Plastic surgery concept. Hyaluronic acid injection

Hyaluronic acid is a natural substance found in the human body, primarily in the skin, connective tissues, and joints. Its remarkable ability to retain water molecules makes it a crucial component in products for maintaining skin hydration, volume, and elasticity.

The use of hyaluronic acid (HA) in the composition of cosmetics and injectables has become commonplace, offering patients effective solutions for enhancing their natural beauty. However, even with the proven safety and versatility of HA-based treatments, medical professionals must remain vigilant and informed about the potential side effects that can arise and the methods to prevent and manage them. So, let’s focus on the early signs of hyaluronic acid side effects in injectable treatments, how to detect them, and the appropriate course of action for medical professionals.

Types of Adverse Effects of Hyaluronic Acid

Here are some of the potential negative effects of HA injections:

Common and mild side effects:

  • Swelling – typically subsides within a few days but can persist for up to two weeks in some cases;
  • Bruising – is usually temporary and resolves within a week or two;
  • Temporary redness or erythema at the injection site – typically fades within a few hours to a few days;
  • Mild pain or discomfort may be present at the injection area immediately after the procedure but usually resolves quickly;
  • Itching at the injection site is relatively uncommon but can occur. It is typically mild and transient.

Less common hyaluronic acid reactions:

  • Small lumps or bumps may develop at or near the injection site. These are typically temporary and can often be massaged out by the healthcare provider;
  • Although rare, infection is a possible side effect. Its signs include redness, swelling, pain, and pus formation. Prompt medical attention is necessary if infection is suspected.

Rare and severe side effects:

  • Some individuals may develop allergic reactions to hyaluronic acid. Such cases require immediate medical attention;
  • In rare cases, hyaluronic acid fillers can inadvertently be injected into blood vessels, leading to vascular complications, which include skin discoloration, tissue damage, and, in extremely rare instances, necrosis (tissue death);
  • Small, firm nodules or granulomas can develop at the injection site. These irregularities are more challenging to resolve and may require additional treatment.

Despite the myths, HA has no adverse reactions in the case of oral intake as a food supplement. However, hyaluronic acid might have side effects on the liver for patients with liver diseases, as the increased levels of HA in their bloodstream can cause thrombosis. Such patients are contraindicated from using hyaluronic acid. That said, there is no evidence of any negative impacts on the health of the patients who don’t suffer from liver conditions.

Detecting Early Signs of Adverse Reactions

While hyaluronic acid products are generally well-tolerated, early signs of side effects can manifest in some patients. Timely recognition of these signs is crucial for effective management and patient safety. Here are some common early signs of reactions to hyaluronic acid to watch for:

  • Mild swelling around the injection site is quite common and typically resolves within a few days. However, excessive or persistent swelling may indicate a potential reaction.
  • Bruising can occur as a result of the injection process, especially if blood vessels are inadvertently punctured during the procedure. While minor bruising is expected, extensive or unexplained bruising may warrant further investigation.
  • Temporary redness and discomfort at the injection site are normal. However, persistent redness or severe distress should be monitored closely.
  • Small lumps or bumps may develop at or near the injection site. These are usually temporary and can often be massaged out by the healthcare provider.
  • Symptoms like itching, rash, hives, facial swelling, dizziness, or difficulty breathing are the signs of an allergic reaction to HA and require immediate medical attention.

Managing Hyaluronic Acid Reactions

Early detection of HA side effects is essential for their effective management. Here’s how healthcare professionals can approach and address these early signs:

  1. Begin by conducting a thorough patient assessment. Inquire about their medical history, allergies, and previous reactions to fillers. Assess the treated area for any concerning signs, for example, excessive swelling, bruising, or lumps.
  2. Any signs of an allergic reaction or severe adverse event require immediate attention. Administer the appropriate treatment, such as antihistamines or epinephrine, as needed. In cases of severe reactions, consider involving an allergist or immunologist.
  3. For mild to moderate side effects of hyaluronic acid, reassure the patient and explain that these symptoms are often temporary. Provide recommendations for at-home care, such as applying ice packs for reducing swelling and taking over-the-counter pain relievers for discomfort.
  4. Be prepared to administer hyaluronidase if necessary to dissolve excess filler or alleviate complications.

Aftercare and Prevention

In addition to effective management, aftercare and prevention measures are crucial in addressing hyaluronic acid side effects. There are several recommendations that may help medical professionals to achieve safe and satisfying treatments for their patients:

  • Patient education about post-treatment care, including avoiding strenuous activities, minimizing alcohol consumption, and protecting the treated area from excessive sun exposure.
  • Using proper dosages of hyaluronic acid preparations to avoid overcorrection and other related symptoms.
  • Follow-up appointments to track the patient’s progress and assess the resolution of side effects. This step is essential for ensuring the patient’s satisfaction and well-being.
  • Ensuring that the HA fillers are sourced from reputable and authentic suppliers like Medica Depot to minimize the risk of adverse reactions due to substandard products.

Conclusion

Addressing HA side effects is vital in providing safe and effective injectable treatments. By recognizing early signs of side effects, implementing appropriate management strategies, and offering compassionate patient care, doctors can navigate potential challenges and deliver positive patient outcomes.

By using preventive methods and proper patient education about the possible side effects of hyaluronic acid injections, medical professionals can ensure that patients receive the highest standard of care and achieve the aesthetic enhancements they desire while prioritizing their health and safety.

FAQ

Are hyaluronic acid fillers safe?

Hyaluronic acid dermal fillers are generally considered safe and well-tolerated when administered by qualified and trained healthcare professionals. However, like any injectable procedure, there can be potential negative effects and risks associated with using HA-based fillers. The severity and occurrence of those reactions can vary from person to person.

What happens if you use too much hyaluronic acid?

Using an excessive amount of hyaluronic acid filler can lead to several potential issues and complications:

  1. Overcorrection

Management: If overcorrection is noticed immediately after injection, the provider can gently massage the treated area to redistribute the filler. Depending on the situation, hyaluronidase may be administered to partially or completely reverse the effects of the hyaluronic filler. Multiple sessions of hyaluronidase may be required to achieve the desired correction.

  1. Swelling and Bruising

Management: Swelling and bruising are usually temporary and should resolve on their own within a few days. Cold compresses and arnica gel may help reduce these symptoms.

  1. Nodules and Bumps

Management: For these hyaluronic acid side effects, treatment may include massage and hyaluronidase injections.

  1. Vascular Complications

Management: Vascular complications require immediate medical attention. Treatment may involve the use of hyaluronidase, warm compresses, and, in severe cases, hyperbaric oxygen therapy or other interventions to restore blood flow and minimize tissue damage.

Healthcare professionals must exercise caution and adhere to recommended dosage guidelines when administering HA fillers, including Belotero, to avoid overcorrection and other problems.

Who should not take hyaluronic acid?

Some key contraindications for patients include:

  • Pregnancy and breastfeeding;
  • Known allergies to hyaluronic acid or any component of the HA-based drug used;
  • Active skin infections or inflammatory skin conditions in the treatment area;
  • Undergoing radiation therapy;
  • Scleroderma (a condition characterized by hardening of the skin and connective tissue);
  • Autoimmune diseases.

References

Philipp-Dormston WG, Goodman GJ, De Boulle K, et al. Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers. Plast Reconstr Surg Glob Open. 2020;8(4):e2730. Published 2020 Apr 29. doi:10.1097/GOX.0000000000002730.

Funt DK. Treatment of Delayed-onset Inflammatory Reactions to Hyaluronic Acid Filler: An Algorithmic Approach. Plast Reconstr Surg Glob Open. 2022;10(6):e4362. Published 2022 Jun 20. doi:10.1097/GOX.0000000000004362.

Keen MA. Hyaluronic Acid in Dermatology. Skinmed. 2017;15(6):441-448. Published 2017 Dec 1.

Vasvani S, Kulkarni P, Rawtani D. Hyaluronic acid: A review on its biology, aspects of drug delivery, route of administrations and a special emphasis on its approved marketed products and recent clinical studies. Int J Biol Macromol. 2020;151:1012-1029. doi:10.1016/j.ijbiomac.2019.11.066.

Walker K, Basehore BM, Goyal A, et al. Hyaluronic Acid. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482440/.

Eske J. Everything you need to know about hyaluronic acid. https://www.medicalnewstoday.com/articles/326385. Published June 26, 2023.

HYALURONIC ACID: overview, uses, side effects, precautions, interactions, dosing, and reviews. https://www.webmd.com/vitamins/ai/ingredientmono-1062/hyaluronic-acid.