Dermal filler treatments, namely lip fillers, have risen in popularity over the past few years and have become commonplace for many people in the UK. In a recent survey of 51,000 young Brits, 59% said they viewed procedures like lip fillers as comparable to getting a haircut or manicure. This highlights how prevalent and familiar this type of non-invasive procedure has become. 

While more people are opting for dermal fillers, the number of them experiencing complications is also rising. According to The British College of Aesthetic Medicine’s annual survey, 82% of its 400 members treated patients with complications caused by another provider last year. The survey also found that dermal fillers caused the most complications, with three reported for every 1,000 treatments last year, compared to 1.5 in 1,000 treatments in 2021.

Additionally, nearly 2,000 of the reported complications – which equates to 59% of all reported complications – came from treatments performed by beauticians. To build trust with the UK public and set yourself and your practice apart from others in the industry, being prepared for potential complications, should they arise, is crucial. Read on to find out how to manage complications from dermal fillers confidently and competently while maintaining high standards of patient care.

Common Complications Associated with Dermal Fillers 

The majority of complications that arise when administering dermal fillers are caused by inexperienced practitioners. Poor technique and a lack of understanding of facial anatomy also contribute to complications. That’s why it’s so important to have extensive experience in injectables and develop a solid understanding of facial anatomy. 

Some side effects are quite common and can occur simply as a reaction to the injection of a foreign substance, for example. Some of the most common complications include: 

• Bruising
• Redness
• Swelling
• Tenderness
• Itching
• Rash
• Asymmetry

While these short-term, common complications do not require specific treatment, cooling the injected area is an effective way to alleviate symptoms. 

Uncommon Complications Associated with Dermal Fillers

Very rarely, patients might experience the following symptoms. While these are uncommon, it is vital for you to know their symptoms so you can take immediate action. Some of the rarer complications include:

• Significant pain – Pain that can’t be managed by taking paracetamol and doesn’t subside after a few hours.
• Worsening redness – Redness that spreads across the face and doesn’t subside can be a sign of infection.
• Serious bruising – Very dark bruising, often covering a large area.
• Infection – Symptoms of infection usually include a combination of a lump(s), redness, tenderness, swelling, or pus, and can occur either shortly after treatment or within weeks/months.
• Severe allergic reaction – This includes anaphylactic shock.
• Necrosis – Also known as tissue death, symptoms include discolouration and blanching, nodes or bumps, increased pain, swelling, ulcers, and if left untreated, scarring or deformation.
• Vascular Occlusion – A blockage in the blood vessels, with symptoms including pain or discomfort, swelling, a cooler temperature to the affected area, and changes to skin colour.
• Granulomas – Persistent lumps composed of multinucleated giant cells.
• Migration – The movement of filler material from the site of injection which can result in a lumpy or distorted appearance.

Initial Assessment and Immediate Response

When complications arise, patient safety is vital. Conducting a swift initial assessment will allow you to gauge the severity of the complication and determine whether it’s safest to treat the patient in the clinic or refer them to a hospital.

Different aesthetic procedure complications require different treatment options. Before determining a course of action, you should consult with colleagues and external specialists to ensure all possible options have been explored.  For managing acute complications, immediate response strategies are crucial. 

One of the most adverse effects of fillers includes vascular occlusion, a blockage in the blood vessels. This is a very serious condition that requires immediate medical treatment. 

In some cases, it may be possible to resolve vascular occlusion with conservative measures, such as massage, tapping or applying heat to the treated area. If this fails, however, hyaluronidase injections should be administered immediately to dissolve excess filler. Left untreated, vascular occlusion can cause cell and tissue death (necrosis), organ damage/failure, heart attack, stroke, and in some cases, death. 

Long-Term Management and Monitoring 

Some complications can occur weeks and even months after the procedure. This is why it’s so important to conduct follow-up appointments to monitor the patient’s recovery and manage any delayed reactions. 

For example, while it’s common for patients to experience temporary lumps shortly after the procedure, delayed onset nodules (DONS) can appear after several weeks and require treatment to disappear. DONS appear as lumps, masses, indurations, or abscesses at the injection site. To treat them, the first point of call is usually antibiotics, followed by steroids. Hyaluronidase and intralesional steroid injections are also used to treat nodules, but if this fails, surgical excision may be necessary.

Managing persistent complications effectively requires ongoing care and support for patients beyond the immediate resolution of the issue. You may need to support your patients by addressing physical concerns, such as scar management or corrective treatments, as well as providing them with psychological support.

Communication with Patients

Patient communication in cosmetic procedures is crucial. Firstly, setting realistic expectations with your patients ahead of any aesthetic procedure, including dermal filler treatment, is critical. Not only will this provide patients with a clear understanding of the potential outcomes, but they will also be more likely to feel satisfied with their results – if all goes well. 

When managing dermal filler complications, calm and clear communication is key. Explain the situation in an understandable manner without using too much medical jargon. Make sure you clearly explain the next steps and course of action to put the patient at ease. Be polite, empathetic, and reassuring. By being open, honest, and transparent with them, you’re more likely to build their trust and alleviate any anxiety they may be feeling.

Documentation and Legal Considerations 

Navigating the legal considerations of aesthetic complication management can be complex, to say the least. Having thorough documentation from the initial consultation to the management of any complications will help alleviate those difficulties and ensure you’re legally protected. 

Keeping effective written records is key. This includes obtaining informed consent that covers possible risks and complications. In the event of a complication, you’ll need to carefully document everything, from the nature of the issue and the proposed course of action to potential risks or limitations associated with the treatment. 

Preventive Measures and Best Practices 

Implementing preventive measures and adhering to dermal filler best practices is essential for minimising the risk of complications. Preventative measures include conducting in-depth patient assessments, using the correct dermal filler techniques, and choosing the right filler material. You should also opt for slow filler delivery to reduce pain and conduct post-treatment follow-ups to monitor patient outcomes. A deep understanding of facial anatomy is also crucial for enhancing technique and ensuring patient safety. 

The more experienced you are, the fewer complications you’ll experience which is why continuous education in aesthetic medicine is so vital. Additional training will also help you to keep up-to-date on the best practices in dermal filler safety and the latest techniques in dermal filler applications, minimising the chances of complications occurring. 

FAQs

How do I reduce the risk of infection and bruising when administering dermal fillers?

To avoid infection, the injection site must be disinfected and clear of makeup. The risk of bruising can be reduced by using arnica, aloe vera, or vitamin K creams. 

How do I define late complications?

Late complications can be defined as any side effects or issues that occur after 2 weeks.

What does a bad reaction to fillers look like?

Whether it’s worsening redness or severe bruising, reactions will usually appear in and around the injection site. 

The Importance of Continuous Training in Aesthetics 

Whether you’re a solo practitioner, a medical student, or a clinic owner, the importance of continuous learning in aesthetics can’t be understated. To reduce the risk of complications, ensure patient safety, and deliver the best-in-class care, consider taking expertly crafted courses like our complications masterclass.