Hyper-inflated faces. Blowfish lips. Forehead nodules.
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 (death) of tissue, blindness and stroke.
Sun MediaIn the early days, doctors targeted a line or two. Now, the goal is to plump an entire face.
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, should be able to recognize them when they occur and know how to manage them properly,” they write.
Popular among the Hollywood set — the Internet was atwitter over Tom Cruise’s “pillow face” at this year’s British Academy of Film and Television Arts awards, while reality star Khloé Kardashian confessed in March that fillers “f**ked” up her face, and she had to “go and get this whole thing, like, dissolved” — dermal fillers have become so commonplace, Toronto cosmetic dermatologist Nowell Solish recently saw a woman who had fillers injected into her face by a nurse at a hair salon. Others are using Groupon discounts.
In the early days of fillers, doctors were “line chasers,” Solish said. They targeted an isolated wrinkle or fold.
Today, the focus is on padding and plumping up the entire aging face, meaning greater quantities are being injected.
The dominant fillers on the market contain synthetic forms of hyaluronic acid (HA), a substance produced naturally by the body that binds with water to plump up sunken, aging skin. (Botox works another way, by causing facial muscles to relax, smoothing out wrinkles).
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 per cent from 2014, and a staggering 274 per cent since 2000.
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 per cent from 2014, and a staggering 274 per cent since 2000.
Dermatologists say fillers offer minimal downtime and risk, serious complications are rare, and mistakes can be fixed with an injection of hyaluronidase — an enzyme that works like an opioid-overdose antidote, rapidly breaking down excess or unwanted filler.
However, technical errors can lead to serious “suboptimal outcomes,” the researchers report in Facial Plastic Surgery.
The authors describe cases involving deep bruising, swelling or bluish-tinged skin, mistakes in volume (too much, 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 deep ulcer that developed after she was injected with a calcium hydroxylapatite filler in her nasolabial folds, the lines that run from the sides of the nose to the corners of the mouth. A man was left with facial paralysis lasting six weeks after he was injected in the cheeks.
HandoutA patient about to get an injection of Botox in Toronto.
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 volumization of the diamond-shaped central portion of the face has become culturally popular,” the researchers report in Facial Plastic Surgery.
“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 Dr. Vince Bertucci, past-president of the Canadian Dermatology Association. “We know there is very high patient satisfaction with these treatments.”
However, Halifax researchers who interviewed women who had less-than-positive experiences with Botox and/or facial fillers described side effects from unwanted skin changes to panic, anxiety, hypersensitivity to light and depression.
The study involved only seven women (four of them Canadian) and the researchers deliberately sought out women who had negative or mixed experiences, “because their voices have seldom been heard,” they write in the Journal of Women & Aging.
The women had no proof their symptoms were caused by the injections, but “they felt abandoned by the medical industrial complex when they turned to it for help,” the authors report. Doctors said their problems were probably due to hormones.
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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.
In Canada, a doctor or nurse under the direction of a physician should inject fillers, which cost about $600 to $700 per syringe.
However, Solish is aware of clinics where nurses are injecting with no supervision, or the doctor is Skyped in. “So they hold their phone, they do a FaceTime, the doctor looks and says, ‘OK, do this, that and the other.’
“Those are on the edge of what may be acceptable, or not acceptable by law,” said Solish, an assistant professor of dermatology at the University of Toronto.
“It’s not the safest, and it’s not something I would endorse.”
• Email: skirkey@postmedia.com | Twitter: sharon_kirkey