Ensuring Safety with Dermal Fillers and Botox

Date: Dec 15, 2020

With the prevalence of advertising of injectables, and with specials running on every corner, it can be difficult to make a decision regarding where, when, and who should be performing your nonsurgical facial rejuvenation.

The most common question from patients is whether or not Botox® and dermal fillers are safe to use in the long term. This is a reasonable question — after all, there is no shortage of exposures these days that we later discover have been harmful to us all along. But Botox (and its counterparts, Dysport© and Xeomin©, which we will refer to under the heading of Botox for simplicity) has been used in the treatment of facial wrinkles since the 1980s and 1990s — although it was only approved in 2002 for cosmetic use. We have therefore been watching the effects and risks of this potent and effective treatment for over 30 years now. There are also few other medications that have been studied quite as much as Botox for both cosmetic and non-cosmetic uses.

Dermal fillers, you may be surprised to know, have been used in their collagen form since the 1980s. The problem with using collagen fillers was that it required allergy testing and the effects of the filler only lasted about 3 months. With the onset of hyaluronic acid fillers, and some of the other longer-lasting options available, results can last from months to years depending on the type and placement. Hyaluronic acid options are generally considered extremely safe, as this is a component of our own cellular structure and therefore does not require additional allergy or skin testing. It also has an excellent safety profile because it can be dissolved if the need arises by injecting an enzyme that breaks up the filler.

The issues of primary importance when you are contemplating who or where to have your treatment are the experience of the injector and where the product is obtained. Reputable physicians and surgeons will obtain the product directly from the manufacturer, not a discounted offshoot. There is little the consumer can do to ensure this other than to ask if the product has been obtained from the manufacturer and not a third party. This guarantees the product is pure and sterilely packaged.

The other issue is to have your treatments performed by someone who is comfortable not only with the methods and materials, but who has experience dealing with complications. Botox used for cosmetic purposes has risks of local bleeding or bruising, and diffusion into surrounding structures. This can lead to eye drooping or changes in mouth position if injected in these areas. In most cases, for cosmetic uses, the risk of breathing difficulty or swallowing problems does not reasonably occur.

Fillers can carry other risks. As with Botox, some of the common risks are bleeding and bruising. These are temporary and most often do not interfere with the final result. However, fillers should be considered an injectable implant. Sterile technique should always be used — cleaning the face with alcohol to remove all makeup, avoiding touching of the face after preparation, and keeping needles and products packaged sterilely until use. Local infections can occur and can result in delayed results or other complications if sterile technique is not used.

Finally, injections of foreign materials into blood vessels can be dangerous and can cause changes in the surrounding tissues in a dramatic way. This can, in many cases, be avoided with proper attention to the anatomy of the face and knowledge of safe areas to inject fillers. Notably, in the U.S., silicone is not FDA-approved for soft tissue injection. Make sure to ask your injector if the product that is being recommended is FDA-approved for facial injection and whether there are specific risks associated with these injections. You can also ask if they can be reversed if a poor outcome or complication occurs. You should always be asked to sign a consent form prior to injection of a new product. Please take the time to read the consent forms. Many patients feel that since these products can be obtained at a spa or without “surgery,” the risks are minimal and not worth reading about in detail. Injectables are still elective procedures and carry risks associated with them. Make sure you understand what the risks are before embarking on this journey.

The overwhelming majority of patients obtaining Botox or dermal fillers are exceedingly pleased with their results. The risks of some of the more worrisome complications is quite low — 0.0001% in some of the available literature. Once you are aware of the possibilities, you are an informed consumer. Be sure to ask questions of your injector and preferably consult a surgeon familiar with the anatomy and soft tissues of the face that utilize injections in their practice on a daily basis. Injectable treatments can be powerful tools for nonsurgical facial rejuvenation with tremendous success.


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