Right after injections expected side effects include needle marks, swelling, and bruising. Using ice and avoiding blood thinning medications before hand will reduce this problem. Giving Arnica before the procedure can lessen bruising as well.
Hematoma (bleeding) under the eye
Hyaluronic acid fillers may cause hypersensitivity reactions appearing as several red tender nodules. There can be redness, itching, and painful swelling seen. Allergy to bovine collagen is seen in 3%. Therefore 2 skin tests are recommended before treatment. Necrosis is very rare, less than 0.001%. It can occur on the brow, cheeks, and lips. It occurs when filler is injected into a blood vessel and a patch of skin loses its blood supply and ulcerates or breaks down. Injection into an artery causes immediate pain and blanching. First, the injection is stopped. Massage may diffuse the product. Nitroglycerin paste and warm compresses can be applied to open up the vessel and hopefully reestablish circulation to the tissue. If skin breakdown occurs the wound needs antibiotic ointment, Vaseline and acetic acid soaks.
Another complication is blindness from filler injection into the retinal artery of the eye. Vision loss can be temporary or permanent.
Herpetic ulceration
Skin infection can occur so the area must be well prepped with alcohol. Antibiotics can be started 2 days before and kept on 3 days postop. Valacyclovir 500 mg 2 times a day can help prevent herpes activation. Bacteria like streptococcus and staphylococcus aureas can cause red single or multiple nodules. If nodules contain pus, it should be cultured and antibiotics tested on the bacteria isolated. Antobiotics used include Keflex, amoxicillin, Levaquin, Biaxin, and minocycline. If the nodules do not respond this may be an atypical mycobacterium. Biaxin 500 mg 2 times a day may treat this.
Misposition of the implant can occur. If placed too superficially collagen will give a whitish lesion. Hyaluronic acid fillers placed too shallow cause a bluish discolorization (Tyndall effect).
Tyndall effect
Injection of 15 units of hyaluronidase can dissolve the nodules away. A nodule may be nicked and filler expressed out. Some nodules will improve with steroid injection. Poly l lactic acid (Sculptra) can cause nodules as well.
Examples of skin nodules
Skin erosions following intravascular injections of fillers
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