It is generally well-tolerated; however, severe adverse effects, such as swelling, lumps, abscesses, facial disfigurement, gel dislocation, and respiratory distress, have been known to occur.
Persistent Puffiness
Several signs point to a facial filler injection gone wrong, but the main one is puffiness that doesn't go away after the first injection. Typically, you will experience some swelling and puffiness on the treated area, but this goes down after 24 hours.
Signs to look for include pain at the injection site and discolouration of skin (pale or deep red) for up to a few hours after filler injection.
Hyaluronidase. If something goes wrong with HA fillers, hyaluronidase can be a lifesaver. This enzyme can dissolve HA fillers, making it possible to correct issues like overfilling or misplaced filler.
People unsatisfied or even embarrassed by their dermal filler results don't want to wait for the gel to break down on its own, which could take six months to a year or longer depending on the treated area and type of dermal filler. Dermal filler revision is an option in these circumstances.
After your first dermal filler appointment, you want to avoid any hot and humid place. For example, don't rush to the sauna or a hot tub right after your treatment. The high heat makes swelling in your face a lot worse.
Vascular occlusion warning signs (2): pallor
After the initial injection, the next sign of a problem with a VO is usually pallor. In the case of a true, complete vascular occlusion, pallor is very stark, particularly in lips. There will be a grey patch on the lip that sometimes has zero capillary refill.
“Pillow face” occurs when too much filler is injected into areas like the cheeks, nasolabial folds (the lines from your nose to the corners of your mouth), lips, and under-eye area. This repeated overfilling can result in a bloated, round appearance that looks far from natural.
Late complications are defined as those appearing after about 2-6 weeks. They comprise late allergic reactions, chronic inflammation and infection, granulomas, filler migration, loss of function, telangiectasia, and hypertrophic scars. A detailed history may disclose a potential allergy.
While most patients are satisfied with the results of dermal fillers, some find the change too drastic or have other reasons and would want to undo it. Using injectables like dermal filler is not a perfect science, and some patients react differently to the treatment, which is why dissolvers exist.
To reduce marionette lines without fillers, focus on non-invasive treatments like retinoid-based skincare products, which boost collagen production and improve skin elasticity. Regular facial exercises targeting the muscles around the mouth and chin can also help tone the area and minimize sagging.
The best results of dermal fillers are seen typically 1 to 2 weeks post treatment with some of the swelling and bruising dissipating by then. It could take up to 4 weeks for everything to completely settle down, at which point you will notice the results you're expecting.
The symptoms of ischemia can occur immediately after the injection or several hours after the procedure. Here, the authors report three cases of necrosis after hyaluronic acid injection with the first symptoms presenting only several hours after the procedure.
The most important sign of occlusion is poor capillary return on the affected area. In comparison, a bruise will have quick capillary return. The bruising is contained in a certain location and takes on a relatively defined shape, as opposed to discoloration, spreading and a mottled appearance.
How do you identify blanching following toxin injections? The skin around the injection site(s) will generally turn much paler than your patient's normal skin tone. Often the skin turns completely white, especially in Caucasian patients.
Stay away from unnecessary blood thinners. Several medications reduce the likelihood of blood clots. Aspirin, Advil (ibuprofen), and Aleve are some of widely used blood thinners among patients. It's recommended to stop taking blood thinners 7 days before and a day after your dermal filler session.
If you're less than thrilled with your filler results—at any time, for whatever reason—talk with your injector. They should be “guiding you through the injectables process, not only during the procedure but afterward too,” says London-based plastic and reconstructive surgeon Dr. Ashwin Soni.
Avoiding Physical Disturbance to Facial Fillers
Resist the urge to touch, poke, or massage the treated area after your nose filler treatment or any other type of filler. Applying pressure or disturbing the treated area can potentially displace the filler, leading to suboptimal results.
The onset of symptoms of vascular occlusion from dermal filler treatment can vary depending on the case, but it can show up immediately after receiving the facial filler injection or as late as 24 hours.
The skin might become splotchy, or might become pale, numb or “tingly”. In these instance tell your injector immediately. It can happen several hours after the injection, when the vessel finally becomes occluded, but that is rare.