COVID-19 Vaccines and Soft Tissue Fillers

Reports recently in the press discussed three patients who developed facial swelling or lip swelling within 1-2 days of receiving their vaccine. We wanted to take the opportunity to teach about delayed soft-tissue filler reactions and share what this may mean for patients who have had soft tissue fillers injected. These injectables should not be confused with Botox or Dysport injections.

There are currently two FDA-authorized COVID-19 vaccines: Pfizer and Moderna. Both are two-doses separated by a few weeks. Although there are two vaccines, to date, there have only been reports of transient swelling with the Moderna vaccine. It is certainly possible with the Pfizer vaccine; however, it was not reported in the Pfizer trial.

What actually happened to these patients who got swelling?

Of the 15,184 patients who received at least one dose of the Moderna vaccine, three patients reported swelling. This is a rare reaction that yields a likelihood of occurring to 0.02% (2 out of 10,000 people) of those who are vaccinated.  The three patients were women. The first reported case was a 51-year old woman who had filler within two weeks of getting vaccinated and developed facial swelling two days after her first dose. The second case was a 46-year old woman who had filler six months earlier and developed swelling one day after her first dose. And lastly, a 29-year old woman who had multiple lip fillers developed lip swelling two days after receiving the vaccine. Of note, this patient had previously developed lip swelling with the flu vaccine. All three patients experienced transient swelling which resolved without any lasting effect.

I had Botox – does this apply to me?

No, the described reaction has only been reported amongst those who have received soft-tissue fillers not Botox, Dysport, Xeomin, or Jeaveau.

Why would fillers react this way and is it any specific filler that I have received?

You may be wondering why fillers would cause swelling but we know that anything that upregulates the immune system – whether it be a bacterial or viral infection, dental procedures, or any vaccination – may cause a delayed soft-tissue filler reaction. We have learned that certain filler products are more immunogenic than others and cause delayed reactions in approximately 1% of patients injected. Namely, the specific technology known as Vycross, found in Voluma, Vollure, and Volbella, has been associated with this delayed swelling. As a result, we at Gramercy Park Dermatology have not used any products in this family of fillers since March 2017. (Humphrey et al. J Amer Acad Dermatol, 2020, pp.86-95.)

 I had filler in the past year, should I not get vaccinated?

You should not delay getting vaccinated.

If I know that I am going to get vaccinated, when should I plan my filler appointment?

For those patients that know when they’re going to get vaccinated, they may wait two weeks before and after vaccination to have soft-tissue fillers injected.

In summary, we do not anticipate any of our patients will experience this rare reaction. However, we have expertise in treating delayed reactions such as the ones described in the vaccine trials, and we know that this is a transient sign of a normal intact immune system. As board-certified dermatologists, we are adept and ready to handle any filler reaction to the vaccine.