Hello Internet! I'm going to talk to you today about a subject which somebody asked me to discuss on one of my earlier videos and it's something which I talk about literally every single day when I'm in the clinic because it's really super important that people know when they come into the clinic about the potential complications. And today I'm going to be talking just specifically about the complications which can occur with dermal filler. Now that actually
takes up most of my day and administering dermal filler so it's the one which for me anyway is the most relevant. So without further ado here I go.
The fact is guys, complications are a numbers game. If anybody says to you that they have had zero complications in their professional career they're either not telling you the whole truth or they're just not seeing enough patients.Because the fact is that things can and do happen even in the best hands and that's what I'm here to discuss with you today. You guys can manage the risk of anything happening by going to a safe competent practitioner who's able to mitigate these risks by knowing the anatomy by using a safe product and just
by using the loaf, that's their brain. That's what my dad used to call it, use your loaf.
So what are these complications that I'm talking about?
Well the first two are not really true complications because they're just things that can happen after you have a dermal filler treatment and number one is swelling.
So pretty much anybody whenever they have a filler injected inside the tissue you're going to get some swelling. It's the same if you go to the dentist and you have a dental procedure done or say you you bang your leg on the side of a chair there is going to be a degree of inflammatory response after that trauma and having a dermal filler is no more or less than doing a little bit of
trauma to the tissue. There are some areas where you're more likely to get the swelling occurring so for example in the lip area that is quite notorious. As soon as you wave a filler or even a needle without filler in it in the general vicinity of the lip, the lip will swell up it really doesn't like it and this is just one of those things that you just kind of have to go with it.
So if you're one of these people who is maybe a little bit more reactive. Sometimes there can be products which are either better or worse for you so if you have tried a number of different products and maybe just stick with one that you know and is not going to give you a problem. Doing things like using some ice after the procedure can definitely help you can also use some
bromelain which is a pineapple extract and there was a review study done and fairly recently looking at whether or not arnica or bromelain were more effective in reducing bruising and
swelling and it showed that bromelain had a little bit more evidence behind it so out of the two I generally prefer to give my patients bromelain.
The second complication is bruising and again that's something which it can just happen. As clinicians we know where the arteries and blood vessels are underneath the skin and you know the depth of that vessel you don't always know the exact pathway of that vessel and actually there are many different forms of anatomy. So for example on one person an artery may run in one particular direction on another it may go in a slightly different direction so you you can't really replicate this one person to the next when you're injecting. What we do is identify an area where your your likely to run into a problem you're less likely to run into bruising but there's nothing a hundred percent guaranteed and bruising is just one of those things it's normally not anything significant. We do have little tricks and tips that we use to try and make any bruising a little better. So for example putting some pressure on the area which has just been injected that could definitely help minimize the risk of bruising. Again taking the bromelain that definitely helps as well but sometimes unfortunately you do just kind of have to suck it up.
Now we're getting into the slightly more unusual complications
which happen much less frequently. So the third thing that I'm going to talk about
is infection we all get patients who come in and they're wearing like a foot
of makeup which has to be removed before they have their treatment. I try and ask
patients please if you can try not to wear any makeup at all when you're
coming in for your treatment because when we clean the skin perhaps we might
just miss a tiny little bit or when you're actually scrubbing the surface of the skin you are braiding it slightly. And if you have to take off you know some long wear lipstick and you're getting your lips done probably not the best idea. Thankfully even if you do get an infection this is something which can be managed and the way that we would do that is by first of all giving you some antibiotics and second of all removing the hyaluronic acid which is in there. If you've had a
product which is semi-permanent or permanent then things do get a little bit more tricky but in any case most patients have hyaluronic acid filler so it's really not that much of a concern.
The fourth thing that I'm going to talk about today is granuloma. Granuloma’s kind
of a funny medical term it refers to when your body walls off an area of infection and it looks clinically like kind of like a hard lump underneath the skin. This can be harder to treat but
again we treats it generally in a similar way to how we treat an infection. So we dissolve the filler sometimes we use a little bit of steroid there to try and modulate the immune response and
dampen it down slightly but every case is different. There is a theory that granuloma is a long-lasting infection so if you get a subclinical infection which doesn't make itself known for say
several weeks or months after the treatment has been done and it can manifest itself as sort of a hard palpable lump like a granuloma. Which is why it's really really super important
that when you have your treatment done it's done in a clean environment and your face is as clean as possible. Before you come into the clinic someone asked me on a previous youtube video whether or not somebody can have lumps and bumps after a filler has been done and just
because you have like a little lump or bump it doesn't mean that you have a granuloma. It's something which is very very very well demarcated it's not the same thing as when you just have a little bit of contour irregularity after having a dermal filler. That's more of a
perhaps a placement issue or product migration issue which we will come on to
So that would be the fifth thing which I'm going to discuss product placement and contour irregularities. The two halves of your face should be sisters and not twins. So they're not going to be completely symmetrical one side to the other whether that means that you have to add
a little bit more products in one side or the other over keep it the same it really depends on a whole host of other considerations such as how close you are to meeting your aesthetic goals. The closer you are the more likely it is that you may have more filler put on one side or the other
if you're quite far away from that actually I'll more often put the same on each side and that's because it's a it's a dilutions issue. So we're diluting the asymmetry which is present it's normal
for you to be able to feel a little bit of the products underneath the skin that normally disappears maybe a couple of weeks maybe a month or so after you've had the treatment done. After about a month or so generally you don't really feel it inside the skin because if you actually feel hyaluronic acid filler it just feels like a serum it's very liquid very watery so if you do get any lumps and bumps it's actually normally your body's reaction to that filler being in there. And I know that could be quite scary for some people because they think oh my god my lip is is really firm now it feels really really hard, it doesn't feel like it's part of me. Well don't worry because that goes. It goes in time, it just takes a little bit of time for your inflammatory response to just calm down and then you shouldn't be able to feel the products anymore.
I think we're up to number six sorry I'm not right about that but I think it's number six. Okay so the sixth thing that I'm going to talk about is hypersensitivity reaction this is really really unusual. What we know about hyaluronic acid is sometimes if you're unwell in another part of your body. So say you have a urinary tract infection or you get a chest infection or you get into gastroenteritis kind of primes your immune system because that's just the way the body works. And then your white blood cells kind of go looking for something which isn't quite right and sometimes it will identify that it's found some filler and it makes that our area that you've had filled and go a little bit firm a little bit stiff for the period of time when you're on well. The good news about this it generally just last for as long as you have the problem for. So like with myself I got gastro and psoriasis a few months ago and my lip swelled up where I'd had lip filler. My chin swelled up a little bit as well. A couple of days later I’ve absolutely right as rain back to normal. Like I mentioned to you before these things are really super manageable and often it's
just a question of letting your bod take its time to heal after you've had the procedure done. And that's one thing that we can't speed up is the rate at which it takes the inflammation to go down or the rate of healing. We just have to have a little bit of patience now.
Let's go on to the seventh thing and we are getting a little bit more serious now. So I'm going to talk about the thing you guys probably see them most often and the newspapers has been flagged up as a complication of having a dermal filler treatments. Talking about of course necrosis. So as I alluded to before under your skin you have various different arteries and veins and we have an idea of where the track of that particular vessel will be. And we pretty much know the depth at which that will be. We don't know the exact track that it takes. In some occasions you can have dermal filler inadvertently injected inside of an artery or it can compress that artery. Normally it's not that much of an issue. In fact I can bet it probably happens a lot more frequently than we actually realize. It's just that because your face has got so much different supply of blood from various different directions contralateral places it means that even if a vessel is slightly blocked temporarily it's really not a problem. In fact in facial surgery it's often common to remove even some of the largest blood vessels in the face if it has to be done say for example as part of an oncology operation. You know if someone has cancer and they're having a big resection it's quite common to take out huge chunks and the rest of the skin still survives nevertheless there are certain key areas which are more risk of getting necrosis. So for example in the nose the nose is one of the highest risk areas to have injected that and the forehead. And the reason for this is because in the nose you don't have this contralateral blood supply. You block a blood vessel down and that's it that. That bit of skin which is relying on that blood vessel it doesn't have anywhere else to take the oxygen to take the nutrients from. Thankfully even with necrosis it's actually normally not too much of an issue because what we do is you know nine times out of ten you'll see that a blood vessel has been blocked because the skin immediately goes a different colour. And then you just pop the enzyme which dissolves hyaluronic acid into that area, breaks down the filler and then the blood flow is restored. Where you really run into problems is either if you are using a filler which you cannot dissolve so that would be something like , Radiesse, Ellansé. Or if you're using fat or if you don't spot it until later. The body is a strange thing and nothing is ever a
hundred percent. That's why it's really important that you keep in close contact with your injector after you've had a procedure done. If you're worried about anything so I always encourage my
patients - look if you're concerned about something you take a picture you give us a call you, email it over and we'll talk you through it. Of course the very very vast majority of the time it's no
shoot at all. But for that, you know, one in a thousand to whom it would make a
difference if we knew about it. Of course it's really important that you let us know and tell us so even with a blood vessel blockage it's actually not the end of the world because you just dissolve the filler and then it restores the flow of blood there. If it's left too long and then the skin starts to break down then that's when you run into trouble. But actually the face is amazing. Even then I've had patients for whom I was a little bit concerned but actually they've always been completely fine in the end because the tissue heals in such a good way. And they do very well of course.
There are things that we could do to assist tissue healing as well which probably is a little bit too lengthy for this video but nevertheless even if you get that it's not the worst thing in the world.
No, the worst thing in the world is reserved for number eight. Eight, yes eight, whenever you have something particulate injected into the skin so I'm talking about hyaluronic acid, sometimes people injects silicone. They used to inject paraffin or wax into the skin. Yeah, that's right, fat as well you run the risk of blindness. Obviously this is a horrific and life-changing event to occur to those particular patients. And that's why it's really really important that when you are going to have a cosmetic procedure you make sure you pick someone who is appropriately qualified to do that procedure. They have to know the anatomy that they're injecting into. They have to
be able to deal with any complications which may occur. To put that into perspective for you guys - last year in the States alone there were about two million dermal filler injections. In
terms of the number of people who have become blinded as a results of these injections it's a handful. It's a handful - less than a couple of hundred.
If you're worried about this complication - and let's face it who wouldn't be - it's really worthwhile having this conversation with your injector to see how they try and mitigate the risk of this happening. And of course the risk is extremely extremely small but there are certain things that we do as injectors to train tip the scales even further in ours, in our patients direction. The two
most common areas for this complication to occur are the nose and the forehead. It has been documented to a curb when injecting anywhere on the face, but these are the two most frequent areas. And that's because of the anatomy in those areas. That's why it terrifies me when I see inappropriately qualified people. And performing these injections I just have my heart in my mouth.
Okay guys, so that's it for this week I hope that completely terrified you because if it didn't then
I didn't think that you would be a normal human. But try not to panic too much. I'm talking here about really really really really super super super unlikely things that just could potentially happen. So whilst it's important that you know the risks, they are risks that your injector should be able to competently manage. And there are many many people like myself who are
happy to take the risk of having a procedure done knowing that at least for me the benefits from it will outweigh the risks. I hope you guys can join me again next week where I'm discussing my
thoughts on a question that a lot of people ask me which is how do I go about choosing a cosmetic injector. In the meantime I hope you've enjoyed the video. If you did don't forget to smash that like button and subscribe to the channel.
I'll see you later
Check out the all of Dr Sarah Tonks's awesome videos here - https://www.youtube.com/channel/UCd-VkndyEgqx1_k-L2K5V6A