Fillers: Now the fine print

Once again, these are the risks and instructions I discuss with my patients. If you are not my patient, you should listen to what your doctor tells you. I know you get tired of hearing this, but my lawyer doesn't.

Once again, these are the risks and instructions I discuss with my patients. If you are not my patient, you should listen to what your doctor tells you. I know you get tired of hearing this, but my lawyer doesn’t.

In general, the hyaluronic acid fillers last 1 year in the smile lines and lips; longer under the eyes, in the cheeks and temples. Sculptra lasts 2 years on average. Your filler may not last as long, or it may last longer. Results with Juvederm are seen immediately and settle in over a couple of weeks. Results with Sculptra are seen within 6 months.

I am always asked “do filler injections hurt?” In our office we use a anesthetic cream. The hyaluronic acid fillers now have anesthetic in them. Sculptra is mixed with anesthetic. With the combination of anesthetic in the filler itself, and in a pre-treatment cream, most of our patients find the procedure very tolerable. If needed for lip treatment, additional anesthetic can be given in a dental block just like at the dentist. Now that Juvederm has anesthetic in it, only about 10% of our patients request a dental block. Before the anesthetic was added, 99.9% of our patients wanted a dental block.

There are risks with any medical procedure. The main risks with volume replacement and wrinkle treatment with cosmetic skin fillers are: bruising, infection, swelling, lumps, mild tenderness. Bruising is the most common problem after cosmetic dermal filler injections but can be reduced a great deal if you follow the instructions in my post “if you don’t want to look like I beat you with a stick, read this.” So read it.

Sculptra, or any of the longer lasting fillers, like Radiesse or Artefill, should not be used in the lips, or in the area immediately around the lips or eyes. If used in those areas, long lasting bumps under the skin can occur. Occasionally, they develop in other parts of the face. After Sculptra injections, our patients massage the treated area several times a day for 2 weeks to help prevent bumps under the skin.

Swelling after treatment is rarely a problem, the exception being fat injections in or around the lips, in which swelling may persist for weeks. Rarely unusual swelling occurs months to years after any of the fillers. It is more persistent with the longer lasting fillers Radiesse and Artefill.

Infection is rare but occasionally occurs. The risk is higher with the longer lasting fillers.

Compression of a blood vessel by the filler after injection very rarely occurs, but if not corrected, can cause death of the tissue overlying the occluded vessel. Symptoms include severe pain, gray discoloration (not the same as bruising), often with a light gray or white center, occurring within the first 24 hours after injection. It is most common on the cheeks or the area between the eyebrows. Immediate treatment is required to prevent ulceration of the tissue. If the hyaluronic acid fillers Juvederm or Restylane are involved, they are dissolved with a an injection of a medication, hyaluronidase. Compression of a blood vessel by the longer acting fillers, such as Radiesse, are more difficult to treat.

Occasionally, a patient either develops a lump, too much fullness in an area, or simply doesn’t like the result of treatment (usually lips—and we will talk about lip disasters later). One of the advantages of the hyaluronic acid fillers is that these can be reversed. I don’t know why some doctors don’t offer to reverse an area of filler if the patient is unhappy. I have seen patients, treated elsewhere how suffered with unsightly lips or other areas for a year. Not uncommonly they have seen the injecting doctor multiple times with their concerns, but were not offered reversal with hyaluronidase. So if that is you, know that there are options. In life, the ability to reverse a mistake is worth a lot.

There are quite a few fillers used that have not been approved by the FDA for use in the US. Yes, some doctors in the US use them anyway. Yes, some are used “all over the world.” Yes, some have good safety records. Some don’t. Just say no.

Next: Why you don’t want to look bizarre.