Q-TIPS ON... COMPLICATIONS

This month, our columnist, cosmetic doctor, and founder of Luxe Skin Dr Usman Qureshi (aka Dr Q) looks at how to approach the complications that can arise from dermal fillers and thread lifts

The more widespread cosmetic treatments become, the more complications are becoming apparent. If a treatment has a complication rate of one in 1,000, it may be considered rare for one individual, but with millions of treatments being carried out worldwide, unwanted effects of treatments are a real problem. We all expect that side effects only happen to people who are not trained properly – the rogue injector. However, problems following any treatment are real, even in the best of hands. If you do enough procedures, you will encounter problems at some stage, so rather than panicking, I think we should be prepared for problems and have a strategy to deal with them when they happen. Here are some of the main problems you may encounter when dealing with dermal fillers and threads.

DERMAL FILLER COMPLICATIONS

Dermal fillers are one of the most widely performed procedures. With hundreds of different products available and a wide variety of injectors with varied skill levels, so problems are bound to occur. However, not every problem can be blamed on the injector. Some may be due to the product and others due to the way the patient’s body reacts to the filler. Whatever the reason for the problem, we as aestheticians, need to be able to deal with it.

Allergic Reaction – this can occasionally occur in the form of swelling or a rash. In mild cases, it will respond to antihistamines. In more severe cases you may need to use oral steroids and possibly adrenaline in the case of anaphylaxis. On some occasions, it may be necessary to dissolve the filler using hyaluronidase.

Infection – as with any procedure, there is a chance of infection. It is therefore paramount to carry out the procedure in a clean environment and disinfect the skin thoroughly before injection of the filler. Care needs to be taken not to contaminate the needle or cannula during the procedure. However, an infection can still occur and it is usually in the form of cellulitis, which responds well to oral penicillin or macrolides.

Overfilling or aggregation of filler – if the filler is injected too superficially or too large a volume is delivered, it can appear as a raised lump. Sometimes the filler can also aggregate forming a pea-sized, hard ball. Hyaluronidase works well by turning it into water which then gets absorbed. It usually settles within two days.

Granulomas – these are inflammatory nodules that appear as hard lumps. They often don’t disappear with hyaluronidase alone and require intralesional steroid injection. Often a few doses are needed for resolution.

Necrosis – this is the most serious of all complications and is a true emergency. It occurs when the filler is blocking an artery either due to a pressure effect or being in the lumen of the vessel. The tissue supplied by the artery starts to break down. Rapid revascularisation is needed with ample amounts of hyaluronidase. Subsequent infection may also result, requiring antibiotic treatment. A course of oral steroids may be needed to help with oedema.

THREAD LIFT COMPLICATIONS

Thread lifts are gaining momentum as they help improve facial ptosis and PDO cog threads can be implanted fairly quickly. Although they dissolve over time, they are subcutaneous implants and can cause issues. Here are the main ones:

Infection – as with any procedure, an infection can occur and normally responds well to penicillin and macrolides.

Superficial thread – if the thread is too superficial, it can be visible and cause puckering of the skin. The patient may also complain of a jagged feeling intermittently. This can be corrected by using a blunt cannula and embedding the thread deeper into the skin. If this is not successful then a small puncture can be made proximal to the thread and the end taken out and cut flush with the skin.

Very deep thread – athread placed too deeply can impact muscle movement and be very painful. It needs to be removed. It is often apparent while placing the thread, rather than days later, so it should be extracted at the time.

Hematoma – this can result from a ruptured vessel during implantation. Most hematomas will resolve by conservative management. Very rarely would it need to be excised.

Biofilm – this occurs when a collection of microorganisms attach to the surface of the thread and produce an extracellular matrix that protects them from the body’s defences. This makes them difficult to treat and poorly permeable to antibiotics. The biofilm appears as redness, swelling and tenderness along the track of the thread making the thread more visible. Ideally, the infected thread should be removed thus eradicating the source. However, this is sometimes very difficult. The infected area should be debrided by washing it out with saline thus reducing the bacterial load and breaking down their defences. This should be followed by high-dose antibiotics for at least two weeks. Penicillins tend not to penetrate through the biofilm. Quinolone and macrolides offer better defence in eradicating the infection.

As we set ourselves apart from non-medical practitioners through continuous training and perfecting our techniques, we should also instil confidence in our patients that should a problem occur we are well equipped in treating it and supporting them through the difficult time which invokes anxiety in both the patient and practitioner alike.

DR USMAN QURESHI

Dr Usman Qureshi (aka Dr Q) is a cosmetic doctor and founder of Luxe Skin by Doctor Q in Glasgow. He focuses on non-surgical and minimally invasive cosmetic procedures.