Hyaluronic acid injections: effects, dangers, without prescription?

To fill in facial wrinkles, give volume to the lips, make dark circles disappear… Products based onhyaluronic acid are all the rage in the fight against aging. But if they are not injected by a health professional, there is a high risk of complications.

What are the effects of hyaluronic acid?

Hyaluronic acid was discovered in 1934. It has been used since 1996-1997 in the form of injections for aesthetic purposes. These injections help combat the signs of aging on the face. The injected product fills or gives volume to a specific area: nasolabial folds, lion’s wrinkles (between the eyebrows), crow’s feet (corner of the eyes), cheeks, chin, around the mouth, lip contour, dark circles, cheekbones… Hyaluronic acid injection is performed in women and men in the dermis or deep dermis.

What side effects?

► Erythema may occur immediately after the injection, it generally disappears after a few hours or even a few days.

► Bruises and hematomas may appear in the following days and disappear within a week.

► Redness, swelling may be associated with itching or pain on pressure.

► An outbreak of cold sores is possible, especially in people who have had them before. This should be reported to the doctor.

Can you buy it without a prescription?

Not since July 1, 2024. Since that date, a medical prescription is mandatory to obtain medical devices or injectable products containing hyaluronic acid in pharmacies. Before that date, it was possible to buy them without a prescription in pharmacies. This was denounced by cosmetic surgeons in a Tribune published in 2023 in The Parisian. For these doctors, These products were no longer to be offered freely nor sold on the Internet (which is still the case for this last point). The cause is the “alarming” increase in serious adverse effects that occurred between January and July 2022 in France due to non-medical injectors who are not authorized to perform this type of cosmetic procedure.

What are the dangers of hyaluronic acid?

Hyaluronic acid injections performed by non-healthcare professionals can cause serious side effects. The most common short-term side effects, related to improper use of these productsare :

► if the injection of the product does not comply with the rules of asepsis:

• infection local of the area where the product was injected, which can become generalized (sepsis) if the localized infection is not treated quickly;
• viral contamination (including HIV) or bacterial if the equipment used is shared.

► if the injection of the product is carried out into a blood vessel:

• necrosis may lead to tissue amputation if the product is injected into a blood vessel,
• loss of sight (blindness) if it is a vessel that supplies blood to the eye.

In the long term, the risks are the poor positioning of the injected product due to its migration and the inflammation of the injected tissues.

Who is legally allowed to perform hyaluronic acid injections?

In France, only doctors are authorized to perform hyaluronic acid injections for aesthetic purposes.. “Their training and their knowledge of facial and body anatomy make them the only ones authorized and competent to guarantee the safety of injections” recalls the ANSM. The injection of hyaluronic acid requires the carrying out a clinical interview, to check in particular the medical history of the patient (allergies, autoimmune diseasesetc.) and choose the products suitable for the injection area. Be aware that traceability of the injected product (type, brand, batch number) must be kept by the practitioner. “Doctors know how to manage immediate side effects such as an allergy to the injected product (anaphylactic shock), necrosis/ischemia (blocked blood vessel), by appropriate medical treatment (antibiotic, anti-inflammatory, hyaluronidase, etc.) and will implement appropriate monitoring if necessary in the event of a longer-term adverse effect” adds the health agency. In addition, they master the rules of hygiene relating to surgical waste (dirty syringe) which prevents the risk of contamination of communicable diseases HIV, hepatitis C etc. In a therapeutic context such as to treat an oral-dental pathology, dental surgeons can use injectable filler products in the lips and nasolabial fold.

► However, injections are prohibited for beauticians and, a fortiori, for all non-professionals. This prohibition is valid regardless of the aesthetic purpose of the procedure (for example pigmentation, filling, tattoo removal or semi-permanent makeup).

What precautions should be taken before and after a hyaluronic acid injection?

• Avoid taking aspirin, nonsteroidal anti-inflammatory drugs and vitamin C for the previous 3 days.
• If you have an outbreak of nasolabial herpes before the injection, report it to your doctor.
• After the injection, avoid taking alcohol and anti-inflammatories.
• Stay calm for 3 hours following the injections, avoiding moving your face.
• Sauna, sun exposure, heat, violent sport, dental care, skin cleaning should be avoided for 3 days following the injection.
• Makeup can be resumed the next day
• Facial expressions should not be exaggerated so as not to put excessive strain on the injected areas.