Dermal Fillers and the COVID-19 Vaccine

Localized side effects have been associated with the SARS-CoV-2 mRNA vaccine in patients with a recent history of dermal filler injections. Both the American Society for Dermatologic Surgery (ASDS)1 and the American Society of Plastic Surgeons (ASPS)2 have offered guidelines for patient education and management on this topic. Their guidance is based on data from the U.S. Food and Drug Administration (FDA)3 during Moderna’s phase 3 trial with their mRNA-1273 vaccine.

The FDA reported three out of the 15,184 patients who received Moderna’s vaccine developed localized facial and lip swelling, all of which had a history of dermal filler injections within the last 6 months. Their adverse reactions occurred within 48 hours from vaccine administration. Two of the three patients developed facial swelling, a 46-year-old female who received dermal filler 6 months prior, and a 51-year-old female whose injections were 2 weeks prior. The third patient, a 29-year-old female with unknown date of prior filler injection, developed lip swelling/angioedema. Her reaction was classified as “medically significant,” but not as a “serious adverse event.” Of note, this patient also had a similar reaction after an influenza vaccine. All three cases reported localized-only effects, no systemic manifestations were present. In regards to patient outcomes, all three of the above patients had complete resolution of their symptoms with oral antihistamines and corticosteroids.

The FDA reports did not specify whether the filler products used were hyaluronic acid or non-hyaluronic acid based. Additionally, of the total 15,184 patients that received the Moderna vaccine, it is unknown how many had a history of dermal fillers, thereby preventing a true incidence from being deduced. However, when analyzing the placebo group, no such localized swelling reactions were found. It is thought that these reactions are triggered by a dermal filler-associated delayed hypersensitivity immune response. The FDA has not reported any similar reactions with the Pfizer mRNA vaccine.

Patients are encouraged to get the COVID-19 vaccine.

Both the ASDS and ASPS recommend discussing the above data in patients anticipating receiving the Moderna COVID-19 vaccine who either have a history of dermal fillers or are interested in injections in the future. A thorough medical history should be obtained, including previous reactions to other vaccines or bacterial/viral illnesses. Both groups recommended not discouraging patients with a history of dermal fillers from receiving the COVID-19 vaccine, given the self-limited nature of these adverse events. Similarly, patients that have received the vaccine, should not be precluded from receiving dermal fillers in the future, so long as a frank discussion has been had regarding the pros, cons and alternatives.

Summary:

• A localized inflammatory response has been associated with the Moderna® COVID-19 vaccine in patients with a recent history (within 6 months) of dermal filler injections
• Adverse reactions occurred within 48 hours from vaccine administration
• This response has not been found in patients receiving the Pfizer® vaccine
• The response appears to be self-limited and responds completely to oral antihistamines and corticosteroids
• The ASDS and ASPS are recommending discussing these reactions with patients, but not discouraging patients with a history of dermal fillers from receiving the vaccine