Just last week I operated on a wonderful woman who is educated, sophisticated and very well connected. So well connected, in fact, that she somehow found her way to a“doctor” from South America who was injecting “some type of new filler” into the faces of her friends. With nothing more than the trust in her friends judgment she went ahead and had her face injected in a hotel room by this foreign “injector doc” in Manhattan. There were several treatment sessions and the product was placed behind her jaw line and in her cheeks in an attempt to “lift” the face. There were no complications such as infection or necrosis but over time the product became larger and more firm. The net result was facial asymmetry, firm palpable, and to some degree visible, lumps and a face that seemed overall masculine and too large. At surgery I encountered large areas of a yellow-gray looking substance under the skin and even into the deeper tissues. This material was extremely firm and stuck to all the surrounding tissues. Its removal was quite challenging; with extra care being taken to avoid injuring any nerves and to preventing creation of any dents or holes from loss of its volume. Ultimately I removed more than a Dixie cup full of this synthetic material and was able to achieve a very nice result. One of the reasons this patient looked so good post operatively was because of the removal of so much volume.
Unfortunately this is not the first time I have been presented with this scenario and it is unlikely to be the last. Throughout the world there are a myriad of materials that are used to rejuvenate the face. Our FDA has approved only a few such fillers and only after rigorous testing to ensure safety. Even those fillers that have been passed by the FDA for wrinkles are not actually approved for volumizing the face: Deep injections to plump up the face are being done at the doctor’s discretion and “off label”. While I am comfortable injecting FDA approved fillers for all types of “off label” indications, I avoid ever injecting non-FDA approved products. Often there is an initial “buzz” about products from other countries and how safe and effective they are. There is usually some charlatan out there to take advantage of the media hype and they begin injecting these fillers in secret (because of their illegality) which only adds to their exclusiveness and allure. I implore you to avoid such scenarios no matter how “great” the doctor doing the injections is or how much you trust your very astute friends. This story is repeated almost every 3 years and the ending is always the same; trouble. A few years after the filler materials are touted as safe and permanent, stories begin surfacing of inflammatory reactions, unsightly sores, lumps, bumps, redness and pain. Given how safe and effective the current approved fillers are in the USA there is no reason to risk permanent health problems or disfigurement by using unknown or unapproved substances; even if your best friend does it and “she looks great”….Just don’t do it!