Managing Complications

One of the most common concerns of an aesthetic patient is: what happens if I get a complication?

I believe every single patient should be extensively educated on the potential complications of any aesthetic treatment prior to proceeding with a treatment. The good part is – these are rare with a mindful and experienced injector. 

Let’s TOX about it: neuromodulators such as Botox, Disport, Jeuveau etc are relatively safe in the dosages we use. There tend not to be any irreversible complications per se. Rather, potential is for some unintended temporary effects. Such as: eyelid droop during forehead botox, difficulty using a straw or smoking after upper lip botox (which some people actually desire), changes in smile pattern, smile/eyebrow asymmetry, minor lumps/bumps for a day or so after treatment, and minimal bruising. Fortunately, all these effects are relatively mild and go away in days to weeks.  

Of note, there is no particular reversals as of yet for tox treatments.

How about Hyaluronic Acid (HA) Fillers? Lumps/bumps can be felt at times after treatment but smooth out over a span of days to weeks. Bruising can be common, which can last up to a week. Fillers can migrate overtime, but can be mitigated by the type of filler used. Overuse of filler in a space can also cause migration, but this can be spot dissolved with hyaluronidase. In my acute care setting as a hospitalist, I have also seen a couple of cases presenting with an autoimmune reaction and granuloma formation in the injected area which can be helped by dissolving the filler, and systemic steroids. Infections can occur, but are very rare if proper aseptic techniques are employed. 

Main concern with fillers is a Vascular Occlusion (VO). This is when an injected filler goes into blood vessel and can cause a blockage of blood flow to that area, leading to tissue necrosis. That is why, a good injector is always on the lookout for any blanching of skin after injections, and will always follow up with you regarding how your treatment is settling in. You should never hesitate to reach out to your provider after a treatment if you have any questions of concerns. If a VO occurs, hyaluronidase can be injected to dissolve the filler and restore blood flow in that area. This also is useful to correct any undesired aesthetic results for a quick fix. 

What if I don’t like my filler results? – hopefully in a mindful experienced injector, this will be rare – but can happen. We can use hyaluronidase to dissolve it and restore the tissues.

There are other types of fillers as well which do not have a reversal/dissolving agent, but if used cannula technique, the risk of VO is quite low. 

So overall – low risk, high reward? I like it! And the fact that all of this is temporary, is quite reassuring. 

Did this information help your concerns?