Which COVID-19 vaccine? Risk of reaction with dermal fillers

As UK clinics prepare to reopen to patients this April – after the third national lockdown during twelve months of a coronavirus pandemic – it is vital that aesthetic practitioners understand and can appropriately discuss the currently available and approved COVID-19 vaccine and SARS-CoV-2 vaccinations and any potential risks in relation to aesthetic treatments.

The UK COVID-19 Vaccination Programme is currently delivering the Oxford-AstraZeneca, Pfizer/BioNTech and Moderna brands of vaccine. Vaccines, by their nature, are designed to illicit an inflammatory response from the body to produce antibodies and provide immunity from disease.

Such a response is likely to invoke side effects which may in turn cause the body to have an inflammatory response to implanted dermal filler products. Published literature has so far shown a single report of delayed inflammatory reaction between hyaluronic acid-based dermal fillers and the Moderna COVID-19/SARS-CoV-2 vaccine.

As aesthetic clinicians, we should all seek to be aware of the facts, avoid scaremongering and effectively communicate any risks to our patients, at a time when many will have been vaccinated or be called upon to do so over the coming weeks and month.

Do COVID-19 vaccinations cause dermal filler reactions?

In this blog, Dr Tim will reveal the results of a global research survey of over 1,500 aesthetic clinicians who shared details of dermal filler reactions post-COVID-19 vaccination. Armed with this data, we can look at which vaccine showed the highest risk of reaction, whether the filler brand had an impact, and if pre-existing health concerns had a role to play.

Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better practitioner, then step one is to register for the free webinars by Dr Tim.

Dermal filler and COVID-19 vaccine survey results

A survey distributed by Dr Tim was completed by 1,503 aesthetic clinicians from around the world – 71% from the UK, 11% from the USA, 3% from Canada, 2% from Australia and 13% from elsewhere.

Of this cohort, 79% had received a dermal filler treatment in the past, breaking it down by brand – 20% had Juvéderm Vycross, 15% Teosyal, 13% Juvéderm Ultra, 11% Restylane, 11% Revolax, 6% Belotero, and the remainder was spread across other smaller brands.

52% of respondents to the survey had also received their COVID-19 vaccination. Due to the nature of the audience – healthcare professionals – and the way that vaccines were initially rolled out following licensing, 77% received the Pfizer/BioNTech vaccine, 13% the Oxford-AstraZeneca, 9% the Moderna, and 11% were unsure which vaccine they received.

Following vaccination, 3.73% of clinicians reported experiencing facial swelling. Of those, 46% noted that swelling manifested after 48 hours, 31% within a week, 15% within a few hours, and 8% within a month. No one reported facial swelling more than a month post vaccination.

Of those who reported a reaction, approximately two thirds noted that it resolved by itself, with the other third requiring medical treatment.

Extrapolating a link between the risk of a reaction and the type of vaccine received, the data showed a statistically significant difference between the brands, with Moderna showing a higher incidence of reaction at 11.7%, than Oxford-AstraZeneca (4.1%) and Pfizer/BioNTech (3.1%).

To further qualify the data, respondents were asked to divulge known allergies and autoimmune diseases – 60 people reported having significant allergy and of those 5 experienced a reaction (8.3%), as compared to 3.7% for those with no known allergies. Similarly, of those respondents who had a reaction, 21 (3.2%) did not have an auto-immune disease, compared with 6.4% who reacted and had an autoimmune disease.

This equates to almost double the chance of a dermal filler plus vaccine reaction in those with a pre-existing allergy or underlying health concern.

Finally, we considered whether the dermal filler brand impacted on the chance of a reaction; and are pleased to report that there was no evidence that one brand or one manufacturer produced more reactions. Due to the small number of survey respondents who received individual brands and had a reaction, which can impact on statistical significance, some brands may appear riskier than others. Across the board, there was a 4% risk from dermal filler products reacting to a COVID-19 vaccination.

It must be noted that these statistics are designed to provide you with some broad data which can be used to give your patients information on the percentage chance of experiencing a reaction with their existing or future dermal filler treatments upon receipt of one of the approved COVID-19 vaccines. Data represents a small sample, and more detailed surveys will no doubt take place over time.

What is the normal risk of inflammation from dermal fillers?

It is also worth considering the normal risk of inflammatory reaction to dermal fillers, such as delayed onset nodules or inflammation due to viral contraction.

Based on our survey respondents, when asked if they had experienced facial swelling in the previous 12 months, 120 (9%) reported this history. If we extrapolate this over the year, it gives a risk of an inflammatory reaction to dermal filler of less than 1% in each month, as compared to a 4% risk within a month of receiving a COVID-19 vaccination.

Realistically, as concluded by Dr Tim, the risk of having a reaction post-vaccination is not much worse than the accepted risk of a dermal filler product reacting every time a patient contracts a common cold (rhinovirus).

COVID-19 vaccine and dermal filler interaction conclusions

Forewarned is forearmed as they say, and Dr Tim believes that it is beholden upon aesthetic practitioners to be able to provide their patients with peace of mind, especially in such uncertain times. The results of our survey should give you these key pointers to help you and your patients as we move out of lockdown and attempt to return to normality, which includes embarking upon aesthetic treatments once more.

• The risk of reaction is low – 4%.
• Most patients will not need medical intervention if they experience a filler reaction to vaccine.
• There is no significant difference in the risk between the brands of dermal fillers.
• There is potentially an increased and more significant risk of reaction with the Moderna vaccine, compared to the Oxford-AstraZeneca and Pfizer/BioNTech vaccines.
• Aesthetic practitioners should ideally leave 3 weeks between filler treatment and vaccine dose delivery.
• There is no data to suggest a reaction between botulinum toxins and COVID-19 vaccines.

Download the full survey results on whether COVID-19 vaccines cause dermal filler reaction.

Further guidance in relation to interactions between dermal fillers and SARS-CoV-2 vaccinations is available from the American Society of Plastics Surgeons, The Aesthetic Society, and The Aesthetic Complications Expert (ACE) Group World.

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Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.

Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.