In April, news broke that two spa clients in New Mexico had contracted HIV after wrongly administered PRP microneedling treatments. The treatment involves using a microneedling pen to inject a patient’s own blood plasma into their face, which can stimulate cell renewal and ultimately, reveal younger-longer skin. Done properly, there is no risk of blood-borne infection. But with used needles, another patients’ blood, or a host of other serious issues, a worst-case scenario can occur—and two people are currently dealing with that reality.
Under the care of a board-certified plastic surgeon or dermatologist, the risk of such serious consequences is decidedly low. But we also know that illegal (or even unsanctioned) methods, like black-market butt injections and so-called Botox parties, can lead to unintended and quite dangerous side effects.
There’s no reason to be scared of these seemingly no-brainer procedures, but it is important to ensure that your doctor is doing everything possible to keep you safe. Ahead, we asked the experts to break down the serious downsides of simple procedures, and how to ensure you’ll never have to deal with them yourself.
“Botox is completely safe, in the right hands,” says Dr. Charles Boyd, a Detroit-area plastic surgeon.. But in his own practice, Boyd has seen patients who have been injected unknowingly with a knockoff Botox product. It’s difficult to determine exactly what ingredients go into these knockoffs and just how potent they are, making it a complicated issue for doctors to treat. The solution? As always, visit a board-certified doctor. Once you’re in the room with your doc, make sure they open the needle’s packaging in front of you. Authentic Botox and Dysport are equipped with a holographic label, and any neurotoxin you use should have a barcode.
A less horrifying side effect is what happens when good Botox is poorly injected. “Bruising, droopy eyebrows, sagging eyelids or ‘Spock’ brows that arch out, like the iconic Star Trek character’s brows, are frequently telltale signs of Botox treatments,” says Dr. Jill Fichtel, a Franklin, Tennessee dermatologist. Sometimes, these issues can be reversed with another strategic, face-shaping injection. In the worst case, you’ll have to wait a few months for the neurotoxin to leave your system, returning your face to normal.
Fillers, like Juvéderm and Restylane, differ from neurotoxins in both formula and intended effect. While neurotoxins freeze muscles, fillers plump up facial lines using hyaluronic acid, a chemical that naturally occurs in the body. “The biggest concern with fillers is something called endovascular occlusion,” explains Dr. Boyd. “This occurs when the filler is inadvertently injected into a vein or artery within the skin.” It can lead to damage or even skin necrosis, or tissue death—a condition that is just as disfiguring as it sounds.
Dr. Boyd recommends seeking an injector with an excellent knowledge of facial anatomy, who will be able to recognize signs of endovascular occlusion, such as pain or bruising. Look for RealSelf reviews and photos of satisfied patients to ensure that your injector fits the bill. Dr. Fichtel recommends clarifying that your injector has hyaluronidase on hand; it can dissolve the filler, in the event of a problem.
As with Botox, be sure that you know exactly what is getting injected into your face. Dr. Boyd has seen patients who thought they would get a safe, FDA-approved hyaluronic-acid filler and instead wound up with liquid silicone. “This is a non-FDA-approved material that is permanent and not intended for injection into the face,” says Dr. Boyd.
Milder risks include bruising and bumps, especially in the lip area. “The ‘deal’ you get at a local medspa isn’t a deal if you have these complications,” says Dr. Fichtel.
Coolsculpting is a nonsurgical procedure that freezes (and kills) fat cells, resulting in a slimmer target area.
A rare complication is paradoxical lipohypertrophy. “This means that the fat in the treated area not only doesn’t get eliminated but in some cases gets worse,” explains Dr. Boyd. Aside from the extra weight, the area may look misshapen and irregular. To fix this, you’ll need traditional liposuction—the surgical option that you were likely trying to avoid in the first place. But keep in mind, this occurs in less than .01% of cases.
Other risks include cold injury to the skin, which can lead to pain and nerve damage, explains Dr. Manish Shah, a plastic surgeon in Denver. Plus, since the technology requires various areas be treated separately, you can develop asymmetries if the facilitator isn’t careful or if you choose to treat only one area.
Liquid rhinoplasty, also known as the “nonsurgical nose job,” uses injectable filler to reshape the nose.
Similar to using filler in other areas, the worst-case scenario here involves vascular occlusion and the scarring or tissue death it can cause. But as Dr. Boyd points out, the nose is an even trickier area to work with, for an inexperienced injector. “The blood vessels around the nose and the eye have strong connections, anatomically, with the ophthalmic and retinal arteries. If the filler is injected in the wrong place, the patient can experience irreversible blindness,” he says. Shah adds that minor risks include lumps and asymmetry.
Microneedling made headlines for HIV contamination, but as Dr. Shah points out, the typical risks are fairly minimal. Cross-contamination is what you should watch out for. Needle cartridges inside the device should be single-use, and you should see your technician clean the device itself before using it.
There are various microneedling devices on the market, and Dr. Fichtel points out that patients should be sure their provider uses an FDA-approved pen, like the SkinPen, with a sealed, sterile kit that is fresh for every new patient.