6 Concerns/Complications with Cosmetic Injectables

I’ve decided to share some of the complications/concerns that I’ve seen or know of when it comes to Botox & fillers. This is not to scare anyone but to just get more information out when it comes to these procedures. I’ve seen people treat getting injectables like getting a haircut (which can also be a temporary disaster). Just wanted to remind you these are medical procedures and there are some pretty devastating complications that can happen. If you choose to do cosmetic procedures it’s important to go to an experienced & qualified injector that has a plan if a problem does occur. It’s not the time to shop for the best bargain, sale or deal. I’ve listed 6 concerns & complications although there are others.

1. Vascular Occlusion– This should be on every injectors mind. When injecting it’s important to know anatomy and steps should be taken to avoid causing this potential disaster. The injector should know how to recognize signs of this early and treatment should be implemented if needed. A vascular occlusion is when a filler is injected into a space that blocks blood flow. This can lead to scarring and blindness. In my 20 years of practicing I haven’t seen this until recently. I had a patient come in who was “treated for Botox from a doctor and was in pain and her skin was developing darkening”. When I saw her I immediately knew she had an occlusion. She had severe pain in her right eye/face and a dusky red patch that went from her eye area to her lip. Upon further questioning she did have a filler done in smile line/lip area as well. Thankfully, I was able to treat her with an enzyme that breaks down the filler (she had immediate improvement) & got her into an ophthalmologist to get her eye checked. Her injector should have caught this and been able to help her instead of avoiding her.
2. Over-injecting fillers– We live in a society where sometimes we think more is better. Over filling the lips and face has become the norm for some folks and people are starting to think this alien look is fine and normal. Many areas of the face can be overdone- this happens when someone is focused on one particular area/wrinkle. It’s up to the injector to educate the patient that chasing the area is not the best way to go because it results in artificial looking results. We need to look at the whole picture. The lips are a common area that gets over done. Some people want this look and some say they don’t. Commonly, I see lip filler that migrates to the upper lip skin area and the contour of the natural lip is gone. Injecting fillers and botox (neuromodulators) is both a science and an art. Remember what the normal face looks like and aim for a fresher look v.s. a non-human look. Lately, I’ve seen more and more filler around eyes that is bulgy creating a pillow like face. This can be from over filling or from using the wrong type of filler. On several occasions I have told people I wouldn’t inject them and I wish more injectors would do the same.
3. Over-injecting Botox- Botox and other neuromodulators can also be over done. The placement is crucial. The most common thing I see is too much in the horizontal brows (frontalis muscle) which can result in heaviness in the brows taking away the natural arch. In most men this isn’t an issue but women hate when brows drop! You can always add more but you can’t take it out.
4. Bruising and swelling– When a needle is being injected into the skin this is always a possibility. There are a few precautions the patient and the provider can do to reduce risk of this. Avoiding anything that delays the blood to clot a week before treatment can help. This includes fish oil, Ibuprofen, Aspirin, Exedrin, and certain herbs, like garlic, ginger, & ginko. Supplements like Arnica & Bromelain can be taken a day or 2 before treatment to reduce risks. The injector can reduce risks by moving slow and changing needles often. The good thing is bruising/swelling is temporary. Masks are good for this these days!
5. Cold sores– If you have ever had a cold sore (herpes virus) on face/around mouth it’s important to tell your injector. They can prescribe an anti-viral medicine to take before the treatment to prevent an outbreak. The trauma of an injection can trigger this.
6. Counterfeit products– This is a frightening one but it is out there. When you see fillers/Botox for super cheap prices and in non-medical settings it should be a red flag. What comes to my mind is the chiropractic doctor and his wife who ended up paralyzed in the hospital because a doctor injected them with raw botulism toxin instead of cosmetic Botox. There are knockoff products out there that can lead to disfigurement. So beware of this dangerous business of buying cheap fillers online that can lead to horrific outcomes.