Lip filler side effects : Causes and precautions

Introduction:

Although lip injections such as hyaluronic acids are FDA-approved for lip augmentation, some complications may happen due to the injection routine, low-quality fillers, or even the nature of the skin. This article will summarize some lip filler side effects, their classifications, and the precautions needed to avoid lip filler side effects. Additionally, never hesitate to ask us what is on your mind about lip injections and their complications.

Lip filler side effects can be classified based on:

• Early and delayed side effects based on the onset time.

• Aesthetic relevance (minor and major).

• The reason of the adverse reaction.

First, side effects according to the onset time:

a) Early side effects that occur early, specifically within days to weeks:

• Injection site reaction, redness and swelling.

• Infections and allergic reaction/hypersensitivity.

• Bruising/ecchymosis, itching and pain.

• Inflammation, lumps are caused by biodistribution and solid nodules.

• Tissue necrosis, asymmetry, and Embolism with blindness.

b) Long-term lip filler side effects, which may occur within weeks to years include:

• Granulomatous inflammation/foreign body reaction.

• Migration of the implanted filler.Nodules, erythematous or not.

• Migration of the implanted filler.

• Asymmetry and scarring.

Second, the reason for the lip filler side effects, such as:

A) adverse effects at the injection site:

Lip filler has side effects such as swelling, bruising, redness, pain, itching, and infections, which can occur after needle puncture of the skin during filler injections. Swelling and bruising are common and usually subside within a few days, with measures like firm pressure and ice packs helping minimize them. Infections are rare and may present as erythematous nodules. They are treated with antibiotics. Recurrent swelling is linked to alcohol, sunlight, or exercise after injection.

B) Incorrect injection method or inadequate injection procedure:

This type of lip filler side effect can lead to palpable or visible implants and over- or under-correction. Superficial injections, especially with hyaluronic acid fillers, may cause nodules or bluish discoloration due to the Tyndall phenomenon or hemosiderin presence. Treatment includes massage, aspiration, incision, or hyaluronidase for hyaluronic acid-based fillers, with a skin test to rule out allergic reactions. Injections are cautioned in areas with infections, and there is no evidence supporting fillers triggering recurrent herpes infections.

C) Reactions to different filler materials vary:

Collagens (bovine collagen):

• Immunogenic reactions, causing foreign body granulomatous reactions in 1.3% of cases.
• Erythematous or indurated reactions reported as early as 10 days post-injection.
• 1–3% of patients may develop reactions even with one negative skin test.
• Two pre-treatment skin tests are recommended to ensure no allergy.
• Systemic hypersensitivity reactions with fever, malaise, and urticaria can occur but may be self-limiting or treated with oral glucocorticoids.

Hyaluronic acid fillers:

• Granulomatous foreign body reactions can develop months to years after injection.
• May be asymptomatic or present with erythema and swelling.
• Treatment involves intralesional corticosteroid injections or hyaluronidase in some cases.
• Rare case of angioedema-type reaction reported after hyaluronic acid injection in the lip.

Poly-L-lactic Acid:

• Skin nodules described in HIV-infected individuals, appearing 3–4 months post-treatment.
• Nodules are palpable, asymptomatic, and non-visible, occurring in up to 13% of patients.
• Injections should be made below the dermis to minimize nodule detection.

vascular-related incidents:

This category of lip filler side effects is rare, but serious complications related to vascular events can occur during filler injections.

• Skin Necrosis:

1. a rare complication involving compression or obstruction of a blood vessel.
2. Injecting low volumes over multiple sessions may reduce the risk.

• Retinal Embolism:

1. Intravascular injection into the supratrochlear artery (connected to the ophthalmic artery) can lead to retinal embolism.
2. Technique adjustments, such as withdrawing the needle before injecting and using a constant back-and-forth movement, can help prevent this complication.

Precautions to avoid complications in filler injections:

Start with temporary fillers:

• Tray to begin with temporary fillers to assess cosmetic results before considering permanent ones.

Minimize Swelling and bruising:

• void anticoagulant medication and over-the-counter products.
• Apply ice packs before and after treatment to prevent bruising.
• Apply gentle but firm pressure post-treatment.

Understand Recommended Depths:

• Different lip injections require specific injection depths.
• Non-permanent fillers can be injected more superficially, while permanent ones should be injected more deeply.

Limit Movements Post-Treatment:

• Minimize exaggerated and repeated movements in the first three days to prevent product migration.

The filler injector should consider anatomical locations:

• Certain areas and scar types may be more prone to unwanted reactions.

The filler injector should address Scar Characteristics:

• Different scars may exhibit unique reactions.
• Different scars may exhibit unique reactions.
• Bovine-derived collagen products require skin testing before treatment.

Lip injections are generally safe:

Lip injections are generally safe; nevertheless, improper use and excessive application may lead to negative effects and complications. It is crucial to consult with and seek guidance from an expert lip filler injector at every stage.