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Fillers Blog

How Fillers Can Go Wrong, And How To Minimise Your Risk

August 29, 2019

As dermal fillers have increased in popularity across the globe, so have media reports of botched procedures, infections and even the risk of blindness. While the news media continues to produce examples of patients with botched procedures, social media is overflowing with images of full “Instagram lips” and celebrity procedures gone well. It can be difficult for the average person to get a clear view of the bigger picture. We asked our Principal Nurse Robyn Cussell for some expert advice to empower you with the right information to form an educated opinion and make a safe decision.

What problems can occur with dermal fillers?

Our Principal Nurse Robyn Cussell explains that problems occur when a blood vessel is occluded by filler. “Wherever you inject filler, you have to avoid the blood vessels,” she says. Occlusion of a blood vessel can lead to abnormal swelling, necrosis, and if the filler occludes an artery vessel that feeds the eye, blindness.

According to Nurse Cussell, cases of blindness caused by dermal fillers are rare, but they’re often the focus of news media reports, possibly because they’re the cases that sound the most frightening. News.com recently reported 200 cases of blindness1 but neglected to mention that number represents 200 cases worldwide over 18 years (2000-2018)2. This is a small percentage considering that 2.6 million filler treatments were performed in 2016 in America alone3.

To minimise risk, experience and preparedness are tantamount for any injector, Nurse Cussell advises.

Dermal fillers are classified by the Therapeutic Goods Association (TGA) as a Schedule 4 substance, meaning that you must consult a doctor for safety reasons before getting a treatment. A nurse can provide the treatment, but only after consultation and assessment with a doctor. In your consultation, it’s a good idea to ask how much training and experience your provider has.

Nurse Cussell advises that a doctor or nurse with more experience will be more discerning, more familiar with the anatomy of the face and be able to take better care to avoid the vessel. An experienced injector will also be better equipped to recognise and treat an occlusion if it were to happen.

There is another injectable product that is used to dissolve dermal filler (due to TGA regulations we are not able to publish the name, but you are welcome to ask about it in consultation with a doctor), and Nurse Robyn insists that every injector should have it on hand in case of a possible occlusion. Additionally, she insists that no injector should be treating clients without thorough training and experience gained through shadowing with an expert and significant amounts of supervised practice.

How do problems happen?

The popularity of dermal fillers has somewhat eclipsed the fact that they are a medical procedure. “Many Australians incorrectly believe that procedures involving dermal fillers are beauty treatments, in the same category as facials…The public needs protection from untrained, inexperienced, ‘occasional’ practitioners offering cosmetic procedures who do not understand the high-risk areas of the face,” Dr Irene Kushelew, President of the Australiasian College of Cosmetic Surgery, said in a media release4.

News.com recently reported that a woman who went to a popular laser clinic chain was horrified when her injecting nurse had a brief skype chat with the doctor before going ahead with treatment5, and this is not the first time we’ve heard of this happening.

According to The Age, many problems in Australia have also been caused by unregistered clinics and undertrained injectors who put their clients at risk6.

Although dermal fillers themselves are regulated by the TGA, there is no regulation on the level of training and experience a doctor or nurse requires to be able to deliver injectable treatments. According to Dr Kushelew, “Many practitioners undergo a one or two-day training course only for cosmetic injectables — this is simply not adequate.”7

Nurse Cussell strongly believes that “regulation cannot come soon enough.” At Rejuvenation Clinics of Australia all of our doctors and nurses spend significant amounts of time shadowing our more experienced doctors and participating in regular training sessions to ensure your safety as clients. We would like to see it mandated that all clinics take training so seriously.

How can you minimise your risk with dermal fillers?

Until further regulation comes in, there are steps you can take to minimise your own risk, and resources out there to help you.

We highly recommend going to clinics that offer consultations as a separate appointment so that you have time to ask about the risks and benefits of your procedure, and you’re able to think about your decision before going ahead.

Avoid clinics where your doctor only appears over skype for a quick token chat. You need to see a doctor in person before having dermal fillers for the first time. If a clinic takes this shortcut in consulting clients, you might also wonder if they’re taking shortcuts somewhere else.

The TGA and APHRA have some excellent resources as well. You can look up doctors to see if they’re registered to practice in Australia and if there are any formal complaints against them. The TGA has published a helpful factsheet on dermal fillers with a list of recommended questions to ask in consultation, such as how much experience your injector has and what the risks and benefits of your specific treatment may be. Remember, you’re not obliged to go ahead with treatment just because you had a consultation. Wait until you find an injector you’re comfortable with, and you feel confident going ahead yourself.

Closing thoughts

When administered well, dermal fillers can have benefits. Many of our clients feel refreshed when they see youthful volume restored to their faces. Some get really excited about their new lips while others, whose lips have thinned with age, feel relieved to get their lips back. All the benefits aside, fillers are a medical procedure, so it’s important to be well-informed about the risks and how to proceed safely.

  1. https://www.news.com.au/lifestyle/health/health-problems/200-people-report-blindness-after-botched-dermal-filler-procedures/news-story/767a0e119aaaf61d6995c1c5d999fcf0
  2. https://journals.lww.com/prsgo/Fulltext/2019/04000/Soft_tissue_Filler_associated_Blindness__A.1.aspx
  3. https://d2wirczt3b6wjm.cloudfront.net/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf
  4. https://www.accs.org.au/download/?id=media&doc=126
  5. https://www.news.com.au/lifestyle/health/health-problems/200-people-report-blindness-after-botched-dermal-filler-procedures/news-story/767a0e119aaaf61d6995c1c5d999fcf0
  6. https://www.theage.com.au/national/victoria/plastic-surgeons-forced-to-fix-rising-tide-of-botched-cosmetic-procedures-20190730-p52c5h.html
  7. https://www.accs.org.au/download/?id=media&doc=126

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