When the Moderna vaccine was undergoing clinical trials, two people developed facial swelling after vaccination. Both patients had had dermal fillers injected into their face (cheeks) at different times before they received the vaccine.

One of them had the filler injection a fortnight before the vaccine, and the other had fillers injected about six months before.

A third trial participant had swelling in her lips after the Moderna vaccine. It turned out that she had a history of lip filler treatments (when she had the lip filler injection, or how long before the vaccine, is unclear).

Interestingly, there were reports of a similar response (lip swelling) after receiving the flu jab.

From what is known so far, they are uncommon, and limited to only one of the Covid-19 vaccines. But then, it is early days. We have only just started having the covid-19 vaccine. As with all new medications, it is best to be cautious. We already know that there are immune responses to all vaccines. This is why we defer filler injections if you are flue-ey or unwell. With the covid-19 vaccine being a novel vaccine to a novel virus, I am open to all sorts of interactions over time.

The good thing is that most filler side effects are manageable. We have protocols and effective treatments for most situations.

Depending on the adverse event(s), we may need to use steroids, antibiotics and antihistamines to calm the inflammation, prevent and treat infection. Sometimes it we need to remove the filler to stop it from triggering more reactions over time.

Personally, I prefer to remove the offending filler sooner rather than later, because it will save the patient (and me) from a lot of stress and repeated medication.

Because my clinic is a referral center for complications caused by fillers and other injectables, I see and manage many different adverse events from cosmetic procedures. This means I am reasonably well equipped to anticipate and manage these. But that should not be a reason to be reckless in treating with filler injections while we know there is a degree of risk of side effects in those having the covid-19 vaccine close to the time.

At this time, I would say yes, if you had any vaccine (or infection) within a short time of having dermal filler injection. And vice versa (having filler within a short time of having a vaccine). While reactions like this could seem rather scary in the first instance, if we think about it, it is certainly not limited to dermal fillers, or even to vaccines.

We have known for years that it is unsafe to carry out injectable treatments when there is a chance of infection or inflammation. This is all the more true when we are planning for non-essential or purely cosmetic treatment.

If you are one of my patients reading this, you probably remember the discussion we had before planning your dermal filler treatments, and also when you were going through the consent process. You were asked about whether you are planning to have any dental procedures like implants, root canal treatments, whether you are on any antibiotics for infections elsewhere in your body – and if so, we would have deferred the filler treatment to a time when you were not on any such treatment.

The reason for this, is how our immune system reacts to any foreign substance it encounters: it tries to reject it. Fillers by definition are foreign substances.

If we are currently fighting an infection, there is an increase in number and activity of active immune cells and mediators circulating in our systems. Having a vaccination produces the same stimulation of our immune system (but without the actual infection).

If you have a filler injection at this time, you are more likely to have an immune response to the filler. This response or reaction shows up as swelling, redness, pain and tenderness over the filler. Sometimes the filler forms “nodules” that could be red, hot and tender (inflammatory).

So, the answer is yes, you must plan your injectable treatment safely.

Other than what we know about human physiology, the immune response, and specific properties of fillers, we do not know enough to advise on this with certainty. General safety principles would suggest that we separate the procedures.

We have known for many years that the human body will reject that which is not “self”. Fillers are not “self”. They are foreign particles. If our tissues are recently primed to fight (vaccines, illness, dental infection, inflammation), it is understandable that our immune response and allergic response mechanisms could over-react and actively reject the foreign particles.

Our immune systems include many different cells with specific roles and abilities. The immune response can occur over the short, medium or long term. If a patch of skin was sore or inflamed, we certainly would not inject any dermal filler into it. But what if we have safely injected filler, previously, at some point in time? Can your immune system still attack it? Yes it can. Modern long lasting cross-linked hyaluronic acid fillers are made to last. They remain within the layers of your skin rather like implants. It takes a long while for your body’s natural hyaluronidase enzyme to break down these particles.

If your immune system became very active at any time, in theory, it would still attack the filler – weeks or months after it was injected.

We could apply this understanding of how vaccines and viral illness in general will affect the timing of filler treatments, while considering the existing evidence and the guidelines developed since the covid-19 vaccination program started.

Notice that I did NOT suggest that you delay having the vaccine because you have had a filler treatment: that is because it is vital for you to have the vaccine.

Never delay having the vaccine!

Because this is a new medication, we cannot expect to have a blueprint handed down to us as to what will happen. Instead, we need to understand in more generic terms (for example, how our bodies respond to any foreign substance), and learn from it in order to make future treatments safer and better timed. Our immune systems were designed to protect us from foreign substances, often by rejecting them.

Here is what we know about how the current covid-19 vaccines influence our immune systems:

Most of the immune activation is related to structure of the spike protein in the envelope of the coronavirus. Some of the response is to the vector which carries the antigenic unit – for example the cold virus.

The level of immune protection and timing of immune response may vary between the different brands. But we know that it takes 2 weeks for the immune system to get fully activated, when it is newly exposed. With prior exposure (previous infection, second dose of vaccine) the activation is more rapid.

Either way, the immune system is likely to be most stimulated after 2 weeks of vaccination, and to reach somewhat stable states of activation after 4 weeks. A full explanation of Covid-19 vaccines, is on the Centers of Disease Control website here.

In Europe and the UK, there are over 200 brands of hyaluronic acid fillers, with various physical properties like lifting capacity, firmness, longevity – hence we use different fillers for different parts of the face. Facial fillers are medical devices. We must be diligent in infection control/ asepsis during these procedures.

So, the answer to this question is: “it depends”: You could have the most premium filler injection in less than ideal hygiene conditions – and cause infection, inflammation, nodules. The injection procedure may have been aseptic, but some aspect of your medical history may make you more susceptible to inflammation and filler reactions.

So, it is more to do with choosing the correct type of filler for that part of the face, and that patient (medical history), and whether it was placed with aseptic technique in the correct layer of the facial skin. (I did say “it depends”).

When you do your own research:

You are probably correct in thinking you should do your own research and learn as much as you can about the process, before choosing a doctor to manage your treatments. And that applies to all medical treatments, not just botox or filler injections. It is preferable for the doctor to be thinking as hard about the treatment as you are, and a good bit more when it comes to risk assessment and safety.

Reputable filler manufacturers would have already done research on inflammatory properties of their fillers, as part of the manufacturing and approval process.

The R&D process is rigorous, and in order to get approval, those fillers have to be proven to be consistently safe and effective. Galderma and Allergan (Restylane and Juvederm manufacturers) have decades of research backing their products. So, they are already able to advise us, who use their products, as to what we can do to keep our patients safe.