Aesthetic medicine, there is the emergency room for the “wrong” fillers


It’s easy to tell fillersbut that’s not all touch up are successful or cause no undesirable effects. And who thinks about these mishaps? In Rome, at the Fatebenefratelli Isola Tiberina hospital, the “Complication management service” is active, directed by Dr. Emanuele Bartoletti.

«It was born more than 15 years ago, when we realized that the number of patients with problems deriving from aesthetic medicine treatments was increasing, difficult to solve by the same specialists who had performed them», the head of this department tells us, the doctor Glory Trocchi, which also coordinates the Aesthetic Medicine Outpatient Service. We asked her for some more clarification.

Have you experienced an increase in side effects in recent years?

There has been a 30-40% increase in complications, mainly linked to the use of fillers. The legislation in force imposes the use of absorbable products but in the past the permanent ones prevailed. Thus, reactions with infections and lumps may occur when the patient undergoes other adjustments without informing the physician that he/she first injected a nonabsorbable substance.

How do you recognize a reliable doctor?

He must explain to the patient the characteristics of the treatment, the way it is carried out, the risks, the methods of intervention in the event of problems, the side effects and recovery times. It is also essential to contact a professional specialized in aesthetic medicine. I wouldn’t choose it, therefore, only based on posts on social media.

Is there a postgraduate specialization?

Unfortunately there is no recognized specialization in aesthetic medicine but there are four-year post-graduate training courses such as that of the International School of Aesthetic Medicine of the Fatebenefratelli Foundation which has been active for over thirty years. The School also provides for an internship within the outpatient clinic. It is open exclusively to graduates in medicine and surgery, while graduates in dentistry are not authorized to follow this training course. They can only treat patients in the perioral area, to improve the aesthetics of the smile.

Is there also a patient responsibility for the development of complications?

The patient should provide the aesthetic doctor with precise data on his clinical history and inform him if he has had injection treatments before, especially if performed with permanent products. For this reason, it is essential to keep the coupon delivered after each filler operation, with an indication of the substance used.

Are there other factors that can lead to complications?

Yes. Those who wear make-up immediately after the treatment are more easily exposed to infections. Patients with particular immune pathologies may experience edema and inflammatory reactions and should not be treated. Even exposure to the sun immediately after retouching is a mistake that pays off. Other errors: getting the filler shortly after vaccination, when the immune system is stimulated, or during dental treatment. In these cases, it’s best to wait at least a couple of weeks.

What are the most frequent side effects?

A small blood transfer may occur, visible even 24 hours after treatment, but nodules, tissue ischemia may also occur (when the oxygenation of the treated area is reduced due to compression and that part of the tissue dies) and edema which manifests itself as swelling of the face. The most important complications, if recognized in time, can be treated and leave no results; otherwise, damage that is difficult to manage can be caused. As for the botulinum toxin, in the worst of situations, a temporary asymmetry of the eyelids can occur but it resolves itself in a few weeks.

Some effects are only transient, but…

After the treatment, small bruises, redness and swelling may occur but they last for a few hours. The nodules that appear immediately after the injection may be the result of an accumulation of the product which needs time to homogenize with the rest of the tissue. But if they are delayed, they require a series of tests to see if an abscess or granuloma has occurred.

How do you intervene when a patient arrives with a complication?

We have created a path. A visit is carried out with collection of the patient’s clinical history, physical examination, specific photographic and ultrasound evaluation. The latter uses high-frequency probes and makes it possible to establish whether there is an infection, an inflammatory reaction or if there is an excessive deposit of product; it also allows you to understand if permanent interventions have been carried out. The biggest problem is that patients often come to us without the coupon issued by the doctor indicating the medicine used. An ultrasound is then needed to establish whether it is hyaluronic acid or something else. Once the diagnosis is made, we move on to therapy.

Can you give us some examples of therapy?

If there is edema in the face, an intervention with cortisone or other active ingredients with anti-edema action can be evaluated. If an infection is in progress, antibiotics are used, while when there is an accumulation of the product, a drug that manages to fragment it and favor its reabsorption must be used. In the event that a patient arrives with an infection, we investigate, through appropriate tests, if there are other pathologies that may have favored the inflammation. The patient must be considered as a whole. Adverse events must then always be reported to the Ministry of Health.