Botox, hyaluronic acid… with some 221,650 anti-wrinkle injections per year, these are the most widely practiced aesthetic medicine procedures in France. Depending on the product, these injections of resorbable products sometimes lead to reactions. Currently, severe adverse effects are between 0.1 and 1%.
Botox and hyaluronic acid are resorbable products, i.e. they are naturally degraded by the skin over time. The result is therefore transient, but it is a guarantee of safety. The risk of reaction is much less than with a product that remains permanently in the skin. However, these two injected products do not obey the same regulations.
Botulinum toxin is a drug
This drug has a marketing authorization. Used since the 1970s, it is a safe product. In France, three brands of this localized muscle relaxant are used in aesthetics. Only surgeons (maxillofacial surgery, face and neck surgery, and reconstructive and aesthetic plastic surgery), dermatologists and ophthalmologists are authorized to inject it.
Contraindication: it should not be used in people suffering from certain muscle diseases (myasthenia gravis…).
Hyaluronic acid is a medical device
This large molecule of moisturizing sugar, which corrects volumes, is a medical device in the same way as breast prostheses or dressings. This invasive device (because it is injected into the skin) is therefore not considered a drug. It is subject to CE marking, which only guarantees the sanitary quality of the formula.
In France, about a hundred products are marketed by 35 manufacturers. They are regularly controlled by the National Agency for the Safety of Medicines and Health Products (ANSM), with the help of external experts. All doctors can inject it into the face.
Contraindication: it should not be used in people who have injected with permanent products, suffering from active autoimmune diseases, and in those with keloid scars, an inflammatory scar state.
Choosing the right practitioner
It is not always easy to choose your doctor, especially since aesthetic medicine is not recognized by the National Council of the Order of Physicians. Prefer a practitioner with specialized training. “The anatomy of the face is little studied during medical school, so some diplomas allow doctors to learn injection techniques,” explains Dr. Cécile Winter.
The practitioner must ask you about your medical history and current treatments (if you are taking anticoagulants, these injections are contraindicated). He must be informed of any previous cosmetic treatment: injecting a resorbable product on a non-absorbable one, even several years later, can cause undesirable side effects.
The practitioner must also provide you with an estimate indicating the doctor’s qualification, his or her registration number with the Conseil de l’ordre and the references of the products injected. This estimate must be accompanied by an informed consent form to be signed, as well as oral explanations of the precautions to be taken and possible side effects.
On D-day (after 15 days of reflection), the doctor must put on gloves before injecting you, use sterile material, remove make-up and disinfect the skin. He or she must tell you what he or she has injected (name, manufacturer, lot number), and must provide you with the label on the syringe. If this is not the case, ask for your injection notebook.
Dr. Martine Baspeyras adds, “The doctor must be reachable within two or three days after the procedure. If you’re not sure about a reaction, send him a selfie. »
Resorbable anti-wrinkle products: what are the risks?
As with any medical procedure, there are risks. First of all aesthetic risks, if the result is not suitable. But also medical risks. According to the ANSM, adverse effects linked to hyaluronic acid injections affect 0.1 to 1% of people.
The most common – edemas, small bleeding or hematomas – fade within a few days. Rarely,allergy to hyaluronic acid exists, causing a localized inflammatory reaction such as urticaria. In some women, nodules may appear and create a small ball on the injected area, sometimes several months after the procedure. The white blood cells attack the hyaluronic acid to digest it and die. This nodule is treated with anti-inflammatory corticosteroid treatments and massage, or punctured.
It can also happen that hyaluronic acid is injected into an artery and the mouth. “This is the most serious complication,” says Dr. Ludovic Lievain. It can cause skin necrosis or vascular emboli (a kind of clot). Injection with a round-tipped cannula can prevent this phenomenon. These problems remain extremely rare and can be solved if the doctor reacts immediately by injecting hyaluronidase, an enzyme that dissolves hyaluronic acid. Submitted to a MA, this one is authorized exclusively in the event of vascular complication. Only surgeons, dermatologists and ophthalmologists have this antidote. “Pain, skin that turns white or blurred vision should be warning signs,” Dr. Lievain reminds us.
As for botulinum toxin, there are no cases of side effects linked to the molecule itself.
To find out what is really going on with the various techniques aimed at reducing wrinkles, plumping up the skin and stimulating cell regeneration, listen to this episode of Hypercondriaque, the prevention podcast from Santé Magazine. Aline Perraudin, editorial director, receives Pr Brigitte Dréno, head of the dermato-cancerology department at Nantes University Hospital and member of the scientific committee of Santé magazine.