Filler Complications

Last Updated September 2022

What are facial fillers or dermal fillers?

Facial fillers, or dermal fillers, are substances injected beneath the skin’s surface to restore facial volume and fullness. They are also used to shape and contour the face.

Dermal fillers can be used to treat:

• Thin lips
• Volumise cheeks, temples
• Fill facial concavities and improve facial volume
• Improve the shape of the jawline and jowls
• Folds or wrinkles
• Facial asymmetry

Common filler complications 

Lip filler complications

Lip fillers are used to plump and define the lips. For those concerned about thin lips or wrinkles around the mouth, lip fillers can help to create a youthful balance between the facial features. However, one of the most common complications from lip filler is overfilling. The strong desire to have lip filler combined with frequent injections or excessive amounts of lip filler has made lip overfilling commonplace. This is compounded by the so-called ‘temporary’ lip fillers used last significantly longer than practitioners or their patients expect. Therefore, the doctors at VCI recommend using less than 1ml on the lips and then using the remainder of the syringe on another part of the face, as well as a careful reassessment of the lips before reinjection.

Lumps are a common issue after lip filler and are often related to the injection technique. Most of the time, they cannot be massaged out but require hyaluronidase injections to dissolve.

After lip filler, bruising and swelling are also very common and can often take several days to subside.

Cheek filler complications

Cheek fillers are used to volumise and enhance the cheeks. As part of the natural ageing process, certain parts of the face can lose volume and begin to appear ‘hollow’ – cheek fillers can correct this concern and restore a youthful appearance. 

Common complications with cheek filler include asymmetry (although most cheeks are generally asymmetrical and often this asymmetry is noticed only after having filler performed), an unexpected aesthetic outcome, overfilling, lymphatic obstruction due to filler leading to puffiness of the face, and also puffiness around the lower eyelid. In most cases, the complications arise from either excessive volumes of filler being injected or misplacement of filler, and are corrected with injections of hyaluronidase.

Chin filler complications

Chin fillers are used to sharpen the facial contours and improve the appearance of a ‘weak’ chin. This helps to create a more striking side profile and improve the symmetry of the face, balancing the proportions of other features. Chin fillers can also treat signs of ageing, such as marionette lines and reduce sagging skin on the neck.

Complications from chin filler include; asymmetry, an unwanted aesthetic outcome, migration of chin filler into the neck, and vascular occlusion of the submental or mental arteries.

Temple filler complications

Temple fillers fill the temple concavity that results from volume loss from ageing or weight loss. 

Visible lumpiness or irregularities are a common complication of temple filler arising from too superficial injections of filler or the wrong type (too ‘firm’) filler being used. Similar to other previous examples, this can be reversed with hyaluronidase.

A serious complication from temple filler is the injection of filler into the temporal artery, possibly leading to obstruction to blood flow to the retina causing blindness. Although rare, this complication is not usually reversible.

Nose filler complications

Nose fillers are commonly used to increase the overall height of the nose, to lift the nose tip, or to help give the nose a straighter appearance.

Of all the cases of blindness due to filler injections, nose filler is the most common area causing blindness. Furthermore, in many cases, nose filler may be done in vain, as the lifting effect of nose filler does not usually last very long.

We have ceased performing nose filler at Victorian Cosmetic Institute for these reasons.

Tear trough filler complications

Tear troughs are hollows that sit between the lower eyelid and the cheek and are often a significant concern for many. As a result, they have become a popular area to treat with dermal fillers, mainly hyaluronic acid fillers.

However, given the fine skin of the lower eyelid, combined with the hydrophilic (water-loving) nature of hyaluronic acid dermal fillers in this area, puffiness often ensues after filler to the tear troughs. Furthermore, the tear trough is bound down by the tear trough ligament which means lifting the area with filler is particularly difficult.

We have ceased performing nose filler at Victorian Cosmetic Institute for these reasons.

What are possible side effects of facial fillers?

As with any cosmetic procedure, getting dermal filler injections comes with risks and possible side effects. Some side effects are mild and common, while others are rare but can result in serious complications.

Common side effects

There are a number of mild side effects that are commonly associated with getting dermal fillers. Many of these side effects can be eased by applying a cold compress and keeping your head elevated.

Redness

It is not unusual to experience redness after receiving dermal filler treatment. The redness should subside 1-2 days after treatment, or a little longer after lip injections. Mineral makeup can be applied a few hours after treatment to minimise the appearance of redness, but it is best avoided until the following day.

Swelling

Swelling is also common after getting fillers. The procedure disturbs the soft tissue in the area, so it is natural for the skin to react by swelling slightly while it heals. Any swelling should resolve itself within 3 days, but in some cases it can last up to 4 weeks. It is also common for swelling to subside quicker on one side of the face.

You can use over-the-counter painkillers and ice to reduce any discomfort, but avoid touching the area. If you experience excessive swelling you should contact your practitioner.

Pain

You may experience some residual discomfort after the procedure, as a result of the soft tissue being disrupted. Your doctor may recommend some over-the-counter pain relief or a cold compress for 10 minutes every hour until the discomfort subsides. If you experience prolonged or severe pain, you should alert your doctor.

Bruising

A small amount of bruising after getting facial fillers is normal and should subside within two weeks. Bruising occurs when the blood vessels are punctured by the needle, so the risk of this is reduced by our practitioners using an ultrasound or Accuvein divide to map out your veins and by using a blunt tipped cannula

To minimise bruising, you should avoid blood-thinning medications such as Aspirin and Ibuprofen in the lead up to your appointment and avoid any strenuous physical activity for 24-48 hours afterwards. You may also be able to take Arnica montana, which is a homoeopathic remedy, but you should check with your doctor beforehand to make sure this is suitable for you.

Itching

Itching is not an uncommon side effect, but in some cases it could be a sign of an allergic reaction.Allergic reactions to dermal fillers are extremely rare. If you experience an itching sensation avoid touching the area and apply a cold compress to reduce discomfort. If it doesn’t subside within a few days, contact your doctor. 

You should also avoid places with extreme temperatures, such as saunas and sun beds, for a few days after your treatment.

Rare side effects

Severe side effects after getting facial fillers are rare, but should be treated as soon as possible if they do occur. If you experience symptoms such as severe pain, skin discolouration, blisters, blurry vision or a drooping eyelid, you should contact a medical professional immediately.

Infection

Infections around the injection site are uncommon, but are a possibility whenever a needle or a cannula breaks the skin. If you suspect you have an infection, you should contact your doctor because you may need antibiotics to treat it. 

To lower your risk of infection, you should avoid touching the area or using makeup for 12 hours after your treatment.

Filler migration

Filler migration can occur due to a skin tissue reaction that causes the filler to move or leak through the skin. This can occur as a result of improper technique, overfilling or your body’s response to the filler. 

Sometimes this requires surgical intervention to correct if a non-dissolvable filler was used, however it can usually be resolved by asking your practitioner to dissolve the filler.

Nodules around the injection site

A nodule is a single lump that can occur a few weeks after the filler injection. Nodules are usually caused by errors or incorrect technique, so are unlikely to appear if you’ve been treated by an experienced doctor. Nodules can be dissolved but in rare cases will usually need to be surgically removed.

Inflammation (granulomas)

A granuloma is a small swelling in the bottom layer of the skin around the injection site. A granuloma is an immunological response that occurs when your body reacts negatively to the needle or the filler. A granuloma may not appear for a few weeks after the injection and may persist for a few months. Treatment can involve antibiotics, dissolution of filler or surgical excision.

Blood vessel injury

A vascular occlusion (blood vessel injury) could be caused by filler being injected directly into an artery or vein, or being injected very close to a blood vessel and causing a blood clot or blockage. 

Signs of vascular occlusion include pain, blanching, blue/grey discolouration or mottled skin. If there are signs of this while the filler is being injected, treatment should be stopped immediately. The filler will need to be dissolved if the area doesn’t respond to other methods, such as massaging or applying heat.

Blindness

Blindness is an extremely rare complication that can happen if vascular occlusion causes necrosis (tissue death) and is left untreated. If the artery that supplies the retina is the artery that’s affected, blindness can occur and in some cases it is irreversible. 

Your practitioner will take steps to reduce the risk of this complication, including using a cannula instead of a needle, injecting very slowly and injecting at the right depth to avoid arteries.

Tissue death (necrosis)

Although very rare, this is one of the most severe complications that can occur as a result of dermal fillers. Necrosis can occur immediately or a few hours after treatment. 

Tissue death happens as a result of a blood vessel injury that is not promptly treated, so you should contact your doctor immediately if you experience severe pain, prolonged blanching or purple/grey discolouration around the injection site.

What to do if face fillers go wrong?

If you experience any persistent symptoms or are worried about your recovery after getting fillers, the first step is to visit your original practitioner. They will know the most about your treatment and should be able to identify any problems. Filler can be dissolved using hyaluronidase if necessary.

When to seek medical attention

Filler injections are generally considered a safe cosmetic procedure, but serious and rare complications can occur that require immediate treatment. If you experience any of the following symptoms, seek medical attention immediately:

• Severe pain
• Vision changes
• Extreme paleness or blue/grey discolouration of your skin
• Numbness, facial drooping or difficulty speaking