ORCID

Abstract

Sir, I write with reference to the letter (Br Dent J 2021; 231: 205) regarding the increase in dermal filler-related complications presenting in the Accident and Emergency department, as an oral and maxillofacial dental core trainee working in South West UK.In addition to vascular occlusion-related complications, other complications may present and I would like to highlight a few management options for colleagues faced with similar problems:1. Bruising/ecchymosis: This can be easily treated with the use of cold compresses, arnica, bromelin, aloe vera or vitamin K creams. Medications which can affect anticoagulation (eg vitamin/herbal supplements, NSAIDs and antiplatelets) should be paused for 7-10 days2. Swelling/oedema: Prophylaxis of this should include the use of anti-inflammatory enzymes, arnica/gelsenium/bromelin and cold compresses. Management of this complication can include the use of NSAIDs, short-term steroids and streptokinase/streptodornase in addition to prophylactic measures3. Erythema: The use of antihistamines, oral tetracycline or isotretinoin may be effective. Short-term use of topical medium-strength steroids can be helpful, with the aid of vitamin K cream4. Infection: This can be managed using co-amoxiclav or ciprofloxacin antibiotics. Second-line antibiotics such as cloxacillin, azithromycin, minocycline and flucloxacillin can also be used. Any abscesses should be drained and a microbiological culture is recommended5. Herpes activation: Patients with a history of cold sores should have anti-herpes medication prescribed prophylactically. In this instance, valaciclovir or aciclovir 1-2 days before and three days after the procedure is recommended6. Dysaesthesia/paraesthesia/anaesthesia: In the event of Bell's palsy, a short course of high-dose oral steroids may be beneficial7. Lumps/bumps: In the event that a non-inflammatory lump persists, treatment will include needle aspiration or a minimal stab wound incision with evacuation. Post-inflammation management may include hyaluronidase injections and intense pulsed light/laser, photo-protection or depigment cream8. Tyndall effect: Superficial placement of fillers can result in blanching and a bluish discolouration in the injection area. Management of this includes the use of local massage, incision and drainage and hyaluronidase injections9. Acute hypersensitivity: Antihistamines, NSAIDs, intralesional/systemic steroids, minocycline and hydroxychloroquine can be used to manage this complication. Hyaluronidase injections may also prove useful.In conclusion, I hope that the information above will prove beneficial to dental core trainees working in oral and maxillofacial surgery units when faced with the above complications.

DOI

10.1038/s41415-021-3628-1

Publication Date

2021-11-12

Publication Title

British Dental Journal

Volume

231

Issue

9

ISSN

0007-0610

Embargo Period

2023-02-23

First Page

533

Last Page

534

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