The following is a transcript from Dr. Teo Wan Lin’s podcast, Dermatologist Talks: Science of Beauty on fillers and vaccines. Subscribe to her podcast on a journey to discover the science of beauty. We’ll cover the science behind active ingredients and get deep into the cosmetic formulations. Stay on trend with the latest on botanical actives, technology and be part of our FUTURE OF BEAUTY.
29 DEC 2020: Hi guys, this is Dr. Teo Wan Lin, and welcome to this week’s dermatology flash briefing. The Moderna COVID-19 vaccine apparently causes swelling and inflammation in patients with cosmetic facial fillers. The FDA advisory committee reviewing the new Moderna vaccine, has come out to state this very specific side effect that has involved several trial participants who have had cosmetic facial fillers. I want to just quickly share with you guys today what exactly this is about, how it occurs, and if that’s something we ought to be worried about.
What exactly are dermal fillers?
Dermal fillers are used primarily for facial augmentation. The filling agents are meant to restore fullness in one’s appearance that could be lost over time with age as a result of subcutaneous fat atrophy, or a side effect of certain medications such as retroviral medications. The ideal facial filler should have the following properties: first of all, it should have physiologic compatibility with your body – meaning that it readily incorporates itself with your tissues. It should be free of complications or side effects, and ideally, it doesn’t degrade with time. But this is, of course, untrue for the commonest type of facial filler which is used in most cosmetic practices – that would be hyaluronic acid based and they should be relatively easy to administer. You also have alternatives such as those that are collagen based, or hydroxylapatite based – for example, Sculptra is from poly l lactic acid.
What are the side effects of facial fillers?
In terms of the known side effects from using these facial fillers as injectables, some of the common complications that occur would be tenderness, bleeding, bruising. When lumps and nodules occur, this can be because of inappropriate injection techniques, or accumulation of the filler in a more superficial location than expected.
So what’s the deal with the fillers and vaccines?
Now what’s happening with the Moderna vaccine and this painful facial swelling that occurs where facial fillers have been previously injected, its best thought of as an allergic reaction, or basically an immunological reaction. The key thing here is the process of injecting a vaccine, essentially causes the immune system to be stimulated. That in turn results in the body recognizing that the facial filler in that case, is not a part of the body tissues, and the body starts to mount an immunological reaction against it. Based on the cases that were reported to the FDA, the profile of these patients essentially had swelling and inflammation in the area that was administered the filler. A couple of the patients had the cheek filler 6 months prior to the vaccine, and one patient had lip filler done just 2 days after the vaccine. In all of these scenarios, the patients were treated with oral steroids, anti-histamines, and was observed that their reaction resolved.
What exactly is an allergic reaction?
Typically it is considered a medical event due to an immune system respond to a perceived allergen. It is not likely that these individuals would have developed this response had they not been given the vaccine. The reason is because facial fillers are medically engineered to be biocompatible, but in the case where you’ve had a vaccine, your immune system will start to detect that these substances that were injected, are actually not part of your body tissues.
What are your thoughts, as a dermatologist?
As a dermatologist, I have some opinions with regards to the observation of these adverse events. First of all, we do expect that massive rollout of vaccinations against the COVID19 virus is expected to be happening internationally, and I feel that it is a very important part in ensuring that we get some level of control and immunity in a very severe pandemic like COVID 19. In terms of immunological reactions that are occurring in response to facial fillers in this case, we note that the attendings have actually treated these patients with oral steroids.
We know that oral steroids suppress your immune system, and in fact, make you more vulnerable to the virus. Personally, I have not given oral steroids as far as possible to many of my patients in the last few months. For patients who otherwise would have benefitted from steroid therapy for chronic inflammatory disorders such as severe eczema, I have certainly been a lot more cautious in terms of exploring other therapies before using oral steroids. The reason is because it’s been known to worsen the prognosis in the event you do get COVID, and also, because it reduces your body’s natural immune system response – you’re going to be more susceptible to catching COVID.
The answer is not an easy one. Facial fillers are used in millions of people internationally, and it is not as if it is the first time we are hearing of an adverse reaction. Another known complication from facial filler injections that is relevant in the context of the modern vaccine would be non-allergic inflammatory responses- we call these granulomatous reactions. These don’t occur so quickly, and we right now have no long term data as to what the vaccination would do in terms of individuals who are going to have fillers or have had fillers, and who are going to receive the vaccine.
What are granulomatous reactions?
These granulomatous reactions are usually non-painful lumps, and it is all a part of inflammation that is caused by the immune system being stimulated. In fact, in 2017, there was a case report about a granulomatous reaction to a dermal filler that was hyaluronic acid based in the Journal of Cosmetic and Laser Therapy. A granulomatous reaction is a delayed onset inflammatory nodule that is usually painless, that occurs much later than the so-called allergic reaction in individuals who have painful swellings, such as those who have received the Moderna vaccine and found that the site of the facial filler injection previously became painful. The key thing here is that in order for us to diagnose a granulomatous reaction, it’s going to take a longitudinal study for as long as 5 years before we can determine if it was truly a problem in individuals who received the vaccine, and also had the facial filler injected.
In 2015, in the Journal of Dermatologic Surgery, there was a series whereby the author conducted a retrospective chart review of patients who were treated with HA fillers, within a 5 year period, to evaluate for delayed onset nodules. The conclusion was that although they are pretty uncommon, it is important to be aware of this side effect, and to have a management protocol in place. In their conclusion, the authors also said that from the patients responses and from the literature, that these nodules are immune-mediated in nature.
What I’m trying to say is that because we are currently in an unprecedented public health situation internationally, where we have a raging pandemic that’s deadly, we may have to reconsider the risk that we might be taking with aesthetic treatments. Now, I do perform facial filler and botox injections, but the truth is, vaccinations are going to be a priority for most people and most countries in order for us to get the pandemic under control. I feel that the public should realize that we are also not going to be 100% certain how these facial fillers will further on be affected by these vaccines -for example, the development of granulomatous reactions. The truth is, if you already had a facial filler, I certainly don’t think that should deter you from getting a vaccines because these are established complications. If you do have it then, visit an accredited dermatologist who will be able to diagnose it accurately and will be able to treat it.
A word of caution here, not all painful filler related swellings are due to an immunologic response to the vaccine, depending on the characteristics observed during clinical examination, your dermatologist will also evaluate you for other differential diagnoses which may also include atypical infections. These are usually a result of poor aseptic technique, which introduces environmental bacteria into the deeper tissues.
Overall, my two cents is that if you are thinking of getting a facial filler, as a dermatologist, I feel that you certainly can wait. The reason is really because the cost of human life in this pandemic, simply outweighs any other considerations that one may have.
The human facial structure is a composite of skin (the epidermis and dermis) the subcutaneous fat, the SMAS layer, the muscle and ageing affects all these structures dynamically, fillers only address one part of the ageing equation – restoration of volume. In terms of restoring facial structure and facial sagging – which can be corrected with other technologies such as: radiofrequency, High Intensity Focused Ultrasound, which do not involve injection of other substances into your body tissues. A board-certified dermatologist or plastic surgeon will be able to advise you on these options.
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In conclusion, if you’ve had a facial filler before, don’t let that deter you from getting the vaccine, as the cost of human life is much greater and this is a known filler complication (definitely enhanced by the vaccine) but the benefits will outweigh the risks. If you ARE thinking of getting fillers done, my personal opinion is that you may wish to consider alternatives, given the current context of our pandemic.
This article contains excerpts taken from Dr. Teo Wan Lin’s podcast Episode 10 ‘On Fillers, the COVID-19 Vaccine & Safe Aesthetic Treatments’ Subscribe to the podcast here.
© Dr. Teo Wan Lin 2020