Filler Threadlift Botulinum toxin Fat-freezing Hifu

Four doctors tell CARINA KOH what can go wrong with these popular procedures.

FILLER

Its role: to ll hollowed areas such as those under the eyes, smooth wrinkles or deep lines, and give features a lifted appearance. It is one of the most popular aesthetic procedures in the world – according to the International Society of Aesthetic Plastic Surgery, over 2.8 million ller procedures were done worldwide in 2015. What can go wrong The ller can migrate; this is known as ller migration, whereby the hyaluronic acid (that’s the stuff in llers) moves from where it’s supposed to be to where it’s not – to another part of the face, says Dr Georgia Lee, medical director at TLC Lifestyle Practice. This can happen even if the procedure is done by a renowned professional who has done it 10,000 times.

Why? Because ller migration can just happen; it’s about the luck of the draw.

“It can happen immediately – especially if it’s a tricky spot (under the eye is one), with visible bulges as the telltale signs,” says Dr Lee.

The ller can also be injected into the wrong place, like a blood vessel. What happens next is one or both of these conditions: 1. Embolism, whereby “you’ll experience unusual and intense pain during the ‘wrong’ injection,” says Dr Lee. “Your skin will turn white or pale because arteries – including the ones to the eyes – carrying blood are blocked. This will be followed by the formation of red patches and, in a worst-case scenario, blindness.” 2. Necrosis, which occurs when the “oxygen supply to the skin is cut, and tissue starts to die and turn black. Skin breaks down and ulcers may form over the next few days. Skin can heal, however, with minimal scarring,” says Dr Lee. How they’re xed 1. Embolism: “All injections are stopped immediately and the ller, neutralised and dissolved with pure hyaluronic acid and hyaluronidase, an enzyme,” says Dr Lee. “If vision is compromised, ‘eyeball CPR’ (whereby pressure is applied repeatedly to the affected eye for 10 to 15 seconds, released, then again for three to ve minutes) may be performed, after which an ophthalmologist will be contacted (as there’s a small window of 60 to 90 minutes to reverse the effect). Or, the patient will be sent to a hospital immediately.” 2. Necrosis: “The doctor may use hyperbaric oxygen therapy – which supplies oxygen under high pressure to the area – to inhibit tissue death,” says Dr Lee. How doctors get it right The safety precautions: 1. Use a thinner, smaller needle with a blunt tip at high-risk areas where there are many blood vessels (such as under the eye and along laugh lines), as it is less likely to puncture them. 2. Keep an eye out for any skin-colour changes at the injection site, Dr Lee says.