How Safe Are Cosmetic Fillers?

Medically Reviewed

“With mirth and laughter let old wrinkles come,” wrote William Shakespeare. Yet, some of us would prefer to do without the wrinkles. Americans spend billions of dollars on Botox and injectable cosmetic fillers that smooth out wrinkles like crow’s feet and laugh lines, minimize facial folds, diminish scars, plump the lips and cheeks, and fill in hollow areas under the eyes, according to the American Society for Aesthetic Plastic Surgery.

Injectable gel fillers are made from substances such as hyaluronic acid or calcium hydroxylapatite that fill in lines and wrinkles (unlike Botox, which relaxes facial muscles) and are marketed under such names as Juvéderm, Restylane, Perlane, Sculptra, and Radiesse. Their effects can last from six to 12 months.

Although considered safe and well-tolerated, the practice of injecting a filler is a medical procedure, and there can sometimes be side effects.

Exercise caution

It’s critical that a dermatologist, a plastic surgeon or a facial plastic surgeon trained in using fillers and familiar with the products performs the procedure to avoid adverse effects.

Never get fillers injected at parties, nonmedical spas, salons, or someone’s home. Your results depend on the expertise of the clinician placing the filler. Potential adverse effects include skin breakouts, asymmetry, and skin damage that could result in scarring, itchy skin rashes, or redness.

Although it’s extremely rare, fillers can sometimes leave tender, hard growths under the skin, most notably when someone who’s inexperienced in the procedure administers them. The lumps and lesions can be difficult to treat and in rare cases have left patients permanently disfigured.

The growths are sometimes blamed on allergic and autoimmune reactions to the injections. But Danish researchers say the growths, which can appear weeks to months after the injections, are the result of drug-resistant bacterial infections—a distinction that’s important in preventing and treating the lumps. The researchers believe infection could be initiated during injection of the filler because of bacteria living on the skin.

One solution, says the study, published in 2014 in Pathogens and Disease, is to inject antibiotics along with the fillers, using strict sterile injection techniques. While prophylactic treatment with antibiotics isn’t an established practice—more research is needed—proper hygiene is essential to avoid infection.

If you’re receiving injections, your skin should be makeup-free. Your doctor should clean your skin with an antiseptic, preferably one with an antibacterial effect, before the injections.

Bottom line

Not everyone is a candidate for fillers. Consider injections only if you’re physically healthy, don’t smoke, and have realistic expectations about what the procedure can do for you.

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