In our previous blog post we explored the history and rise of lip fillers, one of the UK’s most in-demand non-surgical aesthetic treatments. There is an extensive amount of information available on who and where to go to for these treatments, including a heavy volume of online marketing material. However, the credibility and accuracy of this information does vary.
As a result, this industry can be tricky and even dangerous to navigate and consequently, media outlets are publishing an ever increasing number of cases of ‘lip fillers gone wrong’. These so-called ‘botched’ treatments are on the rise, but how can lip fillers go wrong and why are we seeing an increasing number of these complications?
How Can Lip Fillers Go Wrong?
Bruising is one of the most common complications with lip fillers. Bruising occurs when larger blood vessels are punctured by the needle being used to inject the fillers into the lips. Some degree of bruising should always be expected but several factors can increase the chance or severity of this occurrence. These factors include improper patient selection, incorrect positioning of the patient, incorrect technique or using the wrong kind of needle to inject the filler.
Although bruising is usually a minor adverse effect, it can sometimes develop into a more serious complication. In rare cases a haematoma may develop, resulting in a firm mass appearing below the skin. Although this usually resolves itself, it can cause damage to surrounding tissue, nerves and vessels if it is allowed to progress. In other instances, haematomas may become infected and require further treatment with antibiotics or surgery.
Lumpy lip filler occurs for two main reasons: incorrect technique or inappropriate product selection. More rarely, lumps may develop through a hypersensitivity or allergic reaction. In the majority of cases incorrect technique, such as overfilling, roughly injecting and injecting too superficially, is to blame. For example, if a practitioner removes the needle from the lip whilst still injecting the filler then this can lead to collections of filler in the surface layers of the lips creating unsightly lumps and bumps. Product selection is also important here. If a product of too great a viscosity (thickness) is used, the results may be lumpy and uneven.
Small soft lumps in the lips can often be eliminated with firm massage to spread the product and smooth the surface appearance. However, harder lumps suggest that an allergic reaction to the filler may have occurred. This is more commonly seen in immune-reactive clients, particularly those who have active autoimmune diseases. A prescription of steroids is therefore required before massaging is attempted. If the lumps still persist then the filler needs to be dissolved using a dissolving agent called hyalase.
Necrosis is arguably the most serious potential complications regarding lip fillers. Necrosis essentially means ‘tissue death’ which can occur as a direct or indirect result of dermal filler treatment. Necrosis can occur immediately after the injection of fillers but may also present with a delayed onset due to the swelling and expansion of the filler. The underlying mechanism of injury can involve the obstruction of a supplying blood vessel which starves the tissue of vital oxygen and nutrients or through direct tissue damage due to physical, chemical or radiation properties.
SYMPTOMS OF NECROSIS INCLUDE:
- Severe pain: which may initially be dulled if anesthetic cream has been applied to the lips.
- Prolonged blanching: when the affected area looks very pale, white or dusky due to the reduction in blood supply.
- Purple discolouration: this typically occurs several hours after treatment when tissue death has already occured.
- Coolness: the lack of blood supply causes the temperature of the tissue to be reduced. This is another symptom which is not apparent immediately after injecting.
The treatment of necrosis is complex and only those who’ve received the correct training and have access to additional products and medication will be able to fully resolve the problem. Failure to quickly address necrosis can lead to permanent scarring and disfigurement.
Blindness is another incredibly serious but very rare complication of lip fillers. The mechanism of blindness is similar to that of necrosis, occurring when dermal filler is injected incorrectly and subsequently blocks one of the blood vessels that supplies the central retinal artery. This occlusion causes visual loss and treatment must be administered within 60-90 minutes to avoid irreversible blindness.
Why Do Lip Fillers Go Wrong?
Although no non-surgical aesthetic treatment is without risk, the chance of complications occurring increases significantly when treatments are performed by someone who is not medically qualified and has not received adequate training for the procedures they are offering. As UK legislation on injectables is scarce, it remains the case that anyone can legally administer dermal fillers. Combined with an increasing number of people seeking cheaper treatments, there is plenty of opportunity for things to go wrong in inexperienced hands.
Why is it so important that someone administering dermal fillers is a qualified healthcare professional who has received surgeon-led training? Healthcare providers have a duty of care which protects you from exploitative marketing and irresponsible practice. Surgeon-led training academies empower delegates to inject safely and competently through a detailed understanding of facial anatomy, including the supplying blood vessels and nerves. This allows practitioners to avoid the dangerous complications that can occur through injecting these vital structures through a safe anatomy-oriented technique and treatment plan.
In addition to this, injectors outside the healthcare sector will have less access to medications and other treatments that may be indicated in the event of a complication. For example, if a patient experiences an allergic reaction to hyaluronic acid fillers, an Epipen and prescribed steroids could be required to prevent serious consequences.
Case Study: “My lips were black and swollen. I was terrified.”
I’d been thinking about having lip fillers for about a year and decided to get them after finding an ‘aesthetic nurse’ on Instagram. The photos on her feed looked great – her results looked amazing and she’d posted lots of positive reviews from people who’d supposedly had lip fillers with her. Never once did I think that the photos might not be of her own results. There was an offer on there for 1ml of lip filler for £150. It seemed like a really good price so I sent her and message and booked an appointment for the following week.
She was practicing from her house, which I didn’t really think much of. Some of my friends had also had treatments done at practitioners houses and they’d never had any problems. She put some numbing cream on my lips and quickly showed me a consent form before asking me to sign it. Everything seemed a bit rushed but I thought that it would all be okay.
When she injected the filler it hurt more than I expected it to but as I hadn’t had filler before I wasn’t sure if that was just how it was meant to feel. I couldn’t really ask her when there was a needle stuck in my lip! After about 15 minutes the treatment was done. She gave me a mirror and the first thing I noticed was how swollen and discoloured my lips looked. When I asked her about this she told me that that was normal and that the swelling and discolouration would be gone within 24 hours.
Rather than the pain getting better, it continued to get worse when I got home. My entire bottom lip was bright red and more than double the size that it was before. The area below my bottom lip was bruised. I tried to contact the women who’d injected the fillers but she just repeated that it would get better within a few hours. When there were still not improvements I sent her some photos on Instagram and she blocked me. At this point, part of my lip was turning black and I was in so much pain.
I sent the photos to one of my friends and she told me that I should go straight to A&E. At the time, I felt that the A+E staff were largely confused and unaware of what to do. They referred me to Plastic surgery and the on-call surgeon attended the unit. I remember the surgeon seeming shocked and worried over the state of my lips. She explained to me that the filler had been injected in a way that blocked the blood supply to my lip and the tissue was dying. I was terrified and thought I’d have to have my lip cut off.
Luckily, the surgeon was able to inject Hyalase into my lips to dissolve the filler. This involved multiple injections directly into my lips which were initially very painful and added to the swelling. The surgeon admitted me for observation and returned every hour to reassess the situation and inject more Hyalase as needed. By the morning, the colour was returning slowly to my lips and although they were still horribly bruised and swollen, the team reassured me that things seemed to be improving and I would most likely escape the need for an operation.”
How Can You Ensure Good Lip Fillers?
1. Research Your Practitioner: We cannot stress how important it is to thoroughly research the practitioner you’re thinking of having treatment with. Are they from a medical profession? Have they received surgeon-led training? How much experience have they had? Never worry about asking too many questions – a good practitioner will always be happy to provide you with this information.
2. Look Beyond Social Media: Social media is a great resource and can help you to initially find a practitioner but don’t forget that the photos they’ve posted may not be of their own results and any testimonials could be made up. Search online for independent reviews or try to find videos of them performing the treatments so that you can be assured that they know exactly what they’re doing.
3. Make Sure You Receive a Full Consultation: You should always receive a full consultation, including explanation of any risks and complications, prior to your treatment. If you feel that you’re being rushed or are not fully comfortable then remember that you’re under no obligation to receive treatment.
4. Other Factors: There are a number of things that you can do as a patient to prevent complications, particularly bruising. Anything that increases blood flow to the face increases the chance of bruising occurring. Examples include exercising on the day of your treatment and getting a massage or facial prior to treatment. Some medications, fish oil and Vitamin E can also thin the blood, increasing the chances of bruising or bleeding occurring.
Acquisition Aesthetics Complication Masterclass
Are you an aesthetic practitioner who would like to learn more about complications management? Our new Complications Masterclass is an absolute ‘must’ for anyone practicing facial aesthetics. We’ve produced an in-depth and interactive masterclass in the management of complications relating to the use of Botulinum toxin and dermal fillers. See here for more information about the Acquisition Aesthetics Complications Masterclass.
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