Throughout the many trials and tribulations of 2020, there’s been one light at the end of the tunnel that promised relief from the COVID-19 pandemic and the endless worry that’s accompanied it: a vaccine. After months of expedited research and clinical trials by some of the pharmaceutical industry’s biggest players, it seemed the end was finally in sight, with the FDA’s emergency use authorization of two vaccines—the first from Pfizer and the second from Moderna. But just as the news of Moderna’s vaccine approval was announced, several reports surfaced detailing the occurrence of facial swelling in vaccine recipients who had gotten dermal fillers.
According to the FDA, during Moderna’s Phase 3 trial, three participants developed facial or lip swelling after receiving the vaccine. Two of the patients had gotten dermal fillers in their cheeks within the six months prior to receiving the vaccine, while the third patient had gotten dermal filler injected in the lip two days after receiving the vaccine. But as distressing as this news may seem at first glance, especially to filler loyalists, dermatologists insist it’s not actually cause for alarm.
“I’ve been very attuned to COVID-19 diagnoses in my own filler patients, not only regarding office safety protocols but also [in] awaiting any viral-triggered reactions,” says Dr. Heidi Waldorf, a board-certified dermatologist in Nanuet, New York. “Colleagues of mine in Italy have collected a handful of cases of filler reactions suspected to be related to COVID-19 viral infection, while others in the USA saw the aforementioned dermal filler reactions to the vaccine [in the Moderna trial].”
However, these reactions are not limited to the new Moderna vaccine. “Swelling and nodules have been reported at the sites of prior hyaluronic acid filler injection even 9 to 12 months later,” Dr. Waldorf explains. “And although most don’t have an obvious trigger, cause-and-effect relationships have been suggested with dental cleanings, flu infections, and vaccines. The cause isn’t well defined, but it’s thought that, in some cases, bacteria after dental cleaning could seed the filler to react later, or a viral infection or vaccine could trigger an immune response to it.” For this reason, Dr. Waldorf asks her patients to avoid any dental appointments and anything else that might bring in bacteria for two weeks before and after receiving filler—and she advises anyone who has a serious bacterial or viral illness or a flare-up of an autoimmune disease to wait until it’s cleared before getting filler. “The thought is, that interval may reduce the risk of immediate or delayed reactions—but it is, again, based on our assumptions of the mechanism,” the dermatologist says.
The reactions reported from the Moderna trial and from other anecdotal instances suggest that they occur most frequently in patients who’ve had a specific subcategory of hyaluronic acid (HA) fillers known as Juvéderm Vycross gels—including Voluma, Vollure, and Volbella—but there have also been cases of swelling with other HAs, like Restylane and Restylane Lyft, and, most recently, with Revance’s RHA. Similar reactions have been seen, rarely, with the CaHA filler Radiesse but not with the PLLA filler Sculptra. “The literature has reports of [a] 0.5% [incidence] of delayed swelling after Vycross fillers,” explains Dr. Ranella Hirsch, a board-certified dermatologist in Cambridge, Massachusetts. “But to be fair, [fillers like] Sculptra wouldn’t be used for many of the same indications, so it’s harder to compare.” She says that the timing of some of these reactions—that is, swelling that occurred up to six months after receiving filler—might be a result of the filler material used. “There are different time periods when people have reactions,” she notes, “although they are, overall, generally sooner.”
It’s also worth noting that sometimes swelling “reactions” are actually a normal consequence of having a water-binding gel injected into your skin. In the case of the trial participant who had her lips filled shortly after being vaccinated, “it’s not clear, given the timing, that [the inflammation] wasn’t [due to] the filler itself,” Dr. Hirsch says, pointing to the swelling that typically occurs within the first few days of receiving filler.
“In simplest terms,” she adds, “many benign things can cause swelling with fillers, which is why we tell people to avoid heavy exercise, salty food, and wine immediately after injections, to reduce swelling.”
Even when filler patients have had reactions to vaccines, including the Moderna COVID-19 vaccine, those reactions were transient and either resolved without intervention or with simple treatment. “Since most, if not all, [reactions] are to HA fillers, the first step is to inject hyaluronidase, the enzyme that dissolves HA,” Dr. Waldorf explains. “If the reaction includes firm nodules, a solution of low-concentration corticosteroid mixed with fluorouracil, a chemotherapy agent now in standard topical preparations, will be injected.” Additionally, patients will often be prescribed oral corticosteroids and antibiotics, and the physician should follow the cases closely until the reaction fully clears.
“These reported reactions are so uncommon statistically, and they are so treatable, that it is not a reason to skip the vaccine,” says Dr. Waldorf. COVID-19 is a rapidly spreading disease with significant morbidity rates and continued health issues, while these are benign, self-limited reactions that are, at most, a mild nuisance. “Frankly, just based on the number of physicians I know who have had the vaccine without any complications, who I know have filler themselves, it’s rare!” the Nanuet dermatologist adds. “I know I’m certainly going to get the vaccine as soon as it is offered to me, and I have buckets of filler in my face.”
Neither Dr. Waldorf nor her colleagues in New York, Brazil, and other regions that have been hard-hit by COVID-19 have seen reactions to the virus or to the vaccine among filler patients, and she notes that most of her patients receive flu vaccines without issue. “So, I would take this finding as not surprising but not high risk—and certainly not a reason to avoid vaccination,” she says. For anyone wanting to take extra precautions, Dr. Waldorf suggests going to someone who knows more than “how to inject by numbers.” “See a dermatologist, plastic surgeon, or other physician board-certified in a core cosmetic specialty. We are prepared to diagnose and treat complications—that’s part of our training. That way, if you notice swelling, discomfort, or a bump forming in the area you had filler at any time, you can feel confident that your doctor can take care of it.”
