Dangerous, this lip product should no longer be sold without a prescription

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?

What are the 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.

What are the side effects of hyaluronic acid?

► 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.

What are the dangers of hyaluronic acid?

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:

• infection of the area where the product was injected, which can be generalized (sepsis) if the localized infection is not treated quickly;
• viral contamination (including HIV) or bacterial if the material used is shared.

► if the product is injected into a blood vessel:

• necrosis which can lead to tissue amputation if the product is injected into a blood vessel,
• loss of sight (blindness) if it is a vessel that supplies blood to the eye.

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.

Who is legally authorized to inject hyaluronic acid?

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).

What precautions should be taken before and after an injection of hyaluronic acid?

• Avoid taking aspirin, nonsteroidal anti-inflammatory drugs and vitamin C for the previous 3 days.
• In the event of an outbreak of nasolabial herpes before the injection, report it to the doctor.
• After the injection, avoid taking alcohol and anti-inflammatories.
• Remain calm for 3 hours following the injections, avoiding moving the face.
• Sauna, sun exposure, violent sport, dental care, skin cleaning are to be avoided during the 3 days following the injection.
• Makeup can be resumed the next day

Sources:

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