Part 1: Learning From COVID-19 Vaccine Filler Reactions

Experienced injectors have likely seen these reactions before from other immune system triggers and know how to manage them using antihistamines, anti-inflammatories and, in some cases, systemic steroids in short course, she says.

Additionally, physicians should continue to encourage patients to get vaccinated in accordance with public health needs while continuing to stay vigilant of potential reactions and treatments.

Staying up to date and getting involved in vaccine reaction and adverse event reporting are key.

Currently, only hyaluronic acid fillers have been reported to be impacted in the vaccination trials, with reactions related only to the Moderna COVID-19 vaccine.

This could change as more data emerges during mass vaccination efforts.

Medical knowledge is only as good as the data reported, Kourosh says.

Providers and patients can use the institutional reporting systems in place to report reactions, including CDC’s v-safe 

, which helps consumers report adverse reactions to the vaccine with their smartphones. That same page also has links to other vaccine safety reporting resources, including the 

The American Academy of Dermatology also houses a COVID-19 registry on its 

Joe Niamtu, III, DMD, an oral and maxillofacial surgeon in Midlothian, Va., says his practice performs many dermal filler injections, but has yet to see a filler reaction from the COVID-19 vaccine.

“My personal take on it is this [reaction] affects a small number of people,” he says. “But we must understand these reactions if filler patients present with inflamed, painful or hardened areas.”

Niamtu explains to patients the potential risk of immunogenic response with the vaccine and recommends they space it, and other immune system triggers, at least two weeks before or after having dermal filler injections.

The only course of action Dr. Niamtu has doubts about is treating filler reactions post COVID-19 vaccination with oral steroids.

As for treatment options available for these reactions, he is hesitant to use oral steroids.

“I’m skeptical about that,” he says. “Steroids are a potent anti-inflammatory and the whole purpose of this vaccine is to set up an inflammatory response, more or less. You do not want to immunosuppress the vaccine. It has to do its job.”

Beleznay K, Carruthers JDA, Carruthers A, Mummert ME, Humphrey S. Delayed-onset nodules secondary to a smooth cohesive 20 mg/ml hyaluronic acid filler: cause and management. 

Rice SM, Ferree SD, Atanaskova Mesinkovska N, Shadi Kourosh A. The art of prevention: covid-19 vaccine preparedness for the dermatologist. 

International Journal of Women’s Dermatology

. Published online January 2021:S2352647521000083.

Articles

Arianne Shadi Kourosh, MD, MPH, and Joe Niamtu, III, DMD, discuss adverse event reporting resources for COVID-19 vaccine filler reactions and the potential treatments when they occur.

Management and Reporting COVID-19 Vaccine Filler Reactions

The evidence showing instance of three patients with a history of dermal filler injections reporting reactions, including facial or lip swelling after getting the Moderna COVID-19 vaccine, is a reminder that immunogenic dermal filler reactions happen.

Researchers studying delayed onset of inflammatory nodules after hyaluronic acid filler injections years before the pandemic, found nodules occurred in 0.5% of patients. Nearly 40% of those patients identified an immunologic trigger, such as flu-like illness, according to a 2015 paper published in 

Recent developments concerning filler reactions related to the vaccine highlight known instances of other vaccines activating the immune system, says dermatologist Arianne Shadi Kourosh, MD, MPH, director of the Community Health at Massachusetts General Hospital.

Aesthetic providers likely already incorporate the concept of immunogenicity when counseling patients for cosmetic procedures, according to Kourosh. The provider might ask, for example, about a history of cold sores, which are due to viral infection, or if a patient was ill in the weeks before a procedure.

“If a person had a recent infection in the mouth, a sinus infection or upper respiratory infection, it could affect their immune reactivity to other stimuli, such as fillers,” says Kourosh, author of the paper “The Art of Prevention: COVID-19 Vaccine Preparedness for the Dermatologist,” recently published in the 

Providers and patients should maximize time between events that can activate the immune system.

“It may be advisable to counsel patients to plan their cosmetic procedures with a window of time of at least a few weeks before and after their COVID vaccination,” Kourosh says, continuing that many things can trigger or activate the immune system.

“It is suspected that the reactions to the fillers were actually nonspecific—just immunogenic activation of more than one thing activating the immune system at the same time,” she says.

Kourosh speculates the patient with a reported reaction in the vaccine trial, who had filler six months prior, had filler still remaining in the skin.

The body breaks down fillers with time, and some of the breakdown product remains in the skin and can ignite immune activation, according to Dr. Kourosh.

NEXT: Management and Reporting COVID-19 Vaccine Filler Reactions

The small incidence of COVID-19 vaccine-induced filler reactions have raised new concerns pertaining to immunogenic activation and how to minimize potential risks. 

Learning From COVID-19 Vaccine Filler Reactions

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Patient Safety Alert Issued Over Children Injecting HA Via “Hyaluron Pens”

ASDSA has issued a patient safety alert after videos surface online of children/teens self-injecting HA via “hyaluron pens”.

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The American Society for Dermatologic Surgery Association (ASDSA) has issued a patient safety alert

 of children self-injecting hyaluronic acid (HA) via pen have surfaced on social media.

Videos have appeared online of children buying and using “hyaluron pens” to inject hyaluronic acid filler into the epidermal and upper dermal layers of their skin, as well as promoting the use of these pens.

The pens are intended medical devices initially developed for insulin delivery, according to a press release from the organization. ASDSA states the use of air pressure technology causes the pens to deliver nano scale molecules of HA into the skin.

“Whenever considering any type of cosmetic procedure, consumers should always consult with a board-certified dermatologist to ensure they’re using the right treatment and avoid any adverse events,” said Mathew Avram, MD, JD, president of ASDSA. “Facial injections require an in-depth knowledge and expertise of anatomy and, when left to untrained consumers, pose the risk of serious injury.”

Marketing materials for these “hyaluron pens” claim that the devices are able to create volume and shape while lifting lips, nasolabial lines, marionette lines, 11 lines and forehead wrinkles.

They also claim the HA only reaches the papillary layer of the dermis, thus causing no occlusion and puncturing of blood vessels, essentially making this delivery method safe.

ASDSA members feel the risk of injury remains, according to the press release.

“TikTok is proving to be an extremely powerful platform to communicate, entertain and even educate, which is why many physicians are getting involved and finding success there,” said ASDS member Sandra Lee, MD, of Dr. Pimple Popper fame, in the release. “Unfortunately, just like the world wide web, there is misinformation there and even dangerous lies. It's very concerning to see young people posting a How-To on injecting their own lips with hyaluronic acid serum using an ‘airgun’ pen, which acts much like a BB gun to push with force the product under the skin. So many things can go wrong.”

According to the organization, ASDSA has contacted the FDA regarding its concern for the safety of these pens and has also alerted state medical and estheticians boards about patient safety concerns.

Consumers have been alerted directly through social media and other educational materials about the risks.

1. ASDSA Members Have Found Questionable Social Media Videos in Which Children Use Pens Designed for Insulin Delivery to Self-Inject Hyaluronic Acid. 

American Society for Dermatologic Surgery Association

Patient Safety Alert Issued Over Children Injecting HA via “Hyaluron Pens”

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