Self-Injected Dermal Filler: Not a Good Idea

N Raoof, SM Salvi

N Raoof, SM Salvi
Self Injection of Dermal Filler: An Under-Diagnosed Entity?
Br J Dermatol 2014 Aug 11;[EPub Ahead of Print]

FillersABSTRACT
Dermal fillers are increasingly used by clinicians (and non-clinicians) in patients for facial rejuvenation as well as other aesthetic uses such as treatment of age related wrinkles, skin folds and depressed scars. We report the case of a patient who self injected dermal filler purchased over the internet and needed intervention for undesired effect. We would like to highlight the ease with which these devices can be purchased over the internet, the risks they pose and the necessity to regulate their administration.

EXPERT COMMENT
Ashish C Bhatia MD, FAAD

There are several dangers associated with self-injection of fillers and toxins purchased and injected by the lay person, including allergic reactions, granulomas, severe infections, blindness, embolism, and skin necrosis, just to name a few.
First and foremost, there is no telling what is in materials purchased from the black market. There have been reports of used syringes refilled with various substances ranging from industrial silicone to paraffin to hair gels. Injection of non-sterile fillers can lead to severe infections, while granulomas, necrosis, and severe allergic reactions can occur from injection of fillers neither approved nor tested. As a physician who has seen patients with severe reactions from unknown fillers, I know that it is very difficult to tackle the problem when the substance injected is unknown. As for toxins, paralysis needing hospitalization has occurred from injection of black-market botulinum toxin that actually had much more toxin than the commercially available FDA-approved botulinum toxins.
Second, improper technique of injections can lead to many issues as well. In this case report, it was simply lumpiness, edema, and erythema; however, injection with improper technique can lead to skin necrosis, embolism leading to blindness, as well as other conditions that a lay person would not be able to identify and correct.
Although injection technique videos make it look easy, there is a tremendous amount of knowledge and skill required to properly inject fillers and toxins. Complications can occur even when experienced injectors are performing the procedure; however, the difference is that the experienced injector can quickly identify and treat any potential issues. Additionally, an experienced injector will know the situations in which should not be done. "First, do no harm," is lost on the lay injector.

[Editor’s note: The following is a list of FDA-approved fillers accessed fromhttp://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/CosmeticDevices/WrinkleFillers/ucm227749.htm on August 15, 2014. This table lists all FDA-approved dermal fillers. It should be noted that not all of the dermal fillers listed below are currently marketed.]

Trade Name 

Material

Approved For

ZYDERM COLLAGEN IMPLANT

Collagen

Use in the dermis for correction of contour deficiencies of this soft tissue.

ZYPLAST(R)

Collagen

Use in mid to deep dermal tissues for correction of contour deficiencies.

FIBREL

Collagen

The correction of depressed cutaneous scars which are distendable by manual stretching of the scar borders.

RESTYLANE INJECTABLE GEL

Hyaluronic Acid

Injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

COSMODERM 1 HUMAN-BASED C

Collagen

Injection into the superficial papillary dermis for correction of soft tissue contour deficiencies, such as wrinkles and acne scars.

CAPTIQUE INJECTABLE GEL

Hyaluronic Acid

Injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

SCULPTRA

Poly-L-Lactic Acid (PLLA)

Restoration and/or correction of the signs of facial fat loss (facial lipoatrophy) in people with HIV.

HYLAFORM (HYLAN B GEL)

Modified hyaluronic acid derived from a bird (avian) source

Injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

RESTYLANE INJECTABLE GEL

Hyaluronic Acid

Injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

JUVEDERM 24HV, JUVEDERM 3

Hyaluronic Acid

Use in mid to deep dermis for correction of  moderate to severe facial wrinkles and folds (such as nasolabial folds).

ELEVESS

Hyaluronic Acid with Lidocaine

Use in mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

RADIESSE 1.3CC AND 0.3CC

Hydroxylapatite

Restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with HIV.

RADIESSE 1.3CC AND 0.3CC

Hydroxylapatite

Subdermal implantation for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

ARTEFILL

Polymethylmethacrylate Beads, Collagen and Lidocaine.

Use in facial tissue around the mouth (i.e., nasolabial folds).

PREVELLE SILK

Hyaluronic Acid with Lidocaine

Injection into the mid to deep dermis for correction of moderate to severe facial wrinkles and folds (such as nasolabial folds).

EVOLENCE COLLAGEN FILLER

Collagen

The correction of moderate to deep facial wrinkles and folds (such as nasolabial folds).

SCULPTRA AESTHETIC

Poly-L-Lactic Acid (PLLA)

Use in shallow to deep nasolabial fold contour deficiencies and other facial wrinkles.

RESTYLANE INJECTABLE GEL

Hyaluronic Acid

Lip augmentation in those over the age of 21 years.

BELOTERO BALANCE

Hyaluronic Acid

Injection into facial tissue to smooth wrinkles and folds, especially around the nose and mouth (nasolabial folds).

RESTYLANE-L INJECTABLE GEL

Hyaluronic Acid with Lidocaine

Injection into the mid to deep dermis for correction of moderate to severe facial wrinkles/folds (such as nasolabial folds) and for lip augmentation in those over the age of 21 years.

RESTYLANE SILK

Hyaluronic Acid with Lidocaine

Indicated for lip augmentation and dermal implantation for correction of perioral rhytids (wrinkles around the lips) in patients over the age of 21.

JUVEDERM VOLUMNA XC

Hyaluronic Acid with Lidocaine

Indicated for deep (subcutaneous and/or supraperiosteal) injection for cheek augmentation to correct age-related volume deficit in the mid-face in adults over the age of 21.