Can I get lip fillers with Master Activation Syndromes (MAS)?

Lip Fillers in Patients with Mast Cell Activation Syndrome (MCAS)

Lip fillers are generally not recommended for patients with Mast Cell Activation Syndrome due to the increased risk of anaphylaxis and other severe mast cell activation reactions during cosmetic procedures. 1

Understanding the Risks

Mast cell activation can occur in patients with mastocytosis or MCAS during surgical or cosmetic procedures, with the risk potentially persisting for several hours afterward due to delayed mast cell mediator release. Patients with MCAS have a higher risk of anaphylaxis in perioperative settings compared to the general population 1.

Key concerns include:

• Risk of triggering mast cell degranulation from:
  • Physical trauma from needles
  • Foreign substance introduction (filler material)
  • Stress/anxiety related to the procedure
  • Local anesthetics (if used)

Pre-Procedure Considerations (If Proceeding Despite Risks)

If a patient with MCAS still wishes to pursue lip fillers after understanding the risks, the following approach should be taken:

1. Multidisciplinary consultation with:

   • Immunologist/allergist who manages the MCAS
   • Dermatologist or plastic surgeon experienced with both fillers and mast cell disorders

2. Pre-procedure medication protocol:

   • Benzodiazepines for anxiety reduction
   • H1 and H2 antihistamines
   • Corticosteroids (consider short course)
   • Continue all regular MCAS medications 1

3. Filler selection considerations:

   • Hyaluronic acid fillers are generally preferred as they can be dissolved with hyaluronidase if a reaction occurs 2
   • Consider autologous platelet concentrates as an alternative with potentially lower reaction risk 1

Procedure Modifications

If proceeding with lip fillers:

• Use smaller gauge needles (27-30 gauge) to minimize trauma 1, 3
• Consider cannula (25 gauge) approach with only two entry points to reduce trauma 1
• Inject above the orbicularis oris muscle for vessel safety 1, 3
• Use minimal volumes (0.2-0.5 mL per quadrant) 1
• Have emergency medications immediately available:
  • Injectable epinephrine
  • IV corticosteroids
  • Additional antihistamines
  • IV fluids 1

Post-Procedure Management

• Observe the patient for at least 30-60 minutes after the procedure
• Provide clear instructions for managing delayed reactions
• Schedule a follow-up within 24-48 hours
• In case of reaction, measure serum tryptase level within 30-120 minutes of symptom onset 1
• Consider a full allergic workup if any reaction occurs

Alternative Approaches

For patients with MCAS seeking lip enhancement:

• Consider autologous platelet concentrates (PRP/PRF) which may provide rejuvenation effects with potentially lower reaction risk 1
• Focus on lip care and maintenance with non-invasive approaches:
  • Hydrating lip products without alcohol or irritants
  • Lip-safe moisturizers containing natural oils 3

Conclusion

The risk-benefit ratio for lip fillers in MCAS patients strongly favors avoiding these procedures due to the significant risk of triggering severe mast cell activation events. If a patient still wishes to proceed, extensive precautions, pre-medication, and emergency preparedness are essential, along with full informed consent about the heightened risks.