Can you mix dermal filler brands in the same face?
Aesthetic clinicians are often advised to wait several months before using a different brand of hyaluronic acid based dermal filler in a patient, this tends to happen when a new patient arrives who has previously been treated elsewhere with a brand you do not routinely prefer to use. So where does this advice come from, and is it relevant?
In this blog, Dr Tim Pearce explores this question that he is frequently asked, can you mix dermal filler brands within the same patient’s face? His answer may surprise you.
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Is there any data showing that mixing dermal fillers in unsafe?
Dr Tim explains that there is no data to state that there is a problem with mixing (hyaluronic acid based) dermal fillers in the same face. Therefore, most aesthetic practitioners make a first principle decision which dictates that these filler products are so similar that it is very unlikely that there is going to be an interaction. Given that most are using hyaluronic acid, and even if it is not a hyaluronic acid-based product, you can ask yourself, ‘is there any chemical reaction that you can think of that would cause a problem?’ The answer if probably not. Thus, without data, a practitioner can make a first principle decision that is likely to be safe.
Why do insurance companies make you wait several months before using an alternative filler brand?
It is well known that insurance companies like to impose restrictions on how long you should wait between using different filler brands, but are they just being cautious?
Dr Tim points to the studies carried out by and discussed in an interview with Dr Mobin Master. These show that if you carry out ultrasound scans on patients, even three years after treatment, most people will still have filler in their system, even though they will say they cannot see it on their face. Dr Tim is not surprised by these findings, and they concur with his clinical experience that fillers last much longer within the skin than we think.
Therefore, it does not make rational sense (for insurers) to say you should wait six months before you mix filler brands. Arguably, you probably should never treat that patient if you want a clean slate and for them to have one filler brand only ever in their face. This is not practical for most aesthetic clinicians.
Some well-known, high profile aesthetic injectors may choose not to treat anyone who has previously had treatment elsewhere, i.e., they are completely new to facial aesthetic treatment at the point they present, so they have a vanilla face as it were, yet most aesthetic clinicians do not have the luxury of being able to reject 50% of their patients in this way. Most must carry out a risk assessment to determine if there is a known problem, probably not, could there be a problem, possibly, but is it likely based on what you know about the products, no, and finally, if there is a problem, what are you going to do to solve it, use hyaluronidase if it is hyaluronic acid.
If the filler product previously used is very similar to the one you intend to use, Dr Tim believes that it is reasonable to mix products, in a practical sense.
Will manufacturers support you if you mix filler products?
It is often claimed that the reason given for not mixing filler brands is because the manufacturers would dispute blame between them if there was a problem, leaving the practitioners with no assistance.
Yet, the real issue would be a situation where a patient has previously bought a ‘product’ via the Internet and injected themselves with an unknown substance. If, as an aesthetic clinician, you are about to inject a patient who has done that, you will have no idea what is in their skin and it may cause a reaction when you add a genuine product that is impossible to solve, with or without the help of the manufacturer of the product that you used. This degree of uncertainty should be a red flag, and Dr Tim notes that if he met a patient who admitted to DIY treatment with unknown products, he would refuse to treat.
If, on the other hand, a patient has gone to reputable clinics and been treated with a different brand of product to the one preferred by Dr Tim, then he notes that is within the realm of risk he is happy to take.
Can you mix different categories of filler products?
Many often ask if you can mix different types, not just brands of soft tissue fillers, for example, calcium hydroxyapatite (Radiesse®), poly-l-lactic acid (Sculptra®), along with hyaluronic acid-based products.
If you know what you are dealing with, explains Dr Tim, and there is good patient documentation to detail placement of the product(s), which often vary depending on their mode of action and indication, then this need not be a problem.
You are, of course, entering a slightly different realm of risk when you are mixing different categories of filler products which may have different reactions, particularly if the reaction is harder to solve or more permanent, than if you are treating again with hyaluronic acid.
For more in-depth advice on potential complications from dermal filler products, read Dr Tim’s blog on delayed onset nodules – how to diagnose and treat after dermal filler, alongside inflammatory lesion – diagnosis and prevention.
Don’t miss getting your hands on a copy of Dermal Filler Complications: The Essential Guide for 2023.
If you have any further questions on dermal fillers, why not drop him a comment on social media, you can find Dr Tim Pearce on Instagram.
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Aesthetics Mastery Show
Can You Mix Filler Brands?
In this episode, Dr Tim explores the issues around mixing filler brands in more detail. Watch the full Aesthetics Mastery Show here.
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.
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