TikTokers Shine Light on Use of Cosmetic Fillers

When we think of TikTok, fun dances, workout moves and possibly ill-advised “challenges,” like eating Tide pods, usually come to mind. But recently, users have been uploading videos showing the potential side effects of facial fillers. Videos, like the one here, demonstrate that facial fillers are “migrating” after treatment and causing unwanted results. 

@reneesdaysWell this is going to be a process #lipinjection#ohno#lipinjectons#juvedermlips#badlipinjections#fixitskincare♬ Oh No – Kreepa

Botox and other facial fillers were once used primarily by older patients to treat deep wrinkles and volume loss or by trauma victims to reshape and heal scars. Now they have become more popular with younger patients looking to prevent signs of aging or enhance features like lips and cheeks. The New York Times reported on the recent trend of patients in their 20s and 30s seeking the treatments before wrinkles set in.

Botox

Derived from neurotoxins, Botox is a brand name that many of us use to refer to a class of treatments injected into the skin to smooth wrinkles. “Botox is the original brand name product by Allergan and was the first on the market to fight wrinkles. Most people refer to the treatment as “Botox,” even when a different product may be used. In the US, we also have FDA-approved [Food and Drug Administration] neurotoxins: Dysport, Xeomin and, most recently, one Jeuveau,” says Olga Bachilo, owner and surgeon at Glamour Plastic Surgery and Med Spa outside Houston. Since the treatment relaxes muscles, it can also be used to prevent migraines and muscle spasms.

In most cases, the treatment is quick. Vincent Wong, MB, ChB, a nonsurgical cosmetics doctor in London, England, explains that the injections usually feel like a quick scratch. To treat just one or two facial areas takes only about 10minutes, he says. The effects of Botox, aesthetic or otherwise, are temporary. If you want  to maintain those effects, you need regular treatments every few months. 

Side effects of Botox

Redness

Swelling

Bruising

Eyelid or eyebrow drooping

Bone loss *

*Animal studies have suggested that Botox injections may lead to bone loss over time, but it’s still unclear if this outcome is true for humans, too.

Toxin Spreading

What you can do

If you have an important event to attend, make sure to schedule your treatment at least two weeks in advance, so that any bruising or swelling has time to heal. You can also treat any pain by taking Tylenol and applying ice to the affected area.

When to see a doctor

Botox contains a warning on the box addressing the possibility that the toxin will spread within hours or even weeks after the injection. The effect is rare, but it can be fatal. It’s crucial to seek emergency medical attention if you experience muscle weakness, visual disturbances, incontinence or difficulty speaking, swallowing or breathing.

Fillers

As we age, we all gradually lose some volume in our faces. Certain conditions, like HIV or severe burns, can expedite that process. As the name suggests, fillers are used to fill in the spaces where you’ve lost volume to help retain a youthful appearance, or even to add extra oomph to features like your lips. The injections can be beneficial for transgender patients managing body dysphoria, because depending on where the fillers are placed, they can contribute to “masculinization” or “feminization” of the face.

Fillers can be made of four different materials: collagen, hyaluronic acid, calcium hydroxyapatite or poly-L-lactic acid (PLLA). Hyaluronic acid is a chemical naturally produced in your skin. As you age, you produce less of it. Hyaluronic acid-based fillers, which make up the majority of fillers used, according to Bachilo, help replace it. Calcium-based fillers are a bit firmer than hyaluronic acid and generally used in the cheeks.

Over time, your body absorbs the materials in the facial fillers, so you need more injections if you want to maintain the look long-term. Hyaluronic acid and calcium hydroxyapatite fillers last six months to two years, whereas collagen and PLLA fillers are effective for about five years. Only one type of permanent filler, made with polymethylmethacrylate beads, has been approved by the FDA. The beads are not absorbed into the tissue and the treatment is only designed for use around the mouth.

Be sure to ask your doctor about their level of experience in delivering the treatment, as well as the scientific details of the product he or she plans to use on you. Fillers are regulated by the FDA as medical devices, but not all variations have been evaluated and approved for safety. For example, the popular filler Juvederm is approved by the FDA, but the same company also makes Juvederm Ultra 2, 3 and 4, which are not. The FDA also warns that fillers are not approved to reshape larger parts of your body such as muscle, butt or breasts.

You can find the names of all of the FDA-approved dermal fillers here, by entering the product code LMH in the designated box. You can also search the names of brands.

Wong explains a concern for transgender patients is that, if you’re using hormone therapy to treat body dysphoria, it’s important to balance the severity of your dysphoria with the fillers’ effects. If you recently started taking the hormones, he suggests keeping the fillers as minimal as possible, because your face will continue to change from the hormones. Once you’ve been taking the hormones for a while, you can add more filler. “It’s very important to understand the extent of the dysphoria,” says Wong, and only to alter  as much as is necessary to manage the dysphoria to start. “The hormones are going to change the distribution of the soft tissue of the face and the skin quality. There’s no point [in] doing too much at the beginning stage.”

According to Wong, who has consulted with pharmaceutical companies on clinical trials, when receiving fillers, you feel more of a “pressure sensation” than a scratch. Before treatment, he usually applies a skin cream to  the area.

Side effects of fillers

Redness, swelling or bruising

Migration

Lumpy texture

Vascular occlusion (blockage of a blood vessel)

What you can do

On the day before your treatment, you should avoid alcohol and aspirin, which are both blood thinners. In advance, your doctor should also review your other medicines with you.

Swelling and bruising should dissipate within a week. If you feel pain while recovering, you can treat it with ice or Tylenol, while continuing to avoid aspirin.

As the TikTok videos show, fillers can sometimes move. “If the products are injected superficially or in the wrong place for that or that product, migration can happen,” says Wong. “The other thing is the choice of products. There are so many brands in the world. And it’s important for doctors to understand the properties of each filler.”

If the filler is hyaluronic acid-based, there is an “antidote” that your physician can inject to dissolve the filler if it moves.

@killah.kotajust a part 1 PSA. The new studies coming out are wild. 💋💋 #lipfiller #lipfillercheck #botox #filleraddict #juvaderm #lip #cosmetic♬ original sound – karolina.byrgiel

When to call your doctor

A rare, but dangerous, side effect of facial fillers is vascular occlusion. If the fillers are injected incorrectly, they can enter the bloodstream and prevent blood from reaching your tissues, causing them to die. If your skin changes color, either turning whiter, darker or a new rash appears, call your doctor. “That’s when they need to come in and see me immediately, because that could be the first signs of occlusion,” adds Wong. If your physician is not available after-hours, you should go to the emergency room, because it’s important to receive treatment as quickly as possible.

Another reason to call your doctor is if you notice lumpiness where the filler was injected. This could be a sign of an immune reaction or that the filler was not injected correctly.

The use of fillers or neurotoxins to improve your appearance is, in many cases, a very personal decision. It’s crucial to take your time deciding to ensure that you’re completely comfortable with both the treatment being used and the doctor providing it. Most of all, Wong says, “Never let anyone tell you to change something or treat something that doesn’t bother you.”


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