Are Fillers Life-Threatening? A Comprehensive Guide

In general, dermal fillers are safe, according to Dr. Paskhover. However, there can be complications when they are used, especially if someone is not trained for it. Most problems are not life-threatening, but in some cases, fillers have been linked to strokes and blindness.

One risk is that fillers purchased online may contain a variety of non-sterile substances, such as hair gel. When injected, these substances can cause allergic reactions, infections and death of skin cells. Another risk is that an improper injection technique can lead not only to swelling and lumping, but also to more serious side effects, such as death of skin cells and embolism leading to blindness. The FDA has issued an official warning urging consumers never to buy dermal fillers on the Internet as they may be false, contaminated or harmful.

The most serious risk associated with dermal fillers is accidental injection into a blood vessel. Filling that enters a blood vessel can cause skin necrosis (tissue death), stroke, or blindness. Although the chances of this happening are low, if it does occur, the resulting complications can be serious and permanent. Fillers are generally safe and the results are good when done by an experienced professional. However, there are some important risks you should be aware of.

The most serious is embolism or vascular occlusion caused by a filling that can cause tissue necrosis or death. Embolism is caused by injecting a foreign substance, such as a filler, into a blood vessel, causing a clot to form that can break off and then travel through the bloodstream and cause damage. Since it affects the skin (and not an embolism of the lungs or heart), it is unlikely to cause death, but it is more likely to cause necrosis (due to lack of oxygen in the skin, which can lead to tissue death) and consequent scarring and nerve damage. This is a particularly high risk around the eye area because an embolism could cause blindness. This is why non-doctors and non-specialist specialists are advised to refrain from injecting into these higher-risk regions.

There are especially rich arches of blood vessels in the infraorbital region and the forehead, glabella and nasal region that have an increased risk of embolism. This is something that is discussed among doctors at conferences and is a well-known complication. Although it is unlikely to occur in experienced hands, it is a risk that must be revealed and considered. I have done thousands of injections in more than 15 years of practice and this has never happened to me in a patient, but I know of numerous cases reported. There are many more cases of this than with inexperienced injectors that are not doctors or nurses.

There is less risk when injected superficially, but greater risk when injected deep. One of the techniques I use to try to reduce the risk of embolism is to inject lidocaine with epinephrine before injecting the filler. Epinephrine causes vasoconstriction, so the blood vessels are less open, making it more difficult to inject it directly into the vessel accidentally. Fillers such as Juvederm and Restylane now contain lidocaine, so many doctors no longer inject local anesthesia before filling. Doing lidocaine with epinephrine before filling has the disadvantage of causing more bruising and swelling and also less precision with correction, but offers the safety advantage of constricting blood vessels, so it decreases the risk of injecting filler into the blood vessel and causing an embolism. If a vascular occlusion of an artery occurs with the filler injection, it would be essential that the doctor be able to recognize the signs and know how to treat it properly. There are definitive steps that need to be taken immediately to address what could minimize and prevent any further harm.

An experienced professional would know how to address these possible complications. Because complications can occur with these seemingly simple procedures, it is important to be under the care of a board-certified dermatologist or experienced plastic surgeon who knows how to treat these complications if they occur. The last person you want to get the shot is someone who says they wouldn't know what to do if a vascular event occurred. Don't let someone discourage you by telling them that this is never going to happen; make sure the doctor you're seeing tells you they'll know exactly what to do if this happens. Botox is a purified form of botulinum toxin that is obtained from bacteria. Although it is deadly in larger quantities, the small regulated amount of Botox given to correct wrinkles has been used safely for decades.

The researchers also analyzed data from the American Society of Plastic Surgeons on the total projected number of filler injections performed during that time, and analyzed court and litigation records related to fillers in the Westlaw Next database. Injectable dermal fillers can fill thin lips, improve superficial contours, smooth facial folds, remove wrinkles, and improve the appearance of scars. The cost of dermal filler treatments varies and depends on the provider performing them, the area being treated, and the type of filler selected. Injecting dermal fillers into the face and hands can improve the appearance of facial lines and volume loss caused by age or certain medical conditions.

See FDA's Tips for Using Dermal Fillers Safely and Learn the Difference Between Dermal Fillers and Botulinum Toxin Injectable Products. Due to the low maintenance factor of most fillers on the market, some of the worst fears people have about long-term use of the filler are unfounded. There is a misconception that temporary fillers rarely cause side effects; however, their frequency is comparable to that induced by permanent and long-lasting fillers but their duration is shorter and therefore less severe. This filler is different from other fillers because its results are gradual; volumizing occurs over several months as it stimulates the body to produce collagen.

A licensed healthcare professional must perform all dermal filler procedures using only FDA-approved fillers injected with a syringe.

Shelly Hongach
Shelly Hongach

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