First of all, it is important to note that allergic reactions to hyaluronic acid fillers are rare. Hyaluronic acid fillers are made from substances similar to those already found in the body. That said, if you have a known allergy to lidocaine, which is used to relieve pain during injections, let your provider know before treatment. Everyone reacts differently to facial injections, such as fillers.
However, it's essential to understand that fillers do not pose significant pain risks. Patients can return to their daily routine after filler injections, and most clients report that they feel minimal discomfort during treatment. We see that the most common side effects of the filler are redness and swelling, which usually go away within a few hours. Asymmetric satiety can be a feature of many complications.
Usually, asymmetric fullness is an indication that the filler was injected poorly. Injectables must be applied carefully and evenly throughout the treatment area to ensure symmetry. Otherwise, the patient may experience uneven results that make the fillers incredibly visible. The asymmetric feeling of satiety can also indicate an allergic reaction, either because of the medicinal ingredient itself or because of the liquid gel in which the ingredient is suspended.
Allergic reactions are rare, so they should be treated with care. Other signs of an allergic reaction include tenderness and swelling. Allergic reactions to hyaluronic acid injection are very rare, as hyaluronic acid is a natural component of the skin. Injectable hyaluronic acid comes from both avian and bacterial sources.
It is believed that residual proteins from the manufacturing process can cause hypersensitivity reactions. Both immediate (type I) and delayed (type IV) hypersensitivity reactions are possible. Although rare, infections secondary to hyaluronic acid fillers occasionally occur due to a violation of the skin's protective barrier, either during injection or during the period after treatment. Late infections occur in a similar way to acute infections, but later, two or more weeks after the injection.
They are highly suspected of an atypical infection, especially with mycobacteria or the herpes simplex virus (HSV) (see the next section, “Reactivation of the herpes simplex virus). Empirical antibiotics are the best initial treatment for acute and late bacterial infections. Recommended starting antibiotics are amoxicillin-clavulanate or cephalexin (ciprofloxacin may be used if you are allergic to penicillin). In cases where the etiology is uncertain, dual coverage may be appropriate with antibiotics and antivirals.
In the case of an acute infection with a fluctuating abscess, an incision and drainage must be performed, as well as a culture and sensitivity, in addition to empirical antibiotics. Once the infection is at rest, administration of hyaluronidase may be reconsidered. In the presence of an active infection, hyaluronidase should only be used in combination with antibiotics to prevent the spread of infected material. Bacterial biofilms form a barrier that protects bacteria from the immune system and antibiotics. Biofilms are omnipresent in the environment and are the leading cause of infection associated with devices in medical devices and implants.
Hyaluronic acid fillers are a foreign material that is injected into the body and should therefore be considered conceptually analogous to medical devices. During the hyaluronic acid injection procedure, potential sources of biofilm inoculation include contamination from the local environment, the needle, local skin flora, or hyaluronic acid itself. It is essential to follow the aseptic technique rigorously to reduce the likelihood of bacterial biofilms forming. Bacteria can remain dormant in the biofilm for long periods of time and reactivate when the local environment is more favorable.
This can lead to granulomatous inflammation, nodules, abscesses, and full-fledged recurrent infections. The nodules are usually negative from a culture standpoint and treatment can be complicated.8 Treatment involves taking ciprofloxacin and clarithromycin orally for 4 to 6 weeks. The filler must be dissolved with hyaluronidase and sometimes surgical removal is necessary. The most devastating vascular complications of hyaluronic acid filler injections are strokes and vision loss.
This occurs due to arterial occlusion when there is a retrograde flow of material into the arterial system. The retrograde passage of the filling material can occur due to Poiseuille's law, which states that the branching of blood vessels and the reduction in diameter exponentially increase resistance to anterograde flow. In addition, the pressure exerted by the needle can promote retrograde flow. Therefore, the injected filler may encounter less resistance through retrograde flow to the more proximal vessels.
You can then return to anterograde flow into vessels away from the injection site, such as the ophthalmic artery. The periorbital area, in particular, is prone to vascular episodes due to its anatomy. The external carotid artery supplies blood to most of the face, except for the eyes, the upper part of the nose and the center of the forehead, which are supplied by the internal carotid artery. The ophthalmic artery has many branches that project to areas outside the eye area toward the nose and forehead.
These branches are anastomosed with other arteries in the face, which explains why intravascular injections at sites distant from the eye can still cause loss of vision (see the example above of loss of vision after an injection in the buttock area). The injection sites with the highest risk of eye complications are the glabella, nasal region, nasolabial fold, and forehead. The purpose of dermal fillers is to create volume on the face, hands, and neck to improve appearance general. If you are concerned about the possibility of an allergic reaction to fillers, it may be beneficial to have an allergy test done.
The exact mechanism is not clear and is not yet well understood; it is unknown if the hypersensitivity is due to a true allergic reaction to the filler or to a flu-like infection. Therefore, due to the lack of clear knowledge of the exact etiology of delayed hypersensitivity reactions in some patients with fillers, it is difficult to conclude that certain filling technologies are more likely to induce these reactions compared to others. At the Qazi Cosmetic Center, Nadir Qazi is an international expert in treating acne scars with lasers, transverse with triacraneous acid, subcision and fillers. Some initial research suggests that sodium thiosulfate is promising as a reversal agent for Radiesse fillers, but it has not yet been thoroughly tested.
Late complications from soft tissue fillers are particularly difficult to diagnose and treat because of the time since the procedure. This means that if your doctor has gone too far with fillers, your case of a cushioned face can be easily reversed at the Qazi Cosmetic Clinic. Most patients experienced reactions everywhere they had been previously injected at the same time (except patient 7, who developed the reaction only on one side of the face), regardless of the type of filler, number of injections, or volumes injected. Hyaluronic acid (HA) fillers are used in the periocular area, along with many other places, for both aesthetic rejuvenation and functional disorders.
The migration of the filler from distant sites can also cause the late appearance of nodules months or years after treatment. It's a little less rare for patients to be allergic to the anesthetic that comes mixed with most brands of fillers.
