Here’s what you need to know about the side effects of the COVID vaccine if you have cosmetic fillers

Just before the new year, the Food and Drug Administration (FDA) reported a new and somewhat unexpected side effect of the COVID-19 vaccine: facial edema.

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Two people – one of 46 and one of 51 – who received the Modern COVID-19 vaccine during clinical trials experienced a “temporarily associated” swelling (ie, on the side of the face) within two days after receiving their second injection dose , according to the report. The suspected cause of the swelling? Cosmetic filling. “Both individuals had previous dermal fillers,” the FDA said in the report. The agency did not disclose further information and a spokesperson for Moderna did not return. Formrequest for comment before publication.

If you have cosmetic fillers or are considering them, you probably have some questions about what to expect if and when you receive a COVID-19 vaccine – whether from Moderna, Pfizer or any other company that may soon receive FDA emergency use authorization. . Here’s what you need to know.

First, how common is this side effect of the vaccine?

Not much. Facial edema is not included in the list of common side effects of the COVID-19 vaccine from the Centers for Disease Control and Prevention (CDC). And the FDA has documented only two reports of this side effect in more than 30,000 people who have participated in the Moderna clinical trials (so far, the side effect has not been reported with the Pfizer vaccine or any other company’s COVID-19 vaccines).

Said that, STATE, a medical news site that posted the FDA’s presentation of these data on a live blog in December, reported a third person in the Moderna trial who said he developed labial angioedema (swelling) about two days after vaccination (it is unclear whether this was after the first or second dose). “This person had received previous injections of dermal fillers in the lip,” said Rachel Zhang, MD, FDA physician, during the presentation, according to STATE. Dr. Zhang did not specify when that person did the filling procedure. (Related: everything you need to know about the side effects of the COVID-19 vaccine)

Although the FDA did not say how many people in the Moderna study used cosmetic fillers, nearly 3 million people in the U.S. receive fillers every year, according to the American Society of Plastic Surgeons – so it’s a pretty common procedure. But with just three incidences of facial swelling in a trial that involved more than 30,000 people, that means we are talking about an approximate 1 in 10,000 chance of developing facial swelling after receiving the COVID-19 vaccine. In other words: it is unlikely.

Why can someone with fillers have swelling after receiving the COVID-19 vaccine?

The exact reason is unclear at this point, but the swelling is “probably some cross-reactive substance between the vaccine and the filler ingredients,” said infectious disease specialist Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security.

The ingredients of the Modern vaccine include mRNA (a molecule that essentially teaches your body to create its own version of the COVID-19 virus spike protein as a way to prepare your body to protect itself from the virus), several different types of lipids (fats that help transport mRNA to the right cells), tromethamine and tromethamine hydrochloride (alkalis commonly used in vaccines to help match the pH level of the vaccine to that of our bodies), acetic acid (a natural acid normally found in vinegar which also helps maintain the vaccine’s pH stability), sodium acetate (a form of salt that acts as another pH stabilizer for the vaccine and is also commonly used in IV fluids) and sucrose (also known as sugar – another ingredient common stabilizer for vaccines in general).

Although one of the vaccine’s lipids, polyethylene glycol, has been linked to allergic reactions in the past, Dr. Adalja says it is difficult to know whether this ingredient – or any other, by the way – is specifically involved in swelling in people with fillers.

The FDA report did not detail exactly what type of cosmetic filler these patients received. The American Academy of Dermatology states that the most common filler ingredients, in general, include fat that is removed from your own body, hyaluronic acid (a sugar found naturally in the body that gives the skin dew, elasticity and shine), calcium hydroxylapatite (basically an injectable form of calcium that helps stimulate the skin’s collagen production), poly-L-lactic acid (an acid that also increases collagen formation) and polymethylmethacrylate (another collagen enhancer). Each of these fillers can come with its own side effects and cross reactions. But since the FDA did not specify what type (or types) of fillers these people had, “it is not clear what cross-reactivity may be,” said Dr. Adalja. “There are many more questions that need to be answered.” (Related: A Complete Guide to Fill Injections)

Interestingly, the person who allegedly experienced lip swelling after the modern vaccination COVID-19 said he “had a similar reaction after a previous flu vaccine,” said Dr. Zhang during the FDA’s presentation of the Modern vaccine data, according to with STATE.

One possible explanation for this side effect – be it from the COVID-19 vaccine from Moderna, a flu vaccine or any other vaccine – is that “the vaccine’s intended activation of the immune system may also be triggering inflammation elsewhere in the body,” says Jason Rizzo, MD, Ph.D., director of Mohs Surgery at Western New York Dermatology. “As the dermal filler is essentially a foreign substance to the body, it makes sense that these areas are more subject to inflammation and swelling in this type of scenario”, he explains. (For your information: dermal filler is not the same as Botox.)

What to do if you had fillers and plan to get a COVID-19 vaccine

More data is being collected on the side effects of the COVID-19 vaccines as a whole, but it is important to pay attention to what has been reported so far – even the side effects that have only been seen in a very small number. With that in mind, Dr. Adalja says it is a good idea to talk to your primary care doctor if you have already completed and are planning to be vaccinated against COVID-19.

If you receive authorization, just be sure to stay in your doctor’s office for about 15 to 30 minutes after you have been vaccinated. (Your provider should follow the CDC guidelines and recommend it anyway, but it never hurts to repeat.) “If you have swelling, you can be treated with steroids or antihistamines, or some combination of them,” says Dr. Adalja . If you happen to develop facial swelling (or any other unexpected side effects) after being vaccinated and leaving the vaccination site, Dr. Adalja suggests that you call your doctor as soon as possible to find the right treatment.

And, if you notice facial swelling (or any other worrying side effect) after the first dose of your COVID-19 vaccine, talk to your doctor about whether it is a good idea or not to take the second dose, says Rajeev Fernando, MD, a infectious disease specialist who works in COVID-19 field hospitals across the country. In addition, if you are concerned about what may have caused the swelling, Dr. Fernando suggests talking to an allergist, who can do some tests to see what may be behind the side effect.

Dr. Adalja emphasizes that this news should not prevent you from getting vaccinated, even if you already have or are thinking of taking fillers in the near future. But, he says, “you may want to be a little more aware of the symptoms you experience after receiving the vaccine, if any, and keep an eye on the areas where you have had fillers.”

In general, however, Dr. Adalja says that the “risk-benefit ratio favors obtaining the vaccine”.

“We can treat swelling,” he says, but we cannot always treat COVID-19 successfully.

The information in this story is accurate at the time of publication. As updates on the COVID-19 coronavirus continue to evolve, it is possible that some information and recommendations in this story have changed since the initial publication. We encourage you to regularly check resources like the CDC, WHO and your local public health department for the most up-to-date data and recommendations.