Dermal Fillers: Indications, Contraindications & Risks
In my last post, ‘Injectable Fillers,’ I reviewed the different types of fillers available in the United States. Now I will cover at least the basic indications, or reasons, for dermal filler use, contraindications to dermal filler use and some of the more common or serious risks. The American Society of Plastic Surgeons broadly classifies the indications for dermal fillers into four groups:
- plump thin lips
- enhance shallow contours
- soften facial creases and wrinkles
- improve the appearance of recessed scars
More specifically, dermal fillers can provide not only lip augmentation or plumping but also can help to reduce radial lip lines or ‘smoker’s lines.’ Also around the mouth, fillers can help to reduce downturned oral commissures, a frown-shaped, sometimes depressed, angled to the corners of the mouth or lips. In some people, filler can lift the angle of the mouth in a small pseudo-smile.
Often facial contours need a little help from fillers. The effects of time and gravity on the cheeks can be alleviated with cheek augmentation. By lifting the cheeks, this augmentation may help with nasolabial folds, marionette lines and fine lines under the eyes as well. Recessed or flat chins can also be brought out with dermal fillers.
Dermal fillers can also help to erase or soften many facial wrinkles. These wrinkles include nasolabial folds (parentheses lines from the side of the nose to the mouth), marionette lines (lines from the corners of the mouth angling down), mental crease (horizontal line between the chin and lower lip), and frown lines (permanent lines between the eyebrows).
Finally, recessed or depressed scars can be raised flush with the surrounding skin helping to minimize their appearance. At De Luz Medical Aesthetics, we have other modalities to improve scar color and texture.
Dermal fillers are not for everyone though. As with most procedures here at De Luz Medical Aesthetics, pregnant women and nursing mothers should wait. Dermal filler injection should also be avoided in a number of medical conditions, such as infection (acne, herpes simplex, etc.) or inflammation (vitiligo, psoriasis, etc.) in the treatment area, bleeding disorder or anticoagulant use, a history of hypertrophic scar (heaped up or excessive scar) or keloid (scar formation outside of the area of injury) formation, isotretinoin use within six months, skin atrophy (as from chronic steroid use, genetic syndromes, etc.). Anyone with a history of a previous anaphylatic reaction or allergy to a filler product, such as to gram-positive bacteria for the hyaluronic acid fillers, should avoid dermal filler.
Finally, dermal fillers have some risks. Some risks are difficult to predict and therefore prevent. The two most common risks of a dermal filler injection are bruising and swelling in and around the injection site(s). Bruising and swelling may be a good reason to postpone further filling for a few days until at least the swelling abates as the swelling can obscure landmarks. Rarely and unpredictably, acne-like skin eruptions can occur several days afterwards in the area around an injection.
Some risks can be minimized through proper procedure. Dermal filler injections, especially in the lips, can predispose to a flare of herpes simplex or cold sores. Taking antiviral medication prior to a filler procedure can reduce the likelihood of an outbreak or at least reduce an outbreaks length and severity. Asymmetry and lumps or bumps are also potential outcomes. Asymmetry can be mitigated by judicious placement of filler and attention to the details of an individual’s anatomy. Lumps or bumps can and should be smoothed out prior to finishing the treatment for a better aesthetics outcome. Under correction or less than desired filling can be ameliorated with additional filler either during the same sitting or at a later date. Over correction is more troublesome. Over correction can occur in those areas where a small volume of filler makes a huge difference, like the lips. Making small or gradual changes while having the recipient check frequently with a hand mirror reduces the risk of over correction. Any injection in or through the skin carries the risk of infection but is minimized by using sterile instruments.
Finally the most serious complication of dermal filler injections is blood vessel compromise. While injecting, especially along the nose, blood vessels can be blocked by filler product either pushing on the vessel from outside the vessel or by injection directly into the blood vessel. Blood vessel compromise can cause increasing pain, violaceous reticular changes to the skin or blanching in the area either immediately or up to six hours later. Warm compresses, nitroglycerine paste and, for hyaluronic acid fillers, the injection of hyaluronidase, an enzyme that dissolves hyaluronic acid, can help to reduce permanent damage to the skin or even scarring.
Thank you for your time and attention,
Robert Zieber, MD
De Luz Medical Aesthetics