When Injectables Go Wrong
Updated: Jun 20, 2019
EVERYTHING FROM MINOR ISSUES TO THE MORE SEVERE
Fun fact: if you took all of the blood vessels out of an adult human and laid them out, they would form a line approximately 100,000 miles long.
I recently saw a post by The Beauty Nurse, Melissa Berg (@thebeautynurse, I recommend you follow her for good product recommendations/etc) where she reposted a picture showing all of the injection sites in the face where there had been cases of reported blindness due to filler. Unfortunately, it was posted to her Instagram story, so it disappeared after 24 hours, and I haven't been able to find it since then, but to summarize--there were spots all over the face.
This got me thinking: I think it's important to understand the risks of injectables, but more importantly, you should understand what to do when something goes wrong. Writing about this makes me feel uncomfortable, because on the one hand, I think injectables can be quite fun and I don't want to scare people away unnecessarily, but on the other hand, I think plenty of people aren't aware that there are definite risks. Clients are often concerned with bruising, but fewer people are concerned with potential side effects. They are incredibly rare, granted, but they do happen, and it's important to know what to do.
I'm going to add an addendum here: this blog is going to cover everything from minor issues to the more severe. Botox really only falls under the "minor" category, such as unevenness or heaviness in the eyelids. Filler is primarily the more "risky" injectable, so we'll be focusing on that. I also want to include, for the Nervous Nellie's out there (I'm one of them), that these incidents are extremely rare. This is not a common occurrence AT ALL, with an experienced and trained injector. Notice my double use of underlining AND bold font. That's how passionate I am, y'all. I mean what I say and I say what I mean.
The beauty industry is a huge, ever-expanding place filled with people eager to partake in the various glories of lip filler, facial contouring, and Botox. I keep hearing more and more stories about medical assistants and hair stylists trying to inject Botox and filler, and somehow, these people keep finding clients. This blog is a reminder that going and seeing someone who is not properly trained is always a bad idea. If the prices are cheap, it's probably too good to be true.
Let me start off by mentioning one of the most high-risk areas: the nose and area between the brows. These places are great for Botox (to treat frown lines and those "bunny" lines when you scrunch your nose). However, these aren't great places for filler. Don't get me wrong, it can look great. If you have ingrained lines from years of frowning, or you want to smooth the profile of your nose, it looks good to have a bit of filler placed there. Unfortunately, it's our policy not to inject there, simply because it's so risky.
When you inject filler, it's literally "filling" the space. This is great for added volume, like in the lips or cheeks, or to fill in hollow areas, like a divot in the chin, for example. But, take a look at this picture:
This is a generic map of the blood vessels in the face. Like I said, filler is meant to fill. What happens if filler is injected into one of these vessels, which cover virtually every square inch of the face? Long story short, not-so-good things.
The nose is particularly important here, because the vessels located between the brows and along the nose have a direct connection to the eyes. If filler is placed into one of these vessels, immediate and permanent blindness will occur. Can you say #yikes?
A few of our team members went to an injectables training where the trainer talked about a client they had, where they injected into the nose, and the client immediately and irreversibly became blind. Keep in mind this was a trainer, someone who is supposed to be the top of the chain when it comes to this industry. And they were, but it could have happened to anyone. So please, if you want work done on your nose, go to a plastic surgeon. We've had a few clients beg us to do filler on their nose, and although we'd love to make everyone happy, it's not worth the risk.
So! Moving on.
Minor issues include, but are not limited to: uneven Botox, eyebrows that are too "archy" from Botox, heaviness in the eyelids from Botox, not enough Botox, uneven filler, small bumps of filler due to it "lumping".
These are all easily fixed. The magic answer: call the center you went to! Most of the time these are quick 15-30 minute appointments, and are often complementary. For example, if one eyebrow is a bit higher than the other, your injector will simply inject another unit or two to even it out, and will usually comp the treatment. The same goes for a small filler touch up, or to dissolve filler.
Also, remember that hyaluronic acid filler (the only kind we use at Infinity) can always be dissolved using a product called Hylenex, and will also slowly dissolve over time (6 months-2 years). Botox dissolves faster (3-6 months), but once it's been injected, it can't be removed.
Moderate issues include but are not limited to: poorly placed filler, causing obvious unevenness and/or lumps, excessive swelling, and excessive bruising.
For excessive bruising: apply arnica topically and consider taking it orally. Also make sure you follow the correct prep before your treatment, and take care to avoid blood thinners (aspirin, Advil, alcohol, etc). Usually excessive bruising is due to having taken blood thinners prior to treatment, as well as the person just being someone who bruises easily (for various reasons). Bruising isn't fun, but it's usually nothing to worry about. If, of course, you're worried for any reason--perhaps you have a large, spreading bruise, which is more concerning--definitely call the center you went to and check in with them.
For excessive swelling: first things first, make sure you're not having some type of allergic reaction, due to the numbing cream or other environmental contaminant. There is virtually 0% chance of having an allergic reaction to Botox or hyaluronic acid filler, but sometimes, very, very rarely, the immune system gets triggered, causing one anyways. How can you tell if you're having an allergic reaction? Normal swelling will just make the area look puffy, red, and maybe slightly warm for the first few hours or so. Then the color should normalize, and swelling will continue to increase, reaching its peak 24-72 hours after the treatment. An allergic reaction, however, is usually accompanied by what you'd expect: hives, a rashy feeling, itching, and weird, lumpy swelling (think: Jennifer Lopez in "Monster In Law", when she's tricked into eating peanuts). If you think you're having an allergic reaction, call the center you went to (of course, if it's something where you're having trouble breathing, obviously go to the ER. Always go to the ER if you're having trouble breathing. It's just a good general rule for life). If it's just normal swelling, take an antihistamine, and apply ice intermittently.
For poorly placed filler, or if your results are too big/etc: this is still a fairly easy correction, even if the filler isn't entirely what you'd hoped for. Go in to see the injector and discuss your results. What do you want done differently? Remember to have realistic goals. Even if you get luscious lips, it won't fulfill your goals of looking like Angelina Jolie or Rosie Huntington-Whiteley. Focus on what fits your face. If you go somewhere and your filler is terribly placed, super lumpy, or just all around bad, the first thing that needs to happen is getting that filler dissolved. Either go to a new injector, or a new clinic, unless for some reason you trust the original injector to fix it.
Truly uneven filler is different from small lumps of filler, which I listed under the "minor" issues. Small, very minor lumps (as in, one or two) are normal and common with certain kinds of filler, like Vollure. Truly uneven filler is a more "moderate" issues (hence why I listed it under this category), and takes more work to correct, but never fear! It may take more time, but in the big picture, it's still a pretty easy fix.
Serious issues include but are not limited to: vascular occlusion. This is the big fear for injectors. It's rare, but it happens.
When vascular occlusion occurs, blocking the vessel, it causes blood flow to the area to stop. This causes necrosis, and in some cases will cause blistering and an infection. I'm going to attach a photo below that shows the stages of vascular occlusion, so if you're especially squeamish, maybe close your eyes as it comes into view and just scroll right past it. This picture was pulled from Instagram (as it shows on the photo, credits go to The Consultant Clinic. It's not their patient, just a photo they were given permission to use!)
Okay, here goes! Don't say I didn't warn you.
This occurred because someone without any medical qualifications was injecting. Hence why I always recommend thoroughly looking into clinics. Do your research, y'all!
What do you need to know about vascular occlusion, as a client? First things first: do NOT ignore severe pain. If the injector places the filler and you immediately have incredibly severe pain, this is the first major sign. Mild throbbing, discomfort from the needle, or an achy feeling from the filler is normal. Severe pain is not. Tell your injector right away.
The other big sign is a change in skin color. More specifically, blanching i.e. white spots and patches are the big warning sign that some type of occlusion has occurred. Your injector should be the first to notice this, but if you see any blanching later on, reach out to the clinic you went to.
On a personal note, I scared the Holy Mackerel out of myself for this reason when I had a bit of lip filler done. I didn't want anything drastic, so it was just a few pokes, and yet, when I went to look in the mirror a bit later, I had a big white patch underneath my Cupid's bow. Of course, I scared myself terribly and ran to Dr. Messina in a panic. It turns out that due to an accident I had a few years ago where I was kicked in the face by a horse, I already had discoloration there (my lip was split in the accident, damaging the blood flow to that area). The swelling and volume from the lip filler just highlighted it more. So sometimes blanching or other forms of discoloration can just be highlighted by the filler--we tend to notice it, because we're suddenly staring at the place where we got the filler. If you've noticed the discoloration previously, don't worry about it. But if what was a nice, rosy area of your lips suddenly turns white, or if you've suddenly got a white patch on your cheek/etc--contact your injector.
Here are some things your injector should do if you have a suspected vascular occlusion:
increase blood flow to the area via a warm compress, massage, and/or tapping
give you a dose of aspirin or other anti-coagulant (blood thinner)
attempt to dissolve the filler using Hylenex, "flooding" the area according to careful guidelines
prescribe antibiotics if there is blistering and the potential for infection
use hyperbaric oxygen in severe cases, in order to help save the compromised tissue
if necrosis is inevitable, wound care should be addressed, as well as evaluation for managing scar tissue
Here are some things your injector can and should be doing to prevent occlusion:
have an thorough knowledge of facial anatomy, particularly the higher-risk areas
aspirate for every injection, which means they "draw back" on the syringe, and if there's a flash of blood, that means they're in a vessel
injections should be performed slowly and carefully, to assess whether or not any negative reactions are occurring (the pain and blanching we discussed above)
cannulas (blunt needles) can be used in some areas, to help reduce damage to vessels. The research is mixed on cannulas, so they're not the end-all-be-all (meaning, other safety precautions still need to be taken).
Some final thoughts:
keep in mind if you go to an injector that uses synthetic fillers (non-hyaluronic acid), once the filler is injected, it is virtually impossible to remove it. Products like Sculptra are great, but they act as an irritant, stimulating the body to produce more collagen. Because this collagen is self-produced, it isn't easy to remove like hyaluronic fillers. On the other hand, it lasts longer, but that's a different conversation. Other products like Radiesse are just as difficult to manage once it's been injected. Radiesse is made from calcium hydroxyapatite, which ends up having the consistency of bone. We've had a few clients come in after having had it for 5+ years, and it hasn't disappeared, which is great...unless you're not happy with the results.
I wouldn't recommend you let the potential for issues stop you from getting injectables, especially since it's so rare. It would be like not getting surgery just because of the potential complications of anesthesia, or not driving because you're afraid of getting into an accident. Which is way more common, by the way. However, I recommend never, ever getting filler in the nose, and understand that any area can have risks. So, like I always say, and will probably say until the day I die, and probably even after that from the grave: do your research. Don't go to some random person working out of a van (yes that does happen) just because it's cheaper. If some crazy person gives you bad filler, well, as I like to say, that's one doodle that can't be undid.
I hope I haven't scared anybody off! I swear we'll be back to fun topics next time! In the meantime, just take all of this information in stride, and go forth being a knowledgeable consumer. #YouGoGlenCoco
Take care, lovelies!
Reach out if you have questions using the contact form located on the home page. Questions & suggestions are always welcome. While you're at it, check out my Instagram for more fun tips & tricks, and to say hi!