Is hyaluronic acid filler safe?

Whether you’ve decided to go down a natural aging route, or you are interested in clinical interventions like filler or even surgery, we can all agree on one thing.

Whatever the route, we all want to stay safe and healthy and there have been quite a few scary headlines over the past six months around hyaluronic acid filler treatments in particular and whether they could pose health risks. 

So I invited two aesthetic specialists, Dr Qian Xu, medical director of Clinicity London, and Dr Emmaline Ashley, an award-winning practitioner based in the Cayman Islands, to discuss the safety concerns.

Does hyaluronic acid filler block lymph nodes?

We’ve seen some discussion in the media and social media more widely about a warning from a team of doctors from the US.

The alert was sounded in a presentation to the Annual Scientific Conference of the British Association of Aesthetic Plastic Surgeons in London.

The doctors were concerned that hyaluronic acid filler could cause blockage of the lymph nodes. They play an important part in our immune system because they help the body identify and get rid of toxins and cancer cells.  

Dr Emmaline had this to say about the warning.

“Like anything in medicine or science these conversations require a little bit of nuance and context.

“The research presented was purely looking at excessive filler and stating that excessive filler has the potential to block lymphatic systems.

“So looking specifically at how overfilled faces may lead to lymphatic blockage is a world away from linking the safe use of appropriately placed filler by a medical professional to cancer.  

“I think any clinician who’s ever had filler or demonstrated or administered filler does understand that there is a potential side effect of swelling, and it’s usually temporary. If persistent, filler usually can be dissolved.

“The President of the British Association of Aesthetic Plastic Surgeons came out and said, people don’t need to panic and have fillers dissolved. This is preliminary research that gives an explanation for side effects that we know about with fillers.  

“Another consultant dermatologist came out to the press and said there’s zero scientific foundation that fillers are directly impacting the immune system, leading to increased cancer risk. So it was a sensational headline. And of course, it got attention.

“These types of things, I do struggle with them because I think they can be a little bit irresponsible when they’re spread without having that conversation around it. Because it does scare people and it is quite frightening.” 

Under-eye filler flagged as a particular concern

The team of doctors who presented their concerns around excessive use of injectable hyaluronic acid and its potential to block lymph nodes, flagged that the under-eye area could be particularly hazardous.  

Dr Qian explains.

“So generally under eye filler or tear trough filler is a lot more risky compared to some other areas because that area around the eyes is highly vascular. There are nerves there that are more prone to damage.

“So with lymphatic blockage, I don’t think filler – because it’s such a large molecule – I don’t think it can actually get into the lymphatic system as such.  

“But usually [blockage] would be from large amounts of filler around the lymphatic system and causing compression from outside.

“So when you have too much filler in one area, there’s a lot of pressure within the tissues, and that then compresses on everything in that area, not just the lymphatic system, but also veins, arteries in those areas.”

Patient selection is key to safety

Dr Qian added: “I am extremely picky about who I would do this [under eye filler] treatment for, and the technique used to treat this area also is very important. Theoretically we can also cause damage to the lymph vessels by actually doing the injection itself. Any damage to the lymphatic system can then lead to blockage potentially as well.  

“So it’s more common for that area to become more swollen after the treatment. And for some people that can persist, which is then very difficult to reverse.

“In practice, in the patients that I choose to treat, I’ve not seen problems treating this area. But I have seen people who have had these treatments done elsewhere before. And then they tell me about the problems that they’ve had. And I see puffiness, worsening of the eye bags.  

“That’s really why we have to be careful.”

Watch the full discussion around hyaluronic acid filler safety and the alternative, including biostimulators and polynucleotides.