Can people with face or lip fillers safely get the COVID-19 vaccine shot?

According to the Food and Drug Administration advisory committee, the coronavirus vaccine may cause allergic reactions to people with face or lip fillers. Three aesthetic medicine practitioners share their perspective with Shriyal Sethumadhavan. 

“The effects of temporary fillers are easier to reverse.”

“The COVID-19 pandemic, which has taken the world by storm, is still far from over. The good news however as we all know, a bright ray of hope, is the global roll-out of several vaccines against the virus.

The advisory committee of the US Food and Drug Administration (FDA) on December 17, 2020, released a statement that the Moderna mRNA-1273 spike protein vaccine may cause side-effects in people with dermal fillers. This was due to the reporting of facial swelling in two and lip angioedema in one of the people in the Moderna vaccine trial. The FDA included this in the “Related Serious Adverse Event” (AE).

The release of this document has been quoted by some as one of the main tragedies of medical history. This news got aesthetic physicians and clients of dermal fillers anxious beyond reason. The panic led to many people who have taken dermal fillers wondering if they should take the vaccine or not. But are we really dealing with a serious AE?

All three patients were from the US and received the Moderna vaccine. Two patients developed facial swelling at the sites of prior dermal filler injections taken six months and two weeks prior. In both, the swelling began two days after the vaccine dose and was associated with erythema, pain, and tenderness. The patient who developed angioedema (swelling) of the lip, could not give a history of when lip filler was done. The filler material was hyaluronic acid in all. The swelling in all resolved completely without sequelae with simple medication of antihistamines and steroids. The explanation behind the same was a delayed immunologic reaction to the filler implant.

The reporting of these three cases in December 2020 and none after that, has not led to a causal relationship between the vaccine and the AE. Not taking the COVID-19 vaccine due to these three case reports stands against reason due to several facts. The benefits of the vaccine outweigh the risks from dermal filler reactions by leaps.

Only three out of 15,184 (and later 30,000) patients in the trial had this AE. There was no data as to how many out of the rest without reactions had prior fillers. Delayed immunogenic reactions can occur due to infections, vaccines and dental procedures or poor injection techniques, hence not something unique to the COVID-19 vaccine. They can occur with any filler material used.

The American Society of Dermatologic Surgery (ASDS) has mentioned in its guidelines that patients who have taken prior dermal fillers should NOT be discouraged from taking the vaccine. Fillers should be administered by board-certified physicians, who are capable of managing complications. A proper medical history should be taken for prior allergies.

All consent forms of dermal fillers should have this AE mentioned. Pre-procedure counseling should be done regarding the importance of taking the vaccine yet being mindful of AEs and to reach out to the doctor in case of any swelling at the site of filler injection. It is prudent for doctors to observe and monitor patients whom they have injected with fillers for allergic reactions post-vaccination. In case of an AE, counsel the patient not to panic and prescribe antihistamines and oral steroids if need be. Of course, in case of a severe reaction like anaphylaxis, the patient should be instructed to reach out to the ER immediately.

As of now, there is no affirmative evidence to link the COVID -19 vaccines to any new or serious AEs in patients with prior dermal filler injections and it is an urgent public health requirement to encourage all to take the vaccine.”

“Those with dermal fillers should not be discouraged from receiving vaccines of any kind.”

“Dermal fillers are minimally invasive aesthetic procedures. Hyaluronic acid fillers are commonly used for their versatility and because they are a natural ingredient for our skin. It is used for augmenting the lost volume and beatification. Cheeks, lips, jawline, and chin are the most common areas. It is used as a skin booster to hydrate and rejuvenate. Dermal fillers are inert and not many allergic reactions to them have been reported.

Immunological reactions post influenza and flu vaccination from people who have received dermal filler treatment have been reported. In December 2020, three cases were reported to develop swelling after Moderna COVID-19 vaccine during third phase trails. One person took dermal fillers six months prior to vaccination and developed swelling one day after vaccination. Second person took a dermal filler two weeks before vaccination and developed swelling two days after vaccination. The third person reported lip swelling two days post the vaccination, but the time of filler placement was not known.

In India, no reactions post the vaccination have been reported yet. But Dr Debraj Shome reported a regular patient receiving dermal fillers since six years with no reaction record, developing periocular swelling after 10 months of her last dermal filler procedure. She was tested COVID positive a month prior to the reaction and was antigen positive and later antibody positive too. These may be delayed hypersensitivity reactions, which we see after regular flu vaccination.

In this scenario, American Society of Dermatological Surgery (ASDS) released a guidance regarding the COVID-19 vaccine side-effects and dermal filler patients. The guidance shares insights to practitioners and patients regarding dermal fillers and reaction post the COVID-19 vaccination, based on the latest available data.

Current ASDS guidance regarding dermal fillers and the vaccine are as follows:

• Dermal filler inflammatory events seldom occur with both hyaluronic acid and non-hyaluronic acid fillers.

• Evidence suggests that these reactions can be immunologically triggered by viral and bacterial illness, vaccinations (i.e., influenza vaccine) and dental procedures.

• These rare adverse events are temporary and respond to treatments such as oral corticosteroids and hyaluronidase and are often resolved without treatment.

• Patients already treated with dermal fillers should not be discouraged or precluded from receiving vaccines of any kind. Patients who have had vaccines should not be precluded from receiving dermal fillers in the future.

• In the Moderna mRNA-1273 trial, three reactions were possibly related to dermal fillers out of 15,184 vaccine recipients. It is unknown how many subjects in the trial had previous treatment with dermal fillers.

• ASDS members should obtain a pertinent medical history on all patients.

• Dermal fillers should be administered by board-certified physicians who are experts in both the injection of dermal fillers and management of complications arising from them. 

The number of patients who reacted are few and were helped by regular anti-inflammatory therapy. The dermatologists can follow their regular dermal filler practice. The patients must be observed for any adverse events and swelling. Counsel the patient accordingly. In case of a reaction, treat it with anti-inflammatory medicines and steroids. Hyaluronidase can be used wherever required only if not subsided by an anti-inflammatory therapy.”