Side Effects of Facial Fillers

Facial fillers are synthetic or naturally occurring substances injected into the lines, folds, and tissues of the face to decrease the appearance of wrinkles and restore the facial fullness that decreases with age.

These injectables are also called dermal fillers, injectable implants, wrinkle fillers, and soft-tissue fillers. They’re used to erase smile lines, plump up cheeks and lips, and correct acne scars.

The vast majority of fillers are absorbable. Thus, they offer temporary results that last from months to a couple of years, depending on the product and the person.

Some fillers are marketed as permanent and can last up to several years.

According to the American Society of Plastic Surgeons, 2.7 million facial filler procedures were performed in 2017 alone, an increase of 3 percent over the previous year.

Types of facial fillers

The market is abuzz with facial fillers.

While many facial fillers provide immediate results, says the American Academy of Dermatology (AAD), some of them will require several treatments over the course of weeks or months for optimal benefits, followed by occasional touch-ups.

Commonly used fillers include:

Hyaluronic acid (HA)

This gel-like substance is found naturally in the body. It’s used to “plump up” skin, adding volume to places like the cheeks and smoothing out wrinkles, especially around the eyes, lips, and forehead.

Brand names include Juvéderm and Restylane. Because the body reabsorbs the hyaluronic acid gradually over time, results generally only last 6 to 12 months, reports the American Board of Cosmetic Surgery (ABCS). There have been some advances in the development of these dermal fillers, and these will typically last 12 months or longer.

Calcium hydroxylapatite (CaHA)

This filler uses calcium (in the form of microscopic particles) and adds it to a gel that is then injected. The gel is of a thicker consistency than HA, which makes it better suited for deep wrinkles, says the ABCS.

The results of CaHA (brand name Radiesse) tend to last about a year.

Poly-L-lactic acid

This biodegradable acid helps stimulate the skin’s own collagen production, instead of “filling” wrinkles. This gives firmness to the skin and reduces the appearance of wrinkles.

Marketed under the brand name Sculptra Aesthetic, this filler is used to treat deep wrinkles and increase the volume where fat has been lost. It works gradually, but can provide results for at least two years, making it a semipermanent filler.

Polymethylmethacrylate (PMMA)

This filler consists of tiny balls (called microspheres) and collagen that plump up skin. It is known to have some issues, according to a journal article in Plastic and Aesthetic Research.

Although this type of filler (marketed under the name Bellafill) is considered permanent, with results lasting five years, it’s usually not the first choice of doctors.

According to research published in Aesthetics, long-acting dermal fillers have higher rates of complications, such as infection and nodules.

Autologous fat injections (fat grafting)

This technique takes fat from parts of your body, such as the buttocks, and injects it into facial areas for filling.

This fat is typically removed from your body using liposuction, a procedure in which fat is vacuumed out of the body via a hollow tube inserted through incisions in the skin.

This procedure requires sedation, and you may need a week or two to recover. In most cases, fat grafting provides long-lasting results.

Common side effects

According to the AAD, the following side effects — which tend to occur around the injection site — can be immediate, but usually clear within 7 to 14 days:

redness
swelling
pain
bruising
itching
rash

Rare side effects

While less common, you should be aware of the following side effects:

infection
leakage of the filler through the injection site
nodules around the injection site, which may need to be surgically removed
granulomas, a type of inflammatory reaction to the filler
movement of the filler from one area to another
injury to blood vessels
blindness, which occurs when the filler gets injected into an artery, blocking blood flow to the eyes
tissue death, again due to blocked blood flow

Safety precautions

While facial fillers are generally safe, taking these steps can help ensure your safety:

Use a licensed, well-trained, and experienced medical professional (an experienced dermatologist or plastic surgeon) to inject the filler.
Have the procedure done in a medical setting, not in someone’s home or at a mall kiosk.
Ask the provider about their experience with the particular type of filler you have chosen. The more experience they have with the product, the better.
Don’t purchase fillers online. Only get them from a medical provider.
Fillers should be in unopened and properly labeled syringes. Inspect the syringe to make sure.
Make sure that the filler being used is FDA-approved for that purpose.
Be aware of the risks and potential side effects.
Read the filler ingredients and don’t have it injected if you know you have an allergy to any of the filler’s components (e.g., collagen).
Be sure to tell your doctor about all medications and supplements you take. Some may interact with the ingredients in the fillers or can affect your blood’s ability to clot.

Risk factors to be aware of

Don’t use fillers if:

your skin is inflamed for any reason (for example, if you have a rash, active acne, hives, etc.)
you’re allergic to any of the filler ingredients (read the label)
you have a bleeding disorder
you’re pregnant, breastfeeding, or under the age of 18 (safety hasn’t been studied in younger age groups)
Your skin is susceptible to scarring (e.g., you have a keloid or an overgrowth of scar tissue)

Alternatives to facial fillers

Numerous cosmetic procedures can combat the signs of aging and facial wrinkles, with varying degrees of success. Some popular ones include:

Topical lotions

Some lotions help reduce fine lines by increasing skin cell turnover. Others have slight irritants in them that can cause areas of the skin (such as the lips) to temporarily swell and appear plumper.

Microdermabrasion

Microdermabrasion involves using a wand-like instrument that sprays small, abrasive particles to “sand” the uppermost layer of skin, exposing the softer, smoother underlayer. The procedure helps to tighten skin and reduce the appearance of wrinkles.

Dermabrasion

This procedure smooths skin (and reduces the look of wrinkles and scars) by scraping the top layer of skin away, thereby exposing the more dewy skin underneath.

Chemical peels

Peels place chemicals on the skin to exfoliate the dead outer layer and reveal the new, fresher underlayer.

The takeaway

FDA-approved fillers used by well-trained professionals are typically safe.

Doctors generally caution against massaging the injected area or exposing the newly injected skin to extremes in temperature (for example, using a sauna or skiing in frigid weather).

Over-the-counter antihistamines and anti-inflammatories may help reduce any redness or itchiness you may experience.

If you notice symptoms of infection (fever, pus, or very hot, inflamed skin), see your doctor.