Did you know that it’s possible to react to your dermal filler months post treatment? Well I didn’t, until it happened to me. It was a Friday night, and I was in bed watching Netflix and feeling a little lame for not starting my weekend out with friends.

I had, however, been sick with the flu for a couple of weeks and was frankly still a little exhausted. But while I had plans to binge-watch the whole season of Love is Blind, my body had other ideas.

Out of nowhere, the skin on the right side of my bottom lip began to feel tight and sore. "That’s odd," I thought but wasn’t overly worried, until I went to make myself a cup of tea and caught my reflection in the hallway mirror. The corner of my lip looked like it was going to burst, and my right cheek from the centre up and out over my cheekbone had doubled in size.

I had no idea what was going on, but suspected it had something to do with my dermal filler. Though how that could be exactly, baffled me. It had been years since I had filler subtly placed on the outer corners of my bottom lip to enhance the shape, and it had been almost as long since I’d had it placed along my cheekbone for added definition.

“Over the last decade, hyaluronic acid (HA)-based dermal fillers have become one of the most requested aesthetic procedures, thanks to their ability to offer non-surgical options to address lines and wrinkles, as well as help plump, define and contour areas of the face," shares Marwa Ali, resident Aesthetic Doctor at The Wellness Clinic, Harrods, London. "Part of the appeal of dermal filler is that when performed by an experienced medical professional and with the right pre and post care, side effects are generally mild and transient.”

But what of the not so mild and transient effects? “While rare, people can experience a late onset inflammatory response to hyaluronic acid-based dermal fillers," says Ali. "This presents as induration (a thickening and hardening of the skin), erythema (redness) and oedema (an accumulation of fluid that causes swelling). Late onset reactions typically occur at least three months post treatment, though studies have recorded individuals experiencing an inflammatory response over a year after getting HA dermal fillers.”

An expert diagnosis 

As it was late on a Friday night, and with the fear that perhaps this reaction could escalate into anaphylaxis—though I was reassured later that this would be even more rare—I had no choice but to hotfoot it to A&E. With NHS doctors having very little or absolutely no training in complications that can arise due to aesthetic procedures, I made sure to contact Ali, one of my trusted aesthetic practitioners to get her opinion and to find out what treatment I needed.

“I would always advise patients that have any kind of reaction to contact the medical professional who administered the dermal filler and get them to remove it as soon as possible," says Ali. "However, other methods of treatment would include taking antihistamines, either alone or alongside oral steroids."

Thankfully I was armed with Ali’s sage advice, and my A&E doctor was also able to consult over the phone with a senior member of staff who had some experience in aesthetic medicine. After seven hours of waiting to be seen, I was sent home with antihistamines and oral steroids which I took for a week— slowly the swelling went down, and my face began to look normal again.

Both the senior doctor and Dr Ali were surprised that it had been five years since I'd had filler in my lips, and over three since I'd had any placed in my face, but it just goes to show that recent studies showing that filler remains in the body for much longer than advertised are not wrong.

Post treatment, I had to consider whether I wanted to remove the filler I had left with hyaluronidase, an enzyme that can be injected into the face to breakdown HA dermal fillers, or leave it alone and hope I didn’t get another reaction. To help me make my mind up, I reached out to Ali to understand how this happened in the first place.

“It’s not completely understood why such delayed reactions can occur in a small group of patients," she explained. "However, there are some factors that the aesthetic medicine community believe could be contributing to those experiencing this rare side effect. For example, how much dermal filler a person has, how often filler was administered, the composition of the filler, i.e. what other ingredients the dermal filler contains, and if the HA is of a low molecular weight."

She explained that like me, many people have reported having viral infections in the days leading up to their late-onset inflammatory response, while others have had existing autoimmune diseases—both can trigger a hypersensitivity to foreign bodies.

What I found most interesting was that other areas where I’d had dermal filler placed more recently, namely my chin, saw no swelling whatsoever, which left me wondering whether some formulas were better suited to me than others.

The purity of the HA, and the technology used to manufacture the dermal filler, can vary from one brand to another. Ali explained that it would be hard to determine if any of these variations had been a factor, although she did stress the importance of seeing a reputable practitioner who uses FDA-approved dermal fillers, otherwise one could most certainly run the risk of complications.
 
Ultimately, since I had been ill for two weeks prior to my reaction and hadn’t ever had any issues before, I decided to keep my dermal filler where it was. However, if I do fall foul of this condition again, I will have to seriously consider removing it.