A senior executive at Estée Lauder died in February from a pulmonary embolism triggered by cosmetic filler, the New York City medical examiner announced this week. Kendal Ascher, 56, experienced acute respiratory failure following the event.
A pulmonary embolism occurs when an object, such as cosmetic filler, obstructs an artery in the lungs, preventing blood flow and oxygen from reaching the body. According to Dr. Kenneth Mark, a cosmetic dermatologist, the filler may have been accidentally injected directly into a blood vessel. While rare in facial fillers, this complication is more commonly associated with larger volume fat injections, such as those performed for gluteal augmentation, which is considered one of the deadliest cosmetic surgical procedures.
Cosmetic fillers are injectable substances, like hyaluronic acid or fat transferred from another part of the body, used to reduce wrinkles, creases, and add volume to areas like the cheeks and lips. Dermal facial fillers are generally considered safe when administered by a board-certified plastic surgeon or dermatologist with a thorough understanding of facial anatomy. Over five million people undergo facial filler procedures annually.
Typical side effects from filler injections include swelling and bruising, which can last for 24 to 72 hours. Redness and tenderness at the injection site are also considered normal reactions. However, a more serious, though rare, complication known as vascular occlusion can occur if filler is accidentally injected into a blood vessel, blocking blood flow.
If a vascular occlusion is not treated promptly, it can lead to skin necrosis, blindness, or a pulmonary embolism. Certain facial areas, including the temples, frown lines, and lips, carry a higher risk for this complication.
Medical professionals emphasize that the primary method for minimizing risk is seeking treatment from an experienced, board-certified plastic surgeon or dermatologist. Dr. Lyle Leipziger, chief of plastic surgery at North Shore University Hospital and LIJ Medical Center, noted that many individuals performing cosmetic procedures lack proper training, which can lead to suboptimal results or serious complications.
Patients are also advised to inquire about the type of filler being used, ensure the product is FDA-approved and obtained from legitimate sources. Doctors recommend a gradual approach to filler injections, opting for smaller amounts over multiple sessions rather than a large volume at once, which can also reduce risk.
To mitigate bruising, pre-treatment recommendations include avoiding alcohol the night before, abstaining from fish oil supplements and ibuprofen for 10 days prior, and using oral arnica. Applying ice before treatment can help constrict blood vessels, further reducing the risk of accidental injection into a vessel. Conversely, numbing creams, which are vasodilators, may increase the chance of bruising and potentially vascular occlusion, according to Dr. Mark.