Dermal Filler, Neurotoxins, COVID-19 and Vaccines
With COVID-19 being on the top of everyone’s mind at the moment, it seems timely to investigate the issue of vaccines, neurotoxins and dermal fillers a little further.
As COVID-19 vaccinations begin, cosmetic injectors must be aware of any adverse events that have occurred with the vaccine so far. This article should provide you with information and guidance regarding these events and inform your clinical judgement.
Australia is planning to roll out the Pfizer and AstraZeneca vaccines as soon as mid- February and has recently agreed to be included in the Covax agreement, which is monitoring developments in a number of vaccine suppliers including the manufacturer of the Moderna vaccine. If successful, vaccines included in this agreement may be accessible to Australians in the future. While AstraZeneca has employed traditional vaccine technology in manufacture of their vaccine, Pfizer and Moderna have employed mRNA technology to develop a new type of vaccination.
In the Moderna vaccine trial, a total of three participants out of 15,184 patients who received at least one dose of the mRNA -1273 COVID-19 vaccine developed facial or lip swelling presumed to be related to dermal filler presence. The following chart outlines the data received below:
Female, aged 29, with lip angioedema following Moderna Covid-19 vaccination.
Of note is that no patients in the control placebo group reported any dermal filler related events. Interestingly, the female patient with lip angioedema had also experienced a similar reaction after a flu vaccine in the past.
As a result the FDA has said “it is possible the localised swelling in these cases is due to an inflammatory rection from interaction between the immune response after vaccination and the dermal filler”. In all three cases the swelling subsided with anti-histamine and steroid treatment.
So far, no similar reactions have been reported with the Pfizer BNT162b2 mRNA or other COVID-19 vaccinations, although the information available is evolving and estimation of risk and prevalence of vaccine and dermal filler cross reactivity is limited. In all trials the query regarding past dermal filler treatment was not part of the screening process, hence the true number of patients who have received the vaccine with dermal filler implants is not known.
Both immediate and delayed immunological dermal filler reactions are not common events and there is evidence that in genetically predisposed individuals there is a lower threshold for vaccines, infections and other inciting factors that trigger inflammatory reactions. This predisposition may also cause hypersensitivity reactions to dermal filler following injury, dental procedures, medications and illnesses.
With this in mind cosmetic injection candidates may now benefit from a discussion of COVID -19 vaccine related planning, along with screening for other known inflammatory triggers. If further implications of both COVID-19 infection and vaccine emerges it is possible that patients seeking dermal filler treatments could be counselled about vaccine options and that procedures are planned with a wider time gap between dermal filler injections and vaccination, perhaps of 4 – 8 weeks. Patients with a history of sensitivity to dermal fillers following any vaccine may wish to reconsider having dermal filler treatment.
It has generally been considered safe to have neurotoxin treatments either before or after vaccines. The only exception to this may be having both a vaccination with common side-effects and neurotoxin treatment in close proximity, for example 1 -2 days apart. An example might be having the flu shot and neurotoxin treatment at the same time. This is to ensure that if the “flu-like” symptoms appear, you and your patient are able to tease out and attribute the side effect to the correct medication. Were the symptoms attributable to the vaccine, or were they attributable to the neurotoxin treatment? Although it is unlikely that the symptoms would be severe, it is worth know what event has actually caused the symptoms for future reference, and to be able to provide clear information and re-assurance to your patient.
In Your Practice:
It is worth remembering that in the development of new drugs and vaccines that much of our knowledge of side-effects and adverse events are discovered after they have been commercially released to the market and are distributed in the population in far larger groups than in clinical trials. With the worldwide distribution and take-up of the COVID-19 vaccinations we should obtain this information in a timely fashion.
It is important that the cosmetic injector takes a thorough medical history, questioning past history of allergies, sensitivities and reactions to previous treatments and then plan to treat, delay treatment, or not treat at all accordingly.
It is also important to know that if an inflammatory reaction does occur, studies have shown that resolution usually occurs with short courses of oral steroids of less than 2 weeks duration, and that this does not appear to impact on the efficacy of the vaccine.
Remember to be vaccine aware in your practice.
Need more information?
If you want to learn more about dermal filler, neurotoxins or any of our other courses, then please chat to the team at CPD Institute of Australia today. You can call us on (03) 9041 3782 or email us at [email protected].
We are leaders in cosmetic and injectables training for clinical professionals. With a personalised approach to learning, small class sizes, and hands-on exercises, you’ll get the best training to help your clients look and feel their best.
Guidance issued for COVID-19 vaccine side effects in dermal filler patients – Dermatology Times, 8th January 2021 Morgan Petronelli, Associate Editor.
The Art of Prevention: COVID-19 Vaccine Preparedness for the Dermatologist – International Journal of Women’s Dermatology 12th January 2021, Shauna M Rice et al.
Guidance Regarding SARS-CoV-2 mRNA Vaccine Side Effects in Dermal Filler Patients- American Society for Dermatologic Surgery 28th December 2020, Mathew Avram MD, JD, ASDS President et al.
Vaccines and Related Biological Products Advisory Committee Meeting: FDA Briefing Document for Moderna COVID-19 Vaccine. US Food and Drug Administration, 17th December 2020.