Dermal fillers are on the rise worldwide.

Consumers can’t get enough — in their lips, under their eyes, in their cheeks, and in many other locations that just have to look full and voluptuous.

Already, 3.5 million dermal filler procedures are performed worldwide each year, and that number is growing at a double-digit place. The market potential for these products is substantial and growing: dermal fillers alone represent a global aesthetic market that’s expected to reach $3.5 billion by 2023, with demand and growth concentrated in the US, Europe, and especially the Asia Pacific region.

Multiple forces are driving this rapid global growth, including:

• Immediate positive results: Dermal fillers reduce signs of aging almost immediately, giving consumers near-instant gratification after injection.
• Selfie obsession: Social media use and the emphasis on IG-ready looks is increasing across ages, regions, and socioeconomics.
• Aging population: As the population of aging consumers continues to grow, so does the market of people who want to look younger.
• Men: They want to look their best as well, and are increasingly comfortable with aesthetic procedures to nail the look they want.
• Minimal pain, big gain: Consumer-friendly cosmetic procedures like dermal fillers deliver selfie-ready results with minimal pain and downtime.

And as more and more regions of the world acquire more and more disposable income, the demand for dermal fillers is only expected to grow — especially as satisfied customers come back for their new fillups and extra touchups.

How are providers keeping up with demand?

As the global volume of dermal filler procedures continues to grow, so toes the number of non-medically trained practitioners who are administering those procedures. Day spas, medispas, and aesthetic centers are cropping up everywhere; consumers have dozens of options that don’t require an impossible-to-get appointment with a board-certified dermatologist (and who has one, anyway?).

But as the market for dermal fillers continues to grow — and more and more new injectors step in to meet the demand — the convenience consumers love and expect is also coming with more and more risk. While the vast majority of dermal filler injections are safe and effective, they can still pose hazards. Especially when administered by less savvy and well-trained injectors.

Micrometers from crisis

Often, two key factors make the difference between a successful dermal filler procedure and one that may have serious side effects: anatomy and experience.

That’s largely due to the location of most dermal filler injections. Dermal fillers are often injected around the eyes or in the lips and around the mouth — highly vascularized areas with an abundance of both nearby arteries and veins.

The danger for many dermal filler injections lies in this unseen architecture of arteries and veins below the skin — and micrometers away from the appropriate target for the dermal filler itself.

This anatomical complexity is why injection professionals rely on sophisticated knowledge of facial structures, nerve networks, and vasculature. This expertise is critical for the practitioner to assess where the arteries and veins are before making an injection — and more importantly, to avoid them.

“What matters more than specialization is experience.”

Boris Paskhover, MD, Plastic Surgeon, Newark, NJ

But every patient’s face is different. And what’s more, with simultaneous rise of facial plastic surgery on the eyelids, nose, and lips, many patients’ features have been significantly shifted away from the natural architecture of the face.

This is one of the many reasons why even highly trained medical practitioners use caution when injecting dermal fillers. Because as more and more non-medical practitioners step in to perform these procedures, more and more patients are being placed at risk of poorly targeted injections, unexpected complications, and other errors of inexperienced hands.

“One injection away from disaster”

Despite these risks, the vast majority of dermal filler injections are safe and successful. But significant tissue injuries — and worse — still occur when dermal fillers are accidentally injected of into one of the many blood vessels in the areas where fillers are typically used.

3 out of 1000 dermal filler patients report complications. But the true incidence is believed to be much higher, as side effects are often widely under-reported. Those complications can include:

• Bruising
• Swelling
• Itching
• Infection
• Presence of nodule or lump
• Scarring
• Pain

1 out of 1000 adverse events are serious, including:

• Blood clot
• Air bubble
• Tissue necrosis
• Stroke
• Facial droop
• Blindness

Globally, around 50 cases of blindness after aesthetic facial injection have been reported.

“These fillers are not benign. You’re always one injection away from disaster.”

Brent Moelleken, MD, Plastic Surgeon, Beverley Hills, CA

Not surprisingly, authorities around the world are beginning to take notice of the safety concerns posed by dermal fillers — especially when administered by less experience practitioners. In fact, global regulatory agencies in the US, EU, UK, Australia, and New Zealand have already begun imposing stringent regulations around dermal fillers, such as:

• Requiring manufacturers to include safety warning labels stating the potential for possible serious injury
• Making it illegal for facial injections to be performed without proper training
• Regulating dermal fillers under medical device legislation “in order to protect the health and safety of users” (in the EU and UK)
• Making facial injectables a prescription therapy
• Forbidding direct advertising to consumers

Informed caution is key

For the many consumers who want a dermal filler procedure, picking the right injection provider is critical. Select a qualified injector who has the essential combination anatomical knowledge and injection expertise — and who knows how to treat complications if they occur.

Do your research, ask questions, and assess their experience level. Controlled and accurate needle placement by an experienced practitioner will help mitigate possible risk and injury associated with dermal filler injections.