Filler Complications

• Injectables
• Conditions
• Filler Complications

Medically Reviewed 8th May 2024, by Dr. Susan Mayou (GMC: 2405092) - founder of the Cadogan Clinic and one of the world's leading dermatologists

Which Conditions Can Be Caused By Filler Complications

When carried out by a qualified and experienced medical professional, Dermal Fillers are a safe and effective treatment for a number of aesthetic concerns. However, in rare cases, complications can occur.

Common side effects following Dermal Filler treatment include bruising and swelling. These usually don’t need any further treatment and will subside within a few days. Your consultant will discuss any potential side effects and complications with you before you undergo any treatment and ensure you understand how they may affect your treatment.

Cadogan Clinic have brought together the most experienced and skilled injectables experts in the UK. Their expertise extends beyond addressing aesthetic and functional concerns with injectable treatments and they are experienced in offering correction and improvement to Dermal Filler treatments that have been performed elsewhere.

Choosing to have Dermal Fillers performed by a qualified medical professional significantly reduces the risk of complications occurring, however there is always a small risk of complications. Below we consider some of the more common complications and the most effective treatments.

Migration

Migration is the movement of Dermal Filler from the area it was initially injected, to surrounding areas where it is not wanted. This can result in an uneven, lumpy appearance, which doesn’t reflect the fuller smooth result which patients are usually trying to achieve from Dermal Fillers. Filler Migration can occur in any area that Fillers have been injected.

Common signs of Migration in areas that are regularly treated with Filler include:

• In the lips, Filler will spread outside of the vermillion border, which can create a shelf-like appearance around the edge of the lip
• In the tear troughs, Filler will spread below the eye area, creating a ridge
• In the cheeks, the Filler will spread to unwanted areas, creating a lumpy texture or a ridge around the edge of the cheeks
• In the jawline, the Filler will spread creating an uneven jawline, often with a shelf or ridge around the contour of the jaw

The usual cause of Migration is an area being overfilled with Dermal Filler. This can occur in a single session, or over time with more Filler being added to a single area over a course of appointments.

In some cases, Dermal Filler migrates due to the way a person’s body naturally breaks down the Filler. It is understood that Migration of Lip Filler may be caused by the mouth contracting, causing movement as it naturally dissolves.

Dermal Filler Migration is not usually painful and is not a medical emergency. However, it can look unappealing which leads to people wishing to address the migrated areas of Filler and choose to reinject Filler later on.

Nodules

Nodules are lumps that occur in areas treated with Dermal Filler. There are many different kinds of Nodule which have different causes and implications. In many cases, they are harmless, but the patient may not like how they look. In rare cases, they may be connected to a more serious complication.

In the first four weeks following Dermal Filler treatment, it is normal to feel small lumps of Filler under the skin as the Hyaluronic Acid settles into the treated area. However, if Nodules remain after this time, there may be a need to speak to a medical professional to rule out any serious concerns.

There are different types of Nodules which can impact Dermal Filler treatments:

• Non-Inflammatory Nodules – These are usually caused by Dermal Filler being placed in the wrong area, and being unable to settle, resulting in small lumps showing in the affected area. Although it may look unappealing, it is not a medical concern.
• Inflammatory Nodules – Usually caused by a reaction to the Filler or infection, these Nodules can arise anywhere between 24 hours and several months following a Dermal Filler Treatment. Unlike Non-Inflammatory Nodules, they will feel tender and may be warm. This concern should be examined by a medical professional who specialises in injectable treatments.
• Delayed Onset Nodules (DONs) – The exact cause of Delayed Onset Nodules is not fully understood. They are usually angry, red lumps which appear many months after Dermal Filler has been administered. It is thought  they may be an immune system response to Dermal Filler treatment, or that they may be caused by biproducts produced as the Dermal Filler breaks down in the body.

Nodules affect the appearance of the Dermal Filler and in cases of Inflammatory or Delayed Onset Nodules can be uncomfortable. Seeking advice from your consultant as soon as possible after experiencing Nodules will ensure you are given the correct treatment. 

Tyndall Effect

The Tyndall Effect is an aesthetic complication which results in a blue cast appearing under the skin due to light reflecting off the particles in the Filler. The Tyndall Effect isn’t a medical concern, however it can look unappealing (especially in photographs) and exacerbate other concerns such as Pigmentation, Dark Circles, Under-Eye Wrinkles or Under-Eye Bags.

Although the Tyndall Effect can occur in any area where Filler has been injected, it is most common in areas where the skin is very thin, such as under the eyes, following Tear Trough Filler. It is usually caused by the Dermal Filler not being injected deep enough into the skin, or the skin being very thin, allowing light to reflect off the Filler under the skin.

The Tyndall Effect will usually appear very quickly following Dermal Filler treatment. It is often mistaken for bruising; however, it will not disappear within a few days as a bruise will. 

Vascular Occlusion

Vascular Occlusion occurs when Dermal Filler is mistakenly injected into a blood vessel causing a blockage resulting in the blood being unable to flow. It can be serious complication and treatment should be sought as soon as possible.

Signs of Vascular Occlusion include:

• Pain
• Swelling
• Significant bruising which continues to get worse
• Other colour changes to the skin, turning red, blue/purple or going very pale
• Cool skin temperature in the affected area

These signs and symptoms usually appear 12-24 hours following Dermal Filler treatment.

Vascular Occlusion can be a serious complication and needs to be treated as a priority. If left untreated Vascular Occlusion following Dermal Fillers can lead to:

Tissue death which may require tissue needing to be excised

• Organ damage
• Heart attack
• Stroke

Vascular Occlusion following Dermal Filler injections usually leaves no lasting effect when treatment is carried out quickly. Treatments are effective and prevent further issues and complications from arising as a result of Vascular Occlusion.

Injectables for Filler Complications

When complications occur following Dermal Filler injections there are a number of treatment options available depending on the concern, how severe it is, and the area that has been affected.

One of the most popular and straightforward treatments for Dermal Filler Complications is an injectable treatment called Hyalase. 

Hyalase to Treat Filler Complications

Hyalase (an abbreviation of Hyaluronidase) is an enzyme which can be used to break down Hyaluronic Acid based Dermal Filler. As well as being used to treat complications, it can also be used to remove Dermal Filler if a patient doesn’t like the way their Filler looks. Depending on the reason Hyalase has been used, the Dermal Filler may be reinjected at a later date.

Hyalase takes 12-24 hours to take effect and your consultant will ask you to stay in touch with them, giving regular updates on the progress.

As Hyalase is specifically for dissolving Hyaluronic Acid, it cannot be used to break down other forms of Filler based on ingredients such as Lactic Acid (Sculptra), or to reverse the results of Fat Transfer. 

Hyalase for Dermal Filler Migration

When Migration of Dermal Filler has occurred, Hyalase can be injected into the affected area to reduce lumps and ridges and return the skin to its natural appearance. Normally, your consultant will have to dissolve the Filler in the area fully to treat the Migration.

Following Migration treatment using Hyalase, Dermal Filler can be reinjected in the right quantities to create the desired results. Some people are prone to Migration, and the reasons for this is not fully understood. Therefore, even if the Filler is reinjected in smaller amounts, there is no guarantee it won’t migrate again. 

Hyalase for Nodules

Depending on the cause and the type of Nodules that have occurred, Hyalase can be a highly effective treatment. In some cases, your consultant may recommend another treatment before Hyalase is injected such as massage or antibiotics.

• Non-Inflammatory Nodules – Although these are not a medical concern, they can look unappealing. Within 4 weeks of treatment, they often resolve on their own. However, after this timeframe, many people opt for them to be treated with Hyalase. This will remove the lumps and smooth the area. Dermal Filler can then be reinjected at a later date.
• Inflammatory Nodules – Depending on the cause of the Inflammatory Nodules, Hyalase may be used as part of a treatment plan. If there is active infection in the area, your consultant will initially prescribe a course of antibiotics to treat this first. Once the infection is clear, any Nodules made up of Dermal Filler, can be dissolved using Hyalase.
• Delayed Onset Nodules – When treating Delayed Onset Nodules, many consultants are cautious about treatment, as the cause is not always known, and they don’t want to aggravate any immune response. Hyalase can be used to treat DONs however, consultants may suggest other treatments first, and will want to be confident that no infection is apparent.

Treating Nodules following Dermal Filler requires careful consideration to make sure all contributing factors and causes have been addressed. Hyalase is often used as part of a wider treatment plan. Depending on the cause of the Nodules, Dermal Filler may be reinjected once the Hyalase treatment has been completed. In cases where there is a potential immune system reaction as part of the cause, your consultant may suggest not reinjecting the Dermal Filler. 

Hyalase for the Tyndall Effect

Hyalase is a highly effective treatment for the Tyndall Effect, allowing the Filler to be dissolved, to be reinjected in a more suitable position at a later date for many patients.

In cases where the blue cast is apparent through the skin, Hyalase can be injected into the affected area, removing the Filler and restoring the natural colour to the skin. If the Tyndall Effect is being caused by the Filler having been injected too superficially in the skin, the Filler can be reinjected at a deeper level to prevent the discolouration from reoccurring. If the Tyndall Effect is occurring in an area where the skin is very thin, and it isn’t possible to inject deeper, your consultant may recommend not using Dermal Fillers in this area and considering an alternative treatment.

The Tyndall Effect leaves an unappealing blue colouration to the skin in areas that have been treated with Dermal Filler. This can cause people to avoid having their photo taken or to rely on makeup to cover the area more than they may wish to. Hyalase can be used as a quick and straightforward solution which removes the blue colouring and allows corrections to be made to the Dermal Filler injections.

Hyalase for Vascular Occlusion

Vascular Occlusion can be a serious medical concern and should be addressed as quickly as possible. If you are experiencing any of the signs of Vascular Occlusion, it is crucial to contact your consultant to seek their advice.

Hyalase is effective for treating Vascular Occlusion and is typically used to remove Dermal Filler causing blockages in blood vessels, which may lead to more serious issues if not addressed.

Hyalase is injected into the affected area and your consultant will then monitor the signs and symptoms to see if further treatment is necessary. In serious instances where necrosis may be a factor, tissue may need to be removed to maintain the health of the surrounding skin and tissue.

Following treatment with Hyalase, depending on the severity of the Vascular Occlusion and any lasting effects it may have had, it is possible for Dermal Filler treatment to be repeated, but your consultant may recommend waiting for the area to be fully healed and recovered to prevent further issues.

For the majority of people who undergo Dermal Filler treatment, it is a safe procedure which yields highly satisfactory results. In rare cases, aesthetic and functional complication can arise. These are usually easily treated and resolved to restore a natural appearance or allow for reinjection of the Dermal Filler. 

How To Find Us

The Cadogan Clinic is based at 120 Sloane Street in Chelsea, just off Sloane Square and the Kings Road.

We are accessible by all major bus routes that pass through Sloane Square and Sloane Street, as well as Sloane Square tube station.

We are just a 5 minute walk northwards up Sloane Street once you have arrived at Sloane Square.

Local pay parking is available just around the corner from the Clinic on Cadogan Gate, Cadogan Square and Cadogan Gardens. Our local residential parking zone is the Royal Borough of Kensington & Chelsea.

Address: 120 Sloane Street, Chelsea, London, SW1X 9BW