Does Hyaluronic Acid Filler Expand and Interfere with the Lymphatic System?
The recent discussions about hyaluronic acid (HA) fillers expanding under the skin and potentially blocking lymphatic drainage have gained traction due to growing concerns in the cosmetic community. While HA fillers are generally considered safe, there are rare but serious complications. These include the possibility of fillers expanding due to their hygroscopic nature (ability to attract water), which could lead to pressure on lymphatic vessels, causing issues like swelling or lymphatic obstruction. This topic became trending as more individuals and experts started sharing case reports and personal experiences online, highlighting these potential risks. Aesthetic practitioner and Teoxane ambassador, Dr Elle Reid breaks down the impact of HA fillers on (and under) the skin.
Before we consider whether Hyaluronic Acid (HA) Fillers affect the lymphatic drainage system, let’s define what both HA fillers and the lymphatic system are. HA fillers dominate the UK, and global filler market, favoured for their immediate and natural treatment outcomes, long lasting but non-permanent results and reversibility due enzymatic breakdown. Our lymphatic system could be best described as our bodies drainage system, acting as a key component of the immune system to fight disease. Recently, there has been an increased awareness of how HA fillers can affect the lymphatic system and in September 2023 the British Associations of Aesthetic Plastic Surgeons (BAAPS) raised caution surrounding this fact.
How so?
The main area of concern related to HA fillers’ interference with the lymphatic system is the malar region. This is best described as the area between the tear trough and the side of the cheek. Swelling to the malar region, known as malar oedema, is the collection of fluid between the eye and cheek region and can be a common complication following treatment of the tear trough region using dermal fillers. However, it can also be present as part of the natural ageing process as lymphatic drainage slows down with age or as a result of allergies, sinus inflammation or simply be hereditary. So why is this area so susceptible to swelling and problems with lymphatics after treatment? It comes down to the already tricky anatomy in this region that separates the deep and shallow areas of the face which means, even without treatment we have poor lymphatic drainage in this area. It is for this reason why individuals find they can look ‘puffy eyed’ after a bad night’s sleep or excessive crying. Due to the water loving nature of HA filler, if they are inadvertently placed too shallow in this region then they may impede further of lymphatic drainage. Alternatively, using too much or too thicker HA filler in the deeper layers in this area may also have the same effect.
How can I avoid any adverse effects?
Safe treatment and good outcomes always comes down to finding an experienced and ethical practitioner who will conduct a thorough consultation prior to treatment, more than ever, seeking treatment from a practitioner who is medically qualified is vitally important. The eye and malar region is a hugely complex area anatomically; a thorough understanding of the plains, compartments and challenges in this area is paramount. Don’t be offended if your practitioner says no to treatment. At Paragon Aesthetics we have a very high threshold for selection criteria for patients whom we deem to suitable for cheek and tear trough treatment. If you are prone to allergies, sinus issues or puffy eyes in the morning this should give an indication that you may not be appropriate, but your practitioner will also likely screen for this during a consultation. Ensuring your practitioner is sufficient trained in treatment techniques and product selection are as equally important.
Does it have any correlation to filler migration?
Potentially. As discussed earlier, one element that can lead to malar oedema or interference with lymphatics drainage is filler ending up in the wrong place. Filler migration is defined as the process of filler spreading to another place beyond the site of injection. Though, most reported to affect the lip region, it can happen in any anatomical area of the face. There are lots of theories as to why migration occurs, but the most accepted reasons are:
Incorrect depth of placement
Over correction of an area
‘Build up’ of filler in an area due to repeat treatment that can cause filler to last longer than its intended benefit.
However, regardless of the cause, due to the delicate nature of the under eye and malar region, migrated filler can have the potential to end up where it was not intended and interfere with lymphatic drainage.
How is the best way to avoid this?
Recently there has been a shift in practitioners favouring ultrasound guided product placement. This uses ultrasound technology to know exactly where filler is being placed to ensure correct depth of placement. However, it’s not necessity and many experienced practitioners still choose to work without this aid and instead working with a thorough consultation prior to treatment. Your practitioner should carry out a thorough examination of the treatment area to attain whether you may be appropriate, looking at the tightness of skin, visible puffiness prior to treatment, cheek volume and presence of eye bags. They will want to know about previous treatment history including if the area has been treated before, how many times, over what period and with what product. Attaining this information can assist in screening whether you may be at risk for filler migration and subsequently issues after treatment.
