Complications After Dermal Filler Treatments – Part 1: Lumps and Nodules
Complications After Dermal Filler Treatments –
Part 1: Lumps and Nodules
The overall safety of dermal filler treatments at Skin Resus has been excellent. In over 8,000 treatments we have seen no significant complications.
The occurrence after filler treatment of lumps though is a complication which may be significant.
In the early phase after treatment, lumpiness may be seen which is related to swelling both from the needling and from the water-retaining nature of hyaluronic acid (HA) fillers. This settles within 7 – 14 days. Occasionally filler may present as a visible lump if it is placed too superficially, or when the skin is thin with little subcutaneous tissue such as in the neck or under the eye.
Hypersensitivity or ‘allergy’ to filler can present early and cause swelling and redness. Differentiation from infection may be difficult.
Later phase lumps may be due to several causes:
- Filler movement or migration – this is occasionally seen in two areas in particular – the lips, and under the eyes (tear trough treatments). Lip filler migration is more likely with over-filler lips, and when filler is place too deep within muscle layers of the lip. In the tear trough area migration can occur some years after treatment and present as under eye swelling. Ultrasound or MRI imaging may be required to clarify the presence of filler in the tissue here.
- Delayed hypersensitivity (‘allergy’) is a very uncommon cause of swelling/lumps and presents as swelling and variable redness where the filler is present (may be in multiple locations).
Viral infection or vaccination it seems can trigger hypersensitivity to filler. - Infected filler – the presence of filler in tissue provides a locus for infection to grow. Presentation of a red, swollen and painful area are signs of infection. Filler treatment should not be performed where a person is unwell or when dental abscess or treatment is planned.
- Granuloma – this type of nodule is the result of the failure of the white blood cells (macrophages) to remove a foreign body. The reaction presents months after filler placement and usually affects all sites. Most hyaluronic acid filler granulomas resolve within 12 months if untreated.
Treatment of lumps and nodules
In many cases removal of the filler by injections of enzyme will result in good outcomes. In some cases, this may need to be repeated or guided by ultrasound examination. Where concern exists as to possible infection the ideal assessment includes tissue biopsy. In practice this is often difficult and best guess antibiotic treatment as well as dissolving of filler is performed.
Non-HA Fillers
Several non-HA fillers are available on the Australian market. These are non-dissolvable and therefore constitute a greater risk for difficult-to-treat lumps.
For this and other safety reasons, Skin Resus does not use non-dissolvable fillers.
Next/ Complications after dermal filler treatment Part 2 – Ischaemia
By Dr David Main
