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.
The CollagenUp Facial Wand is a FDA approved device that includes cleansing + treatment + toning + radiofrequency + red photon + blue photon + EMS functions for the ultimate home-based skin rejuvenation system.
Advances in our understanding of textile cosmeceuticals in the form of polysaccharides,polymers and nanoparticle materials can create an optimal skin microenvironment that stimulates collagen production, improving the hydration of the stratum corneum that creates plumpness and firmness of the skin.
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.
Dermal fillers are minimally invasive mainstay cosmetic treatments used to help return the appearance of volume and youth to ageing skin. Volume deficiency, scars, wrinkles, lip augmentation (plumping), facial sculpting and contouring are common facial concerns targeted by dermal fillers.
This guide will tell you everything you need to know about them: how they work, the choices of products on the market, and their possible side effects on your body and skin.
What are dermal fillers?
Before starting on dermal fillers, we need a brief understanding of how the face changes as we age. Over time, the thickness and elasticity of our skin decreases, and our faces loses fat. Soft tissues sag, facial muscles weaken, and the outermost layer of skin wrinkles.
Enter fillers. Dermal fillers help restore lost volume to your face and add lift.
Types of dermal fillers
The classifications of dermal fillers vary according to their properties. Fillers are categorized based on their biodegradability, how long it takes before the filling substance is absorbed by the body, and the duration of a treatment’s effect.
Early attempts to use fillers for facial rejuvenation relied on dermal fat or collagen fillers. However, the effectiveness of fat as a filling agent was risky as a number of variables were involved. These included the method and type of fat harvested, both of which could cause inconsistent absorption rates by the body. There could also be significant side effects including prolonged swelling, internal bruising and cause infections. Bovine (cattle) collagen, the first collage filler used, also had limited success due to its short duration of effect (3-4 months) and potential risk of allergic reaction.
Human-based collagen has since been developed but demand for collagen remains low compared to more effective filling agents.
These are fillers that provide temporary or semi-permanent effects as they gradually degrade and get absorbed by the body. Common biodegradable fillers are collagen, hyaluronic acid, calcium hydroxyapatite and poly-L-lactic acid.
Naturally present in our skin and connective tissues, hyaluronic acid is a key structural component that stabilizes cellular structures and binds collagen and elastic fibers. Hyaluronic acid remains as the most widely used dermal filler due to its ease of use, safety and minimal side effects.
When hyaluronic acid is injected into the skin, it combines with the natural hyaluronic acid found in our body. Due to its hygroscopic nature (ability to absorb water from surroundings), hyaluronic acid binds to water quickly, creating volume that lasts for 6 to 12 months before degrading into the body. It also induces new collagen formation, a desirable quality as our bodies gradually stop producing collagen in our late twenties.
Poly-L-lactic acid (PLLA)
A synthetic, biodegradable polymer of the alpha-hydroxyl-acid family (natural acids found in food), poly-L-lactic acid (PLLA) is another common filling agent. Its safe profile enables PLLA to be actively used in other medical applications such as in dissolvable stiches or soft tissue implants.
PLLA triggers mild inflammation to promote the formation of collagen and tissue fibers. The accumulation of collagen creates volume at the site of injection. Over time, PLLA breaks down into lactic acid and is metabolized to carbon dioxide or incorporated into glucose molecules.
Calcium hydroxylapatite (CaHA)
CaHA is a synthetic compound with a chemical structure that resembles a component found in our bones and teeth. Treatment with CaHA is safe and will not cause allergic reactions. When injected into skin tissues, our body gradually absorbs CaHA, inducing new collagen to be produced. Such an effect typically lasts about 15 months or longer.
CaHA breaks down into calcium and phosphate ions before finally being excreted by the body.
Injecting silicone into the face adds volume directly and immediately and also triggers collagen production that adds to the effect. Silicone is favoured for its stable chemical structure, ease of use, low cost, and long-lasting effects. As a non-biodegradable filler, silicone stays in your body once it is injected.
However, the use of silicon in cosmetic treatments is controversial due to its potential to cause long-term complications such as abnormal swelling, blindness or nerve damage. Issues can also arise from poor injection technique, the amount of silicone used and differences in silicone grades. For these reasons, it is strongly recommended you get your fillers done only by a trained dermatologist.
Warnings and alternatives
Administered professionally and with the proper technique and expertise, a dermal filler comes with minimal side effects. However, with many different rejuvenation treatments available, it’s important you consult a trusted dermatologist for a professional assessment before commencing treatment.
For those who prefer plumping effects without an injection, go for Dr TWL’s Hyaluronic Acid serum. As a skincare ingredient, hyaluronic acid draws moisture from its surroundings and keeps the skin well-hydrated; it is able to hold over 1,000 times its own weight in water. This gives a desirable plumping effect and improves fine lines and wrinkles without the needles.
Soft tissue fillers are injectables that aim to reduce wrinkles, hollows, and furrows or “plump up” or the skin to give the skin a smoother and more pleasing appearance. Derived from either natural or synthetic substance, these fillers are effective at contouring specific areas of the face, such as around the lips and mouth, and correcting depressions and scars.
Who are soft tissue fillers for?
Each filler product is designed for different purposes and effects. For those looking to correct wrinkles, enhance their lips through volume augmentation, correct thin, superficial lines around the eyes, mouth and forehead area, looking to contour the areas around their chin and cheeks area and correct deep folds, soft tissue fillers are an effective treatment method.
What should I know about soft tissue fillers?
Soft tissue fillers come in two forms — natural and synthetic. Synthetic fillers are often a popular choice as they produce immediate results and have a lasting effect in comparison to natural fillers. This is because synthetic fillers are derived from animal and non-animal stabilised hyaluronic acid complex. The sugar chains in these complex are often stabilised for a longer period of time, resulting a lasting effect on the skin when treated with soft tissue fillers. As soft tissue filler are able to create volume for wrinkle, facial folds, lips and lines treatments, you are able to see immediate results.
What are the side effects of soft tissue fillers?
With recent technological breakthroughs, new synthetic and natural filler substances have been created to reduce side effects such as allergic reactions, redness and occasional bruising, swelling, itching, minor lumps, or tenderness which usually resolves quickly. However that being said, one should be wary of the mentioned side effects and consult a dermatologist immediately.
What to expect from the treatment?
The duration of the treatment usually lasts nothing more than 30 minutes. Prior to the procedure, nerve blocks and local anesthetic creams could be used to minimize discomfort occurring during the procedure. An accredited and trained dermatologist will examine your face and then determine an exact location to inject the fillers to achieve optimal results.
Depending on the areas that are being treated, the depth of the lines, the condition of the skin and the lifestyle of the individual, soft tissue fillers can last up to approximately one year. For optimal results, patients may get their fillers topped up every six to nine months, or an alternative combination regime involving lasers can be discussed with your dermatologist for maintenance. Cosmeceuticals may also be used as adjuncts to maximise the benefits from filler procedures. Hyaluronic Acid for example, apart from being a constituent of fillers, can also be used in a topical form to enhance hydration and plumping effects on skin.
Known for her overtly luscious pout, Kylie Jenner has created a buzz around dermal fillers. For those who are looking to enhance their appearance without wanting to go under the knife or suffer the healing downtime drinking pumpkin soups, dermal fillers are an excellent semi-permanent and in some cases permanent option.
Propitious to give you more natural finish compared to botox, dermal fillers are gaining popularity amongst those seeking for youthful perfection. Instead of stopping the muscle movements resulting in wrinkles, dermal fillers aim to plump the skin to smooth out the wrinkles. This does not mean that botox does not have its benefits — read about it here. As both botox and dermal fillers function differently, a combination treatment allows you to walk out of your dermatologist’s office looking 10 years younger.
Types of Dermal Fillers
Setting out to give you a younger face, plumper lips and higher and even nose bridges, dermal fillers come in two different forms – synthetic and natural. Although naturally-derived fillers have a much smaller risk of causing an allergic reaction and risks of migration and lumping and are able to produce an immediate effect, they usually only last from three to 18 months
To maintain your desired result, you will need to go back in and get more fillers injected usually within a year. Synthetic fillers on the other hand, are more of a semi-permanent solution. However, since synthetic fillers provide a more permanent solution, potential allergies and risks of migration and lumping gets harder to correct. To avoid such risks, it is advised that you share your concerns and have a discussion with accredited dermatologist. For an instant youth rejuvenation, fillers are the way to go ladies.
Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email email@example.com. Alternatively, you may fill up our contact form here.