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Cosmetic injectables are on the rise, we see them everywhere we go. In a recent blog post I summarised the FDA meeting from March 2021, noting that adverse effects from cosmetic injectables are on the rise, in part due to their rising availability, often by less experienced injectors and related to this, failure to recognise adverse events when they do occur.
Nonetheless cosmetic injectables are a billion dollar industry, and the marketing is slick and everywhere.
They're in every mall, on every corner, advertising with big signs "injector in clinic today, complimentary consult!"
So you go in, and your venture into the world with your first ml of dermal filler, most commonly, lip or cheek filler for most people.
You are sent home, and told bruising, swelling and some discomfort are normal and it'll all settle in a few days.
So when should you worry if it is just bruising or something more?
Some basics first:
So how do you know what is normal and when to worry?
Vascular Occlusion ie VO due to cosmetic injectables occurs when filler is inadvertantly injected into a blood vessel instead of in the surrounding tissue. This can lead to complete or partial blockage of the vessel.
So what signs should you be looking for to indicate a VO bruising?
Severe pain is sometimes experienced at the time of injection, but it is not always a given. The use of numbing cream or injected local anaesthetic may mask this symptom if used, so may be less reliable until it wears off some hours later. Worsening severe pain during treatment or in the hours following treatment, especially if one sided eg one cheek or one side of a lip, is a possible sign of a VO versus just a bruise, requiring an urgent review.
With compromised blood supply to areas downstream of the injected area, a change in colour of surrounding skin is common, and may vary from white, to pale, or dusky depending on what is happening. This colour will persist and not respond to massage or heat or warmth and with progression may look more like a lacey doiley.
Discolouration of the skin is usually several hours following treatment if it is not picked up earlier as skin begins to accumulate blood that cannot flow and which does not have enough oxygen, leading to a dusky, purplish hue and eventually, blue-grey appearance of the skin. It may resemble bruising, but bruises do not discolour on pressure, while this will if your clinician has shown you how to look for this (I routinely do, especially if injecting high risk areas or new patients).
With compromised blood supply to an area of the skin, the skin begins to cool down over time, and this may be appreciated by comparing warmth in nearby skin versus compromised skin (hard to do if you are not trained).
This occurs if the VO is not picked up, usually around 2-3 days post injury. The compromised skin has begun to die due to lack of nutrients and oxygen downstream from the blocked vessel. At this stage, it is still not too late, though some skin may not survive and repair may take weeks to months compared to if picked up sooner.
So should you simply avoid all injectables?
The aim of this educational blog is to illustrate the following points:
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Skin Essentials will reopen the week beginning 11th October 2021.
Per NSW government regulations, only double vaccinated patients will be served when we reopen and we will be checking vaccination certificates for all patients upon booking. This requirement may change as of December 1st, and we will advise you accordingly.
Please email us (email@example.com) or text us (0413174654) your vaccination certificate as soon after booking as you can. We will not be able to see anyone for treatments or confirm appointments without this.
In the interest of full disclosure, transparency and patient safety, all patient facing staff will be fully vaccinated by the time of reopening. Please read our reopening FAQ for more information.