Fillers are a popular cosmetic treatment but as Dr Sasha Bolin reports, things can go wrong – so what do you need to know before you start?

It seems like everyone is having botox or fillers – or both. And all the hype could make you think there’s no risk. But the internet is awash with pictures of fillers gone wrong and doctors and aesthetic nurses say they are regularly fixing up other people’s botched work – usually done by untrained operators who’ve lured people in with cheap deals. Despite that, fillers are one of the most popular cosmetic treatments, and while generally safe in the right hands sometimes things can go wrong, so it’s important to know the risks and benefits before deciding if this is the right option for you.

What are dermal fillers?

Dermal fillers are different injectable materials which ‘fill’ in and soften skin lines, wrinkles or creases in the skin.  They also can be used to boost volume in lips and cheeks.

Are fillers temporary or permanent?

It depends on which filler material is used.  Most fillers are temporary, lasting from a few months to a few years.  Only a few fillers available are permanent.  Depending on your product, various ingredients include bovine collagen (lasting approximately 3-4 months), non-animal based hyaluronic acid (4-6 months), calcium hydroxylapatite (18 months), poly-L-lactic acid (PLLA – effects over several months can last up to 2 years), and polymethylmethacrylate microspheres (PMMA – permanent).  In general, the permanent options have more risks associated with them.

What can I expect from my treatment?

Each person has an expectation as to how they will look after a procedure.  The best preparation is for you to research products available, risks, benefits, and also have a realistic idea of what can be achieved.  Your skin, genetics, and facial structure will contribute to the end result.  Make sure to thoroughly discuss with the practitioner what you hope they can achieve and listen carefully to what they suggest they can offer.

Will fillers prevent my skin from ageing and getting wrinkles?

To a degree. Your skin will still age but in the areas injected the filler could help prevent expression lines from developing into wrinkles or help stop existing wrinkles from becoming deeper. Remember, however,  that wherever your fillers are injected, other areas may change and form new lines.

Different types of filler may be used for different areas of the face to achieve the best effect.  They will not stop the aging process but they can give you a temporary ‘more youthful’ look by smoothing wrinkles and subtly redefining the face to lift saggy jawlines or other areas of concern.

Many products are injected into other body areas which are not recommended or patented for the face.

Always check to make sure your practitioner is accredited or licensed (depending on where you are) and that they have completed appropriate training. It’s also a good idea to ask about where they get their products from to ensure they are using are medical grade fillers that come from a legitimate supplier.

Red flags:  

• Buying online but not from the manufacturer or reputable source.
• Cheap offers.  If it sounds too good to be true – it probably is, and you may be being injected with something totally unsuitable, and perhaps even dangerous.

How do I choose a practitioner?

It is important to find a practitioner who has a good reputation, experience and does procedures in a clean, professional setting.  If you have any questions regarding your treatment or any concerns, you should feel comfortable coming back to the person who did the procedure and addressing this. If you are in the UK you can check with Consulting Room, Save Face or pick any of the doctors who perform fillers from Harley Street Emporium. Looking up patient reviews may also be helpful although there is no guarantee that they are real and haven’t been written by the injector themselves.

What happens during the procedure?

Sometimes a topical numbing or anaesthetic gel/creme is used before the injections. A small sterile needle tip will be inserted for multiple injections and the area may be slightly massaged.

What can I expect after the treatment?

After treatment, the region may be a bit red, sensitive, and swollen for the following 24-48 hours.

Sometime you may experience these:

• Rash
• bruises
• Itch
• Swelling
• Scar formation
• Infection (may need some antibiotics)

Can anything go seriously wrong?

As with any procedure there is always a risk- especially if you go to an inexperienced or unqualified person. The internet is full of pictures of people who’ve had bad filler jobs done that have left them with infections or unsightly lumps and bumps. Fortunately, depending on which filler was used, they can often be reversed – but this procedure has it’s own risks – so always ask your doctor about what can be done if things go wrong after the treatment and it needs to be reversed.

There are however some more serious – but rare – other complications that could happen.  As you can imagine, injecting a material inadvertently into a blood vessel will allow it to travel wherever that blood is headed.  If a blood vessel ends up being blocked by the filler, blood and oxygen cannot be distributed to the tissues.

Hence, some further serious – but rare- complications include:

• Tissue necrosis or death (due to blood vessel occlusion)
• Blindness: central retinal artery occlusion (retina is denied oxygen)
• Filler can move to a different location or become lumpy (may need surgical removal)
• Pulmonary embolism
• Stroke (if any blood vessel in the brain is blocked by some of the filler).

What I should avoid anything after having a filler?

Avoid coffee, alcohol, the sunbeds, saunas and exercise.  These can increase blood flow to the face and increase inflammation.

When should I NOT have fillers?

You should NOT have fillers if you are:

• Pregnant
• Breastfeeding
• Under age 18
• Skin tends to scar (hypertrophic or keloid)
• Have infected skin
• Have a clotting disorder or are on blood thinners
• Have had previous allergic/anaphylactic reaction (animal products, bacteria, eggs).

What do I do if I have a problem after the procedure?

It is always better to immediately seek medical attention.  Contact the person who did your procedure.  If this is not possible, contact your GP or go to the nearest A&E for an assessment.  Do not ever ignore any symptoms such as visual changes, whitening of the skin (pallor due to lack of blood supply), confusion, dizziness, shortness of breath, difficulty speaking.

How do I report concerns about product or procedural complications?

If you are concerned and would like to report any product or procedural complications, you can through the Yellow Card Scheme .  This scheme collects information for the MHRA (Medicines & Healthcare products Regulatory Agency) to monitor the safety of all healthcare products in the UK.

See Dr Rupert Critchley perform a lip enhancement with fillers while he explains how the process is done in this video: