Markets 
A senior Estée Lauder executive died suddenly in February after cosmetic filler triggered a pulmonary embolism, the New York City medical examiner announced this week.
A pulmonary embolism happens when an object, in this case filler, blocks an artery in the lungs. This blocks blood flow, starving the entire body of oxygen. Kendal Ascher, 56, died of acute respiratory failure after his pulmonary embolism.
But how would that filler end up in the blood stream in the first place — and are others who get filler at risk for this tragic complication?
According to Dr. Kenneth Mark, a cosmetic dermatologist and faculty member of the Allergan Medical Institute who did not treat Ascher, it’s possible the filler was accidentally injected directly into a blood vessel.
This is “extremely rare” in facial filler and “much more classically associated with larger volume injection of fat in the buttocks,” Marks told The Post.
A 26-year-old woman died of exactly this 18 hours after getting filler in her behind. Gluteal fat grafting is one of the deadliest cosmetic surgical procedures.
Normal vs. abnormal side effects of filler
Cosmetic filler is an injection of a gel-like substance, like hyaluronic acid or fat from another part of the body, to “fill” creases and lines and add volume to places that sink or shrink over time, like in cheeks and lips.
Dermal facial fillers are considered very safe — as long as they’re “performed by a board-certified plastic surgeon or dermatologist with extensive experience and knowledge of facial anatomy,” said Dr. Lyle Leipziger, Chief of Plastic Surgery at North Shore University Hospital and LIJ Medical Center.
That’s good news for the over 5 million people who get facial fillers a year.
There are some normal side effects, like swelling and bruising. “Even if someone just gets poked [with] the needle, without any filler injection, they can get some reactive swelling,” Marks said. “When filler is injected, it is normal to get swelling that can last 24 to 72 hours.”
Leipziger says redness and tenderness at injection site are also normal.
Things can still go wrong. “There are always inherent risks and every patient can have a different anatomy,” Marks said.
The rarest and most concerning complication, both doctors agree, is vascular occlusion. This is when fillers are accidentally injected into a blood vessel, blocking facial blood flow. This could be what preceded Ascher’s death.
This might cause pain and discoloration. If caught quickly, it can be reversed with an injection of an enzyme (Hyaluronidase) to dissolve the filler, Leipziger explained.
If not treated, this can lead to skin necrosis, pulmonary embolism or blindness, Marks said. Certain areas such as the temples, frown areas and lips are at higher risk than others.
How to minimize your risk
Leipziger and Marks agree that the best way to protect yourself is to find an experienced, board-certified plastic surgeon or dermatologist.
“There are way too many people performing cosmetic procedures including injections without the proper training and experience,” Marks said. “This has led to fillers getting a bad stigma not infrequently from the wrong filler and too much filler being injected into the wrong places.
“The reality is the worst outcome is not only a bad cosmetic result … but at times serious complications from a vascular occlusion.”
Leipziger encourages those seeking filler to know what kind they’re getting and make sure the product is FDA-approved and obtained through legitimate sources.
Instead of getting a large amount of filler at one appointment, get small amounts over several appointments for a more natural result, he adds.
“I always describe it as a work of art in progress,” Marks said. “I layer different amounts of filler in different areas of the skin over time instead of trying to do it all at once. The more filler one does in a single session, the higher the risk.”
To avoid bruising, Marks recommends avoiding alcohol the night before, taking fish oil omega supplements and ibuprofen in the preceding 10 days before treatment, oral arnica before treatment, as well as applying topical arnica after treatment.
He recommends icing before treatment and avoiding numbing cream.
“The advantage of applying ice is that it helps constrict the vessels thereby lowering the risk of injecting a vessel,” he said. “The numbing cream is a vasodilator, which at best increases chance of bruising and at worst increases chance of vascular occlusion if one injects into the blood vessel. I really think if an injector is not confident enough to inject without applying numbing cream first they should not be injecting.”
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