As the popularity of wrinkle fillers soars, a flurry of scientific papers are warning of serious complications that can occur from “overcorrections” — when too much product is injected into the midface — to infections, abscesses, necrosis of tissue, blindness and even stroke.

Reporting in the most recent issue of Facial Plastic Surgery, American and Canadian dermatologists are cautioning “injectors” to keep EpiPen on hand, in the event of a rare anaphylactic reaction, as well as an emergency reversing agent for mistakes.

“All injectors need to be aware of complications, and should be able to recognise them when they occur and know how to manage them properly,” said the researchers.

According to the American Society of Plastic
Surgeons (which includes Canadian doctors), 2.4 million soft-tissue filler procedures were performed in 2015, up six percent from 2014, and a staggering 274 percent since 2000.

Technical errors can lead to serious “suboptimal outcomes”, the report found. The authors describe cases involving deep bruising, swelling or bluish-tinged skin, mistakes in volume (too much or too little) and depth (too superficial or too deep).

Too much product in the body or border of the lip can also result “in an unnatural look many patients fear,” they warn, while “lumps and bumps” have been seen weeks, months or years after treatment. In one case, too much filler disfigured a woman’s face by “altering the natural topography” and narrowing her eyes by pushing her lower lids up and out.

The most serious complications occur when fillers are inadvertently injected into blood vessels, blocking the vessels and cutting off blood supply to tissues. The product can migrate or move to other parts of the body, causing in rare cases blindness, stroke and death of the skin or underlying facial structures. One woman required six weeks of daily hyperbaric oxygen therapy to heal a skin necrosis that developed after she was injected with a calcium hydroxylapatite filler in her nasolabial folds. A man was left with facial paralysis lasting six weeks after he was injected in the cheeks.

Blindness is the most feared complication. A total of 98 cases have been documented worldwide. Most were reported in the past five years, and most out of Asia, “where volumisation of the diamond-shaped central portion of the face has become culturally popular,” the researchers report.

“What we’re trying to do with this paper is provide our colleagues with awareness about complications and the toolbox to deal with them, should they be confronted with them,” said co-author of the report Dr Vince Bertucci, past-president of the Canadian Dermatology Association. “We know there is very high patient satisfaction with these treatments.”

Since January 2000, Health Canada has received 132 reports related to facial fillers, 51 of which were serious. “None of these reports had fatal outcomes,” the agency said in an email.

Source: National Post

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