When Elizabeth Miller, a 55-year-old clinical social worker from Baltimore, got dermal fillers injected into her face last June, she expected she’d look younger.
What she didn’t expect were the spots.
“My mouth looked droopy, so they put Juvederm in each side,” Miller says. “And the next day, there were these oblong red shapes on both corners of my mouth. Now, instead of putting on cover-up to hide the shadows, I put on cover-up to hide the red spots.”
There’s no denying the rise in popularity of injectable soft tissue fillers to plump up wrinkles. More than 1.5 million were performed in 2009 alone, according to the American Society for Aesthetic Plastic Surgery, making facial fillers the second-most popular non-surgical procedure.
But while side effects and complications from these so-called “liquid facelifts” are rare, they do happen. And according to a recent article in the journal Dermatologic Surgery, “increasing use of dermal fillers … is expected to increase the number of complications.”
Lumps and bumps
“Probably the most common side effects are lumps and bumps — doctors call them granulomas,” says Tom Seery, who runs RealSelf.com, a consumer review site for the cosmetic industry.
“People will feel a lump after it’s injected. Or they’ll say, ‘I got injected in my lip and now I look like a duck.’”
Other facial filler complaints reported to the site include cysts, blobs, swelling, hematomas, bruising, dark circles, hardened lumpy nodules, painful inflammation and lopsided lips.
Dr. D.J. Verret, a Plano, Texas, facial plastic surgeon says he’s had a “fair number” of patients come to him to fix filler issues, including infections, migration (i.e., the filler will move from one spot to another), and lumps, especially under the eyes where fillers have been placed incorrectly.
“Most of the patients with complications had their injections done by either a nurse or a non-physician or by a physician whose primary specialty is not plastic surgery,” he says. “When you have somebody who hasn’t had extensive training, I believe there’s a little bit more risk.”
Dr. Anthony Youn, a plastic surgeon from Troy, Mich., says he’s also seen filler foul-ups caused by “renegade practitioners.”
“People will go to a party and have some injections done by someone claiming to be a nurse and three years later, they’ve got lumps in their lips,” he says.
Not all complications are at the hands of untrained practitioners, though.
Eric Guerrin, a 40-year-old property manager from Atlanta, went to a board certified plastic surgeon in 2007 to get rid of the bags under his eyes. The doctor recommended Sculptra, a longer-lasting dermal filler.
“I realized on the second visit that something was wrong, but he told me swelling and redness was normal,” says Guerrin. “So I had the final injections done. When I went back for the follow-up, he said he’d never seen anything like it. It had formed little lumps under my eyes and it was still red. Everybody was saying, ‘What happened to you? Did you get into a fight?’”
An analysis of reports to a federal Food and Drug Administration database shows there were 930 adverse events related to dermal fillers logged between January 2003 and September 2008.
Swelling was the most common side effect detailed in the 2008 report to an FDA advisory panel, followed by inflammation, redness, allergy, infection, vascular events, pain, lumps and bumps, blisters or cysts, numbness, migration, beading and other effects such as blurred vision, tear duct obstruction and disfigurement.
More than 600 patients required treatment with medication; 94 required surgical intervention (such as the opening an abscess to drain pus or the excision of nodules). Nineteen patients went to the ER because of reactions such as swollen tongue or difficulty breathing; 12 patients required hospitalization.
Guerrin went through cortisone injections, laser treatment and two surgeries — one performed by his original doctor and another by a different plastic surgeon — in an attempt to get rid of the lumps under his eyes. But he’s still not back to normal.
“After all the surgeries, it’s left worse bags than before,” he says. “And there are still lumps — plus a lot of scar tissue.”
Immediate side effects are only half the problem, though. Because of the nature of the various fillers — some of which can linger in the body for months, for years, or forever — there are also longer-term effects.
“Every situation is different,” says Dr. Youn. “It can be right away or in three to five years. Problems can develop later on — infections, granulomas, an inflammatory nodule, or the body can even try to expel it.”
Foreign-approved fillers are another issue.
“One patient I’m treating had a permanent filler done overseas five years ago and has now developed an infection in her lip,” says Verret. “We’re trying to treat it with antibiotics but if that doesn’t work, we’ll have to remove it surgically. But it’s like trying to grab sand.”
Doing your homework
Dr. Roger Dailey, spokesperson for the Physicians Coalition for Injectable Safety, says the Coalition’s biggest concern is non-FDA approved materials being given by inadequately trained people (think Priscilla Presley, who was unwittingly injected with industrial silicone by a scam artist.
But the organization also strives to educate consumers — and practitioners — about the intricacies of injectables, some of which can be more problematic when used in the lips or under the eyes.
“A lot of these products are really very good and they work very well for people but some may get put in inappropriately by people who don’t know how to use them,” Dailey says.
Dailey advises anyone considering fillers to seek out board-certified doctors who are also members of their professional boards.
In addition, he recommends patients consult consumer sites like RealSelf.com and ask potential practitioners questions such as “How many times have you done this procedure?” and “What type of problems have you seen?”
One last thing: no matter how much you want to sip from that fountain of youth (or how many people are jostling you from behind), do read the fine print.
“They give you all this information about everything that can go wrong but then they’re sitting there tapping their finger,” says Elizabeth Miller, who still hasn’t gotten used to the raisin-sized red spots on either side of her mouth. “This shouldn’t have happened, but it did.”