Managing hyaluronic acid filler complications in patients with skin of color
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Key takeaways:
- 90% of filler complications are caused by poor technique.
- Patients with skin of color respond best to fillers when a finer-gauge needle is used.
NEW YORK — Patients with skin of color may experience more reactions to hyaluronic acid fillers than collagen, leading to a need for guidance in managing filler complications, according to a speaker here.
When it comes to complications from dermal fillers, “90% of the technique is the problem, 10% is the product,” Cheryl M. Burgess, MD, FAAD, medical director at Center for Dermatology and Dermatologic Surgery in Washington, D.C., and member of the board of directors of the American Academy of Dermatology and the Skin of Color Society, said during her presentation at the Skin of Color Update 2023 meeting.
However, hyaluronic acid (HA) fillers may be a different story.
“I’ve noticed that in my [patients with] skin of color, I’ve had more reactions to HA than I’ve ever seen when I used to do collagen,” Burgess said.
Thankfully, these complications can mainly be mitigated through technique, Burgess continued. She explained that the best way to reduce the risk for HA filler complications is to slow down the filler injections and watch for signs of pain. If a patient is experiencing sudden, excruciating pain that is ignored, it could lead to necrosis.
Using finer-gauge needles — such as a 30-gauge that is longer than 1 inch — in areas such as the infraorbital hollows is also helpful to avoid complications such as necrosis, particularly for patients with skin of color, Burgess added.
According to Burgess, if the skin also exhibits blanching, immediately use a topical or systemic vasodilator and give the patient Viagra (sildenafil, Pfizer), whether they are a man or a woman, as it will open the blood vessels.
Using hyaluronidase, an enzyme that dissolves HA, can also help reverse the unwanted effects of HA filler, Burgess said. Hyaluronidase can be used to manage milder complications such as an overcorrection or serious complications such as blindness within 90 minutes of the first signs of impaired vision.
According to Burgess, compiling an emergency kit of these materials can help in the management of dermal filler complications.