We have all been waiting with bated breath for a vaccine against the Covid-19 virus since the pandemic began. As of today, Jan 2021, 2 vaccines have approved for emergency use in many countries including the U.S.A and the E.U. The two vaccines are made by Pfizer-BioNTech and Moderna. However, at this moment, only the Pfizer-BioNTech COVID-19 vaccine has been approved by the Health Sciences Authority of Singapore (HSA) for pandemic use.

The vaccines are declared safe by the US Food and Drug Administration (FDA), with most adverse effects being mild and self-limiting, such as temporary fatigue and fever. However, in December 2020, the US FDA reported that 2 people developed swelling and inflammation on sites where they have had dermal fillers administered reported in the Phase 3 trials of the Moderna Covid-19 vaccine (1). The 2 patients, aged 46 and 51 years old, had filler injections to their faces 6mths and 2 weeks prior to vaccination respectively.

A 3^rd person was reported to develop lip angioedema 2 days after vaccination in the trial (2). She had filler injections to the lip prior to vaccination.

All cases were reported with the Moderna COVID-19 vaccine. It should also be noted that there are no reported cases of filler swelling with the Pfizer-BioNTech COVID-19 vaccine to date.

What Causes the Swelling Associated with COVID-19 Vaccines and Filler Injections?

While the exact cause of the swelling is not entirely clear, doctors believe that it is an inflammatory response to the vaccine, also known as a delayed-hypersensitivity reaction (3).

When a vaccine is administered, the body reacts exactly the same that it would if it were invaded by the disease. In a short period of time, your body begins making antibodies and your immune system heightens. When your immune system is on high alert, it can cause areas of your body that contain foreign bodies to swell and become inflamed. This is because your immune system is designed to counter and purge any foreign object in the body. This is what caused the filler swelling experienced by the 3 patients.

This delayed swelling of dermal fillers is not unique to COVID-19 vaccines. It can also happen with other types of vaccines such as the influenza vaccine, or it can happen after patients had an upper respiratory tract infection (4), or a dental procedure. This has been well documented in scientific literature, with an incidence of about 0.1% (5).

Swelling of dermal filler injection sites are rare, and such swelling Is usually easily treated with oral antihistamines, with or without oral steroids. In some cases where the swelling is more persistent, dissolving with filler with hyaluronidase will resolve the problem definitively (6). (Please note that this is only possible for hyaluronic acid fillers, and not semi-permanent fillers). In the 3 cases related to the Moderna Covid-19 vaccine,  the swelling was localized and resolved quickly with oral steroids with or without Benedryl (an antihistamine).

Should I Be Worried And Not Get Dermal Filler Treatments Or COVID-19 Vaccination?

The short answer is: No, you should not be worried, and Yes, you should still get filler injections and the Covid-19 vaccine. But there are some things you should take note of.

While localized swelling in response to dermal fillers and COVID-19 vaccination can occur, it is important to note that these cases are rare, the swelling will usually resolve quickly with oral medications, with no further complications.

The benefits of protecting yourself against Covid-19 via vaccination far outweigh the possibility of temporary swelling with dermal fillers.

Who Should Undergo Covid-19 Vaccination?

In Singapore, COVID-19 vaccination is recommended for the general adult population, including persons with chronic medical conditions (7). Having dermal fillers in the face or body is not a contraindication to COVID-19 vaccination.

You SHOULD still undergo vaccination if you are (7):

• Breastfeeding
• Planning to get pregnant 1mth after the 2^nd dose
• Have chronic medical conditions such as diabetes
• On stable post-transplant immunosuppression

Conversely, vaccination is not recommended for people with severe allergies or a prior history of allergy to the vaccine or its components, pregnant women, children under 16 years of age and people who are severely immunocompromised.

You SHOULD NOT undergo vaccination if you are (7):

• Pregnant
• Under 16 yrs of age
• Severely immunocompromised (e.g. active cancer)
• Previously had an allergic reaction to a dose of the Pfizer-BioNTech COVID-19 Vaccine or any of its components
• Have a history of anaphylaxis or a severe allergic reaction other drugs, vaccines, food, insect stings, or unknown triggers

I’ve Had Filler Injections. What Should I Look Out for When Receiving my COVID-19 Vaccination?

It is important to know that when you get any injections on your face – be it fillers, threads, or even skinboosters, you are introducing a foreign substance into your body, and therefore, there will always be a small possibility of a delayed hypersensitivity reaction. In my practice, I inform all my patients of this possibility prior to injections, not to discourage them of getting the procedure done, but more so that they can contact me when such a reaction occurs, so that I can advise them accordingly. I have encountered about 10-15 such cases in my career, corresponding to an incidence of less than 0.1%. All cases resolved either spontaneously or with medical intervention.  

Please speak to your doctor if you have any further concerns about COVID-19 vaccination, and how they may interact with your filler injections. He/she will be able to better address any questions you may have about the issue.

References:

1. Fact Sheet For Healthcare Providers Administering Vaccine (Vaccination Providers) Emergency Use Authorization (Eua) Of The Moderna Covid-19 Vaccine To Prevent Coronavirus Disease 2019 (Covid-19)
2. FDA advisory panel endorses Moderna’s Covid-19 vaccine, clearing way for authorization – STAT News
3. Ibrahim O, Overman J, Arndt KA, Dover JS. Filler Nodules: Inflammatory or Infectious? A Review of Biofilms and Their Implications on Clinical Practice. Dermatol Surg. 2018 Jan;44(1):53-60. doi: 10.1097/DSS.0000000000001202. PMID: 28538034.
4. Turkmani MG, De Boulle K, Philipp-Dormston WG. Delayed hypersensitivity reaction to hyaluronic acid dermal filler following influenza-like illness. Clin Cosmet Investig Dermatol. 2019 Apr 29;12:277-283. doi: 10.2147/CCID.S198081. PMID: 31118731; PMCID: PMC6501047.
5. Chung KL, Convery C, Ejikeme I, Ghanem AM. A Systematic Review of the Literature of Delayed Inflammatory Reactions After Hyaluronic Acid Filler Injection to Estimate the Incidence of Delayed Type Hypersensitivity Reaction. Aesthet Surg J. 2020 Apr 14;40(5):NP286-NP300. doi: 10.1093/asj/sjz222. PMID: 31410442.
6. Bhojani-Lynch T. Late-Onset Inflammatory Response to Hyaluronic Acid Dermal Fillers. Plast Reconstr Surg Glob Open. 2017 Dec 22;5(12):e1532. doi: 10.1097/GOX.0000000000001532. PMID: 29632758; PMCID: PMC5889432.
7. Indications And Contraindications To Covid-19 Vaccination. Moh Circular No. 09/2021, 25 January 2021