THE NOT-SO- PRETTY SIDE OF FACE FILLERS

Hyper- inflated faces. Blowfish lips. Forehead nodules.

As the popularity of wrinkle fillers soars, a flurry of scientific papers is warning of serious complications that can occur, from “overcorrections” — too much product injected into the midface — to infections, abscesses, necrosis (death) of tissue, blindness and stroke.

“All injectors need to be aware of complications, should be able to recognize them when they occur and know how to manage them properly,” American and Canadian dermatolo- gists report in the most recent issue of Facial Plastic Surgery.

Despite celebrity photos of seemingly botched facial “rejuvenations” — reality star Khloé Kardashian confessed in March that fillers “f-- ked” up her face, and she had to “go and get this whole thing, like, dissolved” — dermal fillers have become so commonplace, Toronto cosmetic dermatologist Nowell Solish recently saw a woman who had them injected into her face by a nurse at a hair salon.

In the early days, doctors were “line chasers,” Solish said. They targeted an isolated wrinkle or fold.

Today, the focus is on padding and plumping up the entire face, meaning greater quantities are being used.

The most common fillers contain synthetic forms of hyaluronic acid (HA), a substance produced naturally by the body that binds with water to plump up sunken, aging skin.

According to the American Society of Plastic Surgeons (which includes Canadian doctors), 2.4 million soft- tissue filler procedures were performed in 2015, up six per cent from 2014, and a staggering 274 per cent since 2000.

Dermatologists say fillers offer minimal downtime and risk, serious reported adverse events are rare, and mistakes can be reversed with an injection of hyaluronidase — an enzyme that works like an opioid- overdose antidote, rapidly breaking down excess material in the face.

However, technical errors can l ead to serious “suboptimal outcomes,” the researchers report in Facial Plastic Surgery. They describe cases involving deep bruising, swelling or bluish-tinged skin, mistakes in volume (too much, too little) and depth (too superficial, too deep).

Too much product in the body or border of the lip can also result “in an unnatural look many patients fear,” while “lumps and bumps” have been s een weeks, months or years after.

The most serious complications occur when fillers are inadvertently injected into blood vessels, cutting off blood supply to tissues. The product can migrate or move to other parts of the body, causing, in rare cases, blindness, stroke and death of the skin or underlying facial structures.

One woman required six weeks of daily hyperbaric oxygen therapy to heal a deep ulcer that developed after she was injected with a calcium hydroxylapatite filler in her nasolabial folds. A man was left with facial paralysis lasting six weeks after he was injected in the cheeks. Blindness is the most feared complication, with 98 cases documented worldwide.

“What we’re trying to do with this paper is provide our colleagues with awareness about complications and the toolbox to deal with them, should they be confronted with them,” said co- author Dr. Vince Bertucci, past-president of the Canadian Dermatology Association. “We know there is very high patient satisfaction with these treatments.”

However, Halifax researchers who interviewed women who had less- than- positive experiences with Botox and/ or facial fillers described side effects from unwanted skin changes to panic, anxiety, hypersensitivity to light and depression.

The study involved only seven women ( four of them Canadian) and the researchers sought out women who had negative or mixed experiences, “because their voices have seldom been heard,” they write in the Journal of Women & Aging.

The women had no proof their symptoms were caused by the injections, but “they felt abandoned by the medical industrial complex when they turned to it for help,” the authors report. Doctors said their problems were probably caused by hormones.

Si nce Januar y 2000, Health Canada has received 132 reports related to facial fillers, 51 of which were serious. “None of these reports had fatal outcomes,” the agency said in an email.

In Canada, a doctor or nurse under the direction of a physician should inject fillers.

However, Solish knows of clinics where nurses are injecting with no supervision, or the doctor is Skyped in.

“Those are on the edge of what may be acceptable, or not acceptable by law,” said Solish, an assistant professor of dermatology at the University of Toronto.

“It’s not the safest, and it’s not something I would endorse.”