Within the last 10-15 years, injectable procedures have become very popular in aesthetic medicine. Eastern Europe started from mesotherapy (and this technique is still very popular) and significantly increased usage of botulinum toxins, fillers and lipolitics.

According to statistical data calculated in Aesthetic Consilium (a project which helps with complication resolution), about 70 % of all complications relate to filler injections and among them about 80% happened after injections of Hyaluronic acid.

However, it is possible to divide all injectable complications into four categories:

- Following Botulinum toxins injections

- Following mesotherapy

- Following fillers

- Following lipolitics

Among the above mentioned there are some common complications and adverse events related to injection itself. They include:

- Pain (normally prevented by local anesthesia)

- Hematoma (Using cannula is the one way to avoid this complication)

Others complications are related to the product being injected or the techniques being used.

For the botulinum toxin injections, common complications are:

- Edema (related to weakness of muscles and followed decrease of lymphatic flow). The most common place of edema is the area around eyes. Normally treated with diuretics treatment.

- Ptosis. Related to muscles weakness. The most common are brow ptosis and upper eyelid ptosis.

For the mesotherapy complication, it is related to the product that was injected. Some products, being poorly cleaned, can cause toxic or allergic reactions. Some of these reactions are hypersensitivity and happen after several injections of the same product.

Fillers can cause complications related to compromised vessels (ischemia or hematoma) and are related to the interaction between tissues and product (granuloma). Sometimes bacterial infection can join the filler leading to bacterial inflammation. Knowledge of anatomy and using some practical tips lower the possibility of vascular damage. One of these tips is using a cannula whenever possible. In case of suspicion of ischemia, it is useful to check arterial flow by pressing skin in distal area with following evaluation of white spot duration. When hyaluronic acid is used as a filler, it is possible to dissolve it with a hyaluronidase injection. According to latest research, hyaluronidase solution should be injected until attaining positive clinical dynamics.

Injection of poorly cleaned filler or fake product may cause granuloma as an immunological reaction.

It is very difficult to treat granulomas completely. For this purpose steroids are commonly used, but sometimes surgery is needed.

Treatment of edema requires diuretics and manual lymph drainage. Sometimes using hyaluronidase injection is the only effective treatment.

Dr Rudenko is one of the topic coordinators for IMCAS Academy's new service, IMCAS Alert.