More than 200 cosmetic surgeons are calling for the over-the-counter sale of hyaluronic acid to be stopped in France because of “sometimes very serious complications”.
To fill in wrinkles on the face, give volume to the lips, make dark circles disappear… products based onhyaluronic acid are now available over-the-counter in French pharmacies, that is to say, without prescription. What 200 cosmetic surgeons denounce in a Tribune published on March 29, 2023 in The Parisian. For these physicians, these products must no longer be offered in free access nor sold on the Internet. “For three years, we note the alarming growth of illegal injections through complications, sometimes extremely serious, that we take care of in our plastic surgery practices and in the emergency departments of the hospital departments” they explain before explaining that “of the hundreds of injectors, non-doctors, practice illegal acts on the population, especially the youngest and most vulnerable, with much publicity on social networks”. In July 2022, theMedicines Agency (ANSM) reported about forty reports of adverse effects following injections of hyaluronic acid made by people – when their profession is known – not allowed. Who really has the right to perform these injections? In which circumstances ? What are the possible adverse effects of hyaluronic acid?
Therehyaluronic acid was discovered in 1934. He is used since 1996-1997 in the form of injections for aesthetic purposes. These injections help fight the signs of facial aging. THE injected product fills or adds volume to a specific area : nasolabial folds, frown lines (between the eyebrows), crow’s feet (corner of the eyes), cheeks, chin, around the mouth, around the lips, dark circles, cheekbones… The injection of hyaluronic acid is performed in women and men in the dermis or deep dermis.
► One erythema can occur right after the injection, it usually disappears after a few hours or even a few days.
► bruises, hematomas may appear within days and disappear within a week.
► Redness, edema may be associated with itching or pressure pain.
► One outbreak of cold sores is possible, especially in people who have already done so. It should be reported to the doctor.
Injections of hyaluronic acid performed by non-health professionals can cause serious side effects. The most common short-term side effects related to improper use of these productsare :
► if the injection of the product does not respect the rules of asepsis:
► if the product is injected into a blood vessel:
In the long term, the risks are the bad position of the injected product due to its migration and the inflammation of the injected tissues.
Only doctors are authorized in France to perform hyaluronic acid injections for aesthetic purposes. “Their training and their knowledge of the anatomy of the face and body mean that they are the only ones authorized and competent to guarantee the safety of injections” reminds the ANSM. The injection of hyaluronic acid requires the realization of a clinical interrogation, to check in particular the medical background of the patient (allergies, autoimmune diseases, etc.) and choose products suitable for the injection area. Know that the traceability of the injected product (type, brand, batch number) must be kept by the practitioner. “Doctors know how to deal with immediate side effects such as an allergy to the injected product (anaphylactic shock), necrosis / ischemia (clogged blood vessel), by appropriate medical treatment (antibiotic, anti-inflammatory, hyaluronidase, etc.) and will set up appropriate follow-up if necessary in the event of a longer-term adverse effect” adds the health agency. Moreover they know the rules of hygiene relating to operating waste (soiled syringe) which prevents the risk of contamination of HIV transmissible diseases, hepatitis C, etc. In a therapeutic setting such as to treat an oral pathology, dental surgeons can use injectable fillers at the level of the lips and the nasolabial fold.
► The realization of injection is however prohibited to beauticians and a fortiori to all non-professionals. This prohibition is valid regardless of the aesthetic purpose of the act (eg pigmentation, filling, tattoo removal or semi-permanent makeup).
Injections of hyaluronic acid for aesthetic purposes: only doctors can perform them. ANSM. July 11, 2022
Injections and other skin piercing practices, Ministry of HealthJanuary 19, 2022
French Society of Dermatology
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