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Avoiding Complications with Fillers

Fillers are among the most popular cosmetic treatments in the world today, perhaps just trailing Botox and other neuromodulators in popularity.  Fillers are an attractive option because they can be done in the office (often at the same initial consultation), are minimally uncomfortable, have a quick recovery, achieve almost instantaneous results, and are fairly safe.  Unlike Botox—which carries no risk of permanent damage– fillers have some risk of complications that are not inconsequential.  Besides the risks of bleeding, infection, and pain that all treatments using needles carry, fillers can result in lumps and bumps and may even create unnatural appearances.  However, the most serious complications that can occur are related to vascular occlusion.  If this occurs, you can develop tissue necrosis or death, or even worse—blindness!  These are very scary complications but you have to be aware that they can occur.  Fillers and Botox are done so ubiquitously—in wide ranging locations from doctor offices to spas to even personal homes—that some may think these treatments carry no risk.  It’s just like getting one’s nails done or getting a hair cut.  Though fillers are very safe if performed by experienced licensed professionals, they can be dangerous if done in wrong hands.

There are many types of fillers on the market today.  By far, the most popular are hyaluronic acid (HA) fillers like Juvederm Voluma, Vollure, etc and Restylane Lift, Define, etc.  The reason for their popularity is the ability to dissolve these products if unfavorable results are seen.  Also, if a major complication such as tissue necrosis develops, the ability to dissolve the fillers is key to the successful treatment of this disastrous complication.   Radiesse is a calcium hydroxyapatite filler that can last longer than HA fillers, but is also temporary.  Unlike the myriad of HA formulations, there is only one Radiesse I’m aware of ; so it’s applications are more limited in the face.  Radiesse cannot be dissolved.  Sculptra is filler made up of poly-L-lactic acid- the same material in dissolvable sutures.  Sculptra has been marketed to be a “permanent” filler, but that is based on if you adhere to the series of injections spaced months apart to achieve your goals.  I’ve heard some doctors pitch Sculptra with achieving your goals gradually and subtly.  However, most patients want instantaneous results.  Bellafil is a newer filler based on old filler called Artecol.  It is a product consisting of polymethymethacrylate (PMMA). Unlike the other fillers mentioned, Bellafil is permanent.  This is the only “advantage” over the other fillers.  In my opinion, this relative advantage is not worth the risk of permanent deformity if you don’t get a good result.  If you get a bad result or if you’re unhappy with the look, you can’t dissolve it and you can’t just wait months or years hoping it will go away.  Occasionally, these complications can be treated with steroid or 5 – FU injections.  Surgically removing these are fraught with challenges and always the last resort.

As I mentioned, fillers are very safe treatments, but only if performed by experienced licensed professionals.  To be performed safely, as well as achieving your desired goals, the injector must be very knowledgeable about your facial anatomy, injection techniques, correct facial planes to inject, as well as possess good artistic judgement.  Finally, it’s crucial the injector knows how to intervene in case of complications.  So the very first step to avoiding bad complications from fillers is to choose someone who is experienced and qualified.  I can appreciate the attraction of getting a good deal on fillers, but I feel strongly this is one treatment you don’t want to skimp on price.  You want to make sure you’re in safe hands.  I would argue certain high risk areas (like the tear troughs and nose) need to be treated only by a doctor who has a lot of experience doing injections.  An experienced physician extender injector (ie Physician assistant or Nurse Practitioner), can also inject but have to be under oversight of a physician in the same office.  I definitely don’t recommend getting these done by just an aesthetician.  I will even argue that lips should be done by someone experienced.  Vascular occlusion and lip necrosis is a rare but real possibility if the injector is not careful.

Since all fillers are injected with needles or cannulas, a certain amount of bleeding is unavoidable.  You can minimize your chance of getting bad bruises by avoiding medications that prolong bleeding before treatment.  The longer the better.  Some common drugs that can make you bleed more include aspirin, ibuprofen, Advil, Motrin, Naprosyn.  Don’t forget some supplements can make you bleed more. Common examples include fish oil and vitamin E.  Drinking alcohol can also increase risk of bruising.

To minimize risk of infection after injectable filler treatment, make sure you don’t have any active acne flareup, skin infection, or dermatitis flareup in the target areas.

Bottom line, facial fillers are very safe if performed by an experienced licensed professional.  Even if you don’t like your Botox results, rest assured everything will wear off in 3-6 months and there is no risk of any permanent damage.  Fillers, however, can result in disastrous complications like blindness and tissue death.  For this reason, it’s absolutely crucial you see reputable qualified practice.

For more information about San Antonio injectable fillers, please visit our interactive website at Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (210) 876-6868 or