical supervision. I asked this nurse what qualified her as a “master injector,” and she told me that she’d had several hours of very intense training in injection techniques. When I asked about her emergency protocols for central retinal artery occlusion, she looked confused and told me she didn’t know what I was talking about. Any patient suffering this side effect in her care would likely end up with permanent blindness, unfortunately.

Dermal Fillers Should be Injected by Physicians Trained to Handle Acute Side Effects

In our office, we have a readily available emergency eye kit intended for use in the rare case of a central retinal arterial occlusion. Our hope is that this kit continues to remain unused, but all of our providers are prepared and trained on its use. The kit contains:

  1. Contact information for an emergency retinal specialist with whom we have made prior arrangements for transfer of care

  2. Chewable aspirin to act as an antiplatelet agent

  3. Oral acetazolamide

  4. Timolol, apraclonidine, and bimatoprost eyedrops to reduce intraocular pressure to help dislodge the filler

  5. Oral sildenafil and topical nitroglycerin, agents used to dilate blood vessels to help dislodge the embolus occluding the vessel

  6. Hyaluronidase to inject into the area or even behind the globe of the eye in an attempt to help dissolve the filler

If needed, we are also prepared to perform an emergent cantholysis/canthotomy to open up the corner of the eyelid and release the tendons to reduce pressure on the optic nerve and allow easier access for injecting hyaluronidase behind the globe of the eye. Other interventions that may save a patient’s vision include heating of the area, massage of the area, re-breathing into a paper bag to increase the concentration of inhaled carbon dioxide, and applying intermittent ocular pressure.

These types of interventions are unlikely to be available at a typical medspa, which is why we strongly recommend visiting a board-certified physician for any type of dermal filler injection.

Dermal Filler Side Effect Risk is Low Overall

Fortunately, the risk of serious complications from fillers remains low, but I can’t emphasize enough that these risks are even lower in the hands of experienced and trained providers.

We want your cosmetic procedures to be pleasant, pain-free, and fear-free, and in our offices, we focus on education and training to ensure they are. Call us today to learn more about