Safety in Aesthetics

Complications and adverse events

Aesthetic medicine has evolved significantly over the past two decades, surpassing any imagined progress. Today we can offer a range of effective, safe solutions for improving general appearance, as well as for addressing problems brought on by time. At the same time, we are witnessing an ongoing increase in the rate of complications in the field, arising from two worrysome trends, both globally and locally.

First, since this field is very lucrative, and at the same time requires no formal training, the number of practitioners has inflated beyond reason. A substantial proportion of practitioners have no knowledge or understanding of substances, anatomy, and technical skills. Aesthetic medicine is a medical field for all intents and purposes; the fact that it focuses on beauty does not mean it requires any less professional knowledge. On the contrary, it requires more. We must be versed not only in anatomy and physiology, in the substances we use and in drug interactions, but also in beauty and in beauty improvement. Regrettably, in reality things are reversed: patients are quick to choose their practitioner, which would never happen were they to consider a joint replacement surgery.

A similar trend is taking place in the market of cosmetic products and, surprisingly, questionable manufacturers and practitioners have been successful at convincing our patients that "all products are made equal". Unfortunately this isn't so, neither in terms of their efficacy, nor certainly in terms of their safety! 23 years ago the first wrinkle-filling hyaluronic acid was made. There was only one manufacturer and 30 doctors in Israel used the product. Today there are more than 350 "manufacturers" of fillers and nearly 4,000 "injector-doctors" in Israel. Surely you understand that they, too, aren't all "made equal"... 

Side effects following filler injections are divided into three types: those related to the punctures, those related to the injected substance, and those related to the injection technique.

Mild local redness, swelling, and bruising are mild injection-related side effects which usually resolve on their own. Using advanced injection techniques and high-quality fillers we can avoid these side effects to a great extent. It is adivsed to stop taking non-medical products which extend bleeding time (omega 3, 6) and to consult your doctor regarding anticoagulants / platelet inhibitors (coumadin, aspirin).

A serious side effect of filler injection involves penetrating into a blood vessel and injecting it with the filler. This may cause local skin necrosis and vision disturbances, potentially leading to blindness. External pressure of viscous or excessive filler may disrupt blood flow, which may result in necrosis. This can be prevented using an adequate injection technique and the doctor's awareness of possible complications. Unlike other fillers, hyaluronic acid can be dissolved immediately, which helps us manage complications.

Another group of complications related both to technique and to the injected substance is infection. It is important to understand that hyaluronic acid is made up of sugars, which is why bacteria "love" it. The injected substance may become infected within days to months following its injection. Therefore it is very important to follow sterile injection practices as well as post-injection guidelines.

Hyaluronic acid has an active and complex role in our immune system. It is not a static substance, and therefore, rare allergic reactions may appear either soon or long after its injection. The purity level of the filler and its production process are highly important, and there are vast differences in the safety of different products. In addition, these allergic reactions tend to appear in patients who are injected frequently and using different fillers.

Furthermore, due to the water absorption mechanism of hyaluronic acids, injecting them in the area under the eyes may cause an edema-like swelling.

Following a few simple measures may prevent most complications, while the rest can be managed relatively easily:

Do not undergo treatments around the face two weeks before and after the injection (dental treatments, cosmetic treatments, acupuncture, dental cleaning, permanent make-up).

Do not inject any filler into an area which has already been injected with a permanent filler (silicone, bio alcamid).

Do not undergo a filler injection treatment during the course of an illness or while taking antibiotics. Wait for two weeks after recovery.

Where there is a tendency for herpes of the lips, taking herpes-prevention pills (Zovirax) before lip injections is recommended.

It is best to avoid a "mix" of fillers and a plethora of practitioners.

I advise against injecting both botulinum toxin and hyaluronic acid during the same session, for both safety and efficacy reasons.

Following a botulinum toxin injection, it is recommended to avoid tilting the head downard for 4 hours and to refrain from intense physical activity / drinking alcohol / sauna for 24 hours.

Under no circumstances should injection treatments be done during pregnancy or while breastfeeding.

Remember: less is more, especially in aesthetics!