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When things go wrong with dermal fillers

Dermal filler injections are becoming one of the most popular cosmetic treatments in Australia and indeed worldwide. Although the risk associated dermal filler treatment is very low, as the number of treatments increases exponentially, the incidence of side effects or complications is expected to rise.

The injectable market in Australia is only partially regulated. The law stipulates that injectable treatments can only be prescribed by a doctor after an initial consultation with that doctor. At many clinics, this consultation takes place remotely as there is often no doctor on site. Nurses will administer the injectables afterwards. If a client were to develop an undesirable outcome, side effect or complication, these clinics may be unwilling, or unable to deal with them. Often clinic staff may not have the relevant experience or qualifications to be able to accurately diagnose and manage these conditions, leaving their clients exposed and vulnerable. We have come across patients who felt that they had been ignored or brushed off by the providers who did their dermal filler treatments. It is for this reason that we have developed a service to provide medical care to these patients who have an undesirable outcome or complication from dermal filler treatment elsewhere.

We would like to think of suboptimal outcomes belonging to the following categories:

Side effects

Bruising (usually mild and self-limiting but can be more significant). The risk of bruising cannot be eliminated entirely. Bruising following dermal filler treatment can be improved with vascular laser treatment if seen early.

Swelling. This can either be early onset and self-limiting, with no treatment necessary, or delayed onset swelling (can occur several years following the dermal filler injections), which usually requires treatment.

Poor aesthetic outcomes

Unappealing appearance. This is arguably the most common reason that patients come to see us for a second opinion. Typically, only one area of the face has been treated in isolation, which causes facial disproportion. Just as commonly, we find that dermal filler has often been injected into the wrong part of the face, or into the wrong layer of the face.

Many clinics advertise natural looking results. Unfortunately, this seems to be a marketing tool only.

Complications

Infection. This is relatively uncommon but requires antibiotic treatment.

Inflammatory responses and/or biofilm formation. Difficult to diagnose and needs medical treatment.

Arterial compromise. This is a medical emergency that needs IMMEDIATE attention. Incorrect diagnosis and delayed treatment can lead to skin necrosis (death) and blindness if the retinal artery is involved.

Whilst cosmetic medicine is relatively safe, it is not completely risk free. Like all medical procedures, complications will arise from time to time, even in the most experienced hands. Experienced practitioners have the wisdom and attention to detail to minimise this risk. What is equally important is the willingness of the practitioner to recognise, correctly diagnose and manage such outcomes.