Vials containing the Moderna COVID-19 vaccine. Image from Wikipedia.
The news that Moderna’s (NSDQ:MRNA) COVID-19 had a small risk of facial swelling for patients with dermal fillers has spooked scores of patients. Dermatologists and plastic surgeons have been inundated with queries from concerned patients.
But the risk of problems is minuscule, according to Dr. Wilbur Hah, the president of the American Board of Cosmetic Surgery (ABCS).
In the following interview, Dr. Hah puts the risk into perspective, explains why Botox recipients are unlikely to experience vaccine-induced facial swelling, and provides advice for drug developers and the CDC.
1. How would you characterize the reaction from patients concerned about Moderna’s vaccine reactivity to dermal fillers?
Dr. Wilbur Hah
Hah: Though it is a potential risk, I want to emphasize that it is extremely rare for patients to experience swelling around their dermal fillers after receiving the COVID vaccine. In Moderna’s clinical COVID vaccine trial in which swelling among dermal filler patients was first noted, only three participants experienced this side effect. In all three cases, the swelling was localized and either resolved itself without intervention or with antihistamines and/or prednisone.
Furthermore, many people don’t realize that swelling is a completely normal side effect of any immunization, illness, or infection, and swelling around dermal fillers is simply a temporary and normal immune system response. For example, we have seen temporary swelling develop around existing dermal fillers if some get a cold or the flu when their immune system mounts a normal response.
Minor swelling around dermal fillers should not dissuade anyone from receiving the COVID-19 vaccine. The risks associated with contracting the COVID-19 virus far outweigh the risk of minor swelling around one’s dermal fillers.
2. Is it likely that vaccines from companies other than Moderna could cause similar problems?
Hah: Yes, since any type of immunization can cause minor swelling in patients, there is reason to believe that swelling around dermal fillers and other medical implants is possible with COVID vaccines manufactured by companies other than Moderna. Again, this swelling is very rare and minor, and should not prevent anyone from receiving the COVID vaccine.
3. What advice would you give patients wanting to optimize the timing of their COVID-19 vaccination with dermal-filler injections?
Hah: This is a great question and an area ripe for research. Because reactions are typically more common during the second dose of the COVID vaccine, I recommend patients wait at least two weeks after their second dose to receive a dermal filler injection. Two weeks will give the body adequate time to adjust to the vaccine and ensure that one’s immune system is functioning normally.
4. Could you provide some more perspective on the types of general events that can potentially cause such facial swelling reactions in patients with prior dermal fillers?
Hah: When the body is introduced to any virus or bacteria — whether from a vaccine or even one’s own blood — the immune system perceives a threat and goes into overdrive. Just as the immune system responds to the presence of bacteria and/or viruses by raising the body’s temperature when we have a fever, inflammation is another immune system response to bacteria or a foreign object. When we get vaccinated, it is completely normal for some amount of inflammation to occur within the first couple of hours, as our immune system is stimulated and attempting to force out the pathogen, along with any other foreign objects.
Visiting the dentist commonly results in swelling for patients with dermal fillers, as a large amount of bacteria is introduced to the body through the mouth. Almost all cosmetic procedures include minor swelling as a potential side effect, as the immune system is typically stimulated to some degree.
5. Is there any data suggesting a possible risk from Botox related to COVID-19 vaccines?
Hah: Patients who have received Botox injections should not experience any swelling around these injection sites after receiving a vaccine. This is because Botox is a neurotoxin that is injected into a muscle and is quickly dissolved, whereas dermal filler injections introduce a collagen-stimulating substance — typically hyaluronic acid — under the skin that remains present for six months to a year.
6. Is there a take-home message for drug developers related to this news about facial swelling associated with dermal fillers?
Hah: The CDC and Moderna both list swelling as a possible side effect of the COVID vaccine on their websites, however, they specifically address swelling at the injection site. It could be helpful for the CDC and drug manufacturers to list swelling around medical implants, including dermal fillers, as a possible side effect on their websites and to make this side effect known to vaccine providers. I would also recommend that the CDC and drug developers explicitly state that concern over minor swelling should not prevent anyone from receiving the COVID-19 vaccine, as this side effect can be easily remedied.
I had the first dose of Pfizer and woke up three days later with my eyes almost totally swollen and red as if I were sunburned. It’s been 8 days and I’m still swollen
I have not had any dermal fillers. It took about a week after my second vaccine. My eye lids swelled and and I wake with crusty eyes in the Morning. Itch! Benadryl at night and flonase during the day have been helpful with the itching but not with the swelling.
I too have puffy eyes and red eyes/eyelids. Started two days after first Pfizer vaccination. No history of injections/fillers. Will try Benadryl.
PD – Lea, I had the Moderna shot the same day you did and woke up Saturday with swollen bottom lip which moved to cheek, above upper lip to other cheek. Finally back to normal today. No facial fillers either.
Same here. Pfizer. No dermal fills.
I have not had any dermal fillers. I had a Moderna shot on Thurs. Feb 4, 2021. I woke up on
Saturday and my upper eyelids are swollen and a goldish color. Does anyone have any info.
I have not had any dermal fillers. I had a Moderna shot on Thurs. Feb 4, 2021. I woke up on
Saturday and my upper eyelids are swollen and a goldish color. Does anyone have any info.
Hi did it resolve? I have swelling too 2 days after pfizer vaccine
Please report these issues to the VAERS database!
same here! got the moderna vaccine 2 days ago and my eye lid is now swollen and painful!
I got the Pfizer vaccine yesterday and my eyelid swoll with terrible itching!!
I got the Pfizer vaccine yesterday and my eyelid swoll with terrible itching!!
Received 1st Moderna shot yesterday, experiencing lower facial swelling. After reading above, thinking it will migrate to eyes. Is Benadryl ok to take? Is anyone concerned about second dose?
I didn’t have a reaction to the first dose but the second…I have a horrible headache, aching everywhere and swollen my eyes and mouth are swollen. Still waiting to feel better.
My swelling was almost gone when I called Dr who told me to take Benadryl, which I did and the next day, it was all gone. Lasted for about a day and a half. I am concerned about the second shot and most professionals are suggesting I don’t get it. Reported to VAERS no one ever returned my call. Saw an allergist today with no clear answer. Can take an allergy test that takes 4 hours but how will they know if I’m allergic to anything in the medicine if my reaction didn’t appear until 38 hours after shot.
I took Benadryl on Monday after speaking with doctor. While at the time I took it, the swelling was beginning to go down and after taking the Benadryl, it was gone the next morning. I am very concerned about the second shot. See my reply below to Lea.
I got the second Pfizer vaccine on Sunday, 2/7/2021. Arm was very sore for three days and on the fourth day, 2/11 I woke up with a bright red itchy blotchy warm rash all over my face with swelling, including my eyes. Called Pfizer and was told it was ok to take benedryl. Now it is 2/13… soaked my face in ice water and still no positive results from taking Benedryl. Will see my doctor on Monday if there is no improvement.
After the pfizer vaccine I became very weak, tired n nauseated. Woke up day 2 with swollen eyes. I don’t mind the side effects sd long as it works!!
I took the Pfizer vaccine on Monday and very tired, nausea and have a nasty metal taste in my mouth. Woke on Thursday with hurting eyelids. I going to take Benadryl tonight, call PC tomorrow. Just so tired and cold.
I took the moderna shot and ended up looking like a chipmunk with cheeks full of acorns. Talked to my doctors assistant and she told me to take benadryl. Since I showed no symptoms of what was on container, I chose not to take. I instead went to the doctors office and saw a different doctor on call. He advised me not to take the benadryl. My cheeks have gone down a little bit. It’s been 1 and 1/2 weeks. I’m due for 2nd shot in 10 more days. I’m freaked out. Btw, both shots are given to me at my doctors office.
Mary, Are you going ahead with your second shot? Same thing happened to me and I’m concerned about getting the second one.
After second Pfizer COVID-19 vaccination February 17, after four days a large swelling and soreness in the front upper leg. I know of nothing that would’ve caused swelling. I’ve had this for three days now.
I took the Pfizer vaccine in my left arm About 2 days after the first vaccine, I had swelling, itch, and redness on my left eyelid. That resolved in about 2 days. I had a similar, but stronger, about 2 days after second vaccine. That resolved in about 3 days. I used cortisone cream.
I’m similar to Lori. I had the first dose of Pfizer and woke up three days later with my eyes almost totally swollen and pink. I get Botox from my neurologist for my migraines, but the majority are in the back of my head/skull, not near my eyes. My head really hurts.
I also have struggled with pink and itchy eyelids after getting my first Pfizer vaccine. No history with botox or fillers (though I do use facial cream to slow the aging process). Benadryl does help, but hasn’t entirely cleared it up.
2nd moderna shot on Thursday Feb 25 Fri and Saturday flu like symptoms, in and out of of bed. Sunday OK. Monday red itchy eyes very uncomfortable and same on Tuesday hope Wed will be much better.