Needle-Free Filler Pens and At-Home Treatments: Which Should Not Be Done, and Which Are Relatively Low-Risk?

Why have at-home treatments become so widespread?

Short videos compress a procedure into a few seconds: the product is opened, applied and the result is shown. The part you do not see is what comes afterwards. You cannot know whether the person who made the video had to see a physician days later because of an infection, a burn or pigmentation. Dermatology associations list at-home filler injections, needle rollers and laser treatments among the worrying trends of recent years.

In this article we do not lump all at-home treatments together. They are not all dangerous to the same degree. In drawing the distinction, the following question is a useful guide: does the treatment puncture the skin, deliver a substance under the skin or burn the skin chemically or with heat? If the answer is yes, this is not skin care but a medical procedure.

Products of unknown origin and injections given by other people outside a healthcare facility are a separate subject; we have covered these in our article “Counterfeit Products and Unlicensed Treatments”. Here we concentrate mainly on treatments that people carry out on themselves.

What is a needle-free filler pen, and why is it not recommended?

A needle-free filler pen (also referred to as a hyaluron pen) is a hand-held device that pushes the substance loaded into it through the skin under high pressure, without using a needle. The filler substance to be loaded into it is mostly sold separately. Although the phrase 'no needle' sounds reassuring, it does not change the fact that the substance enters the tissue; it only changes how it enters.

In its safety communication dated 8 October 2021, the US Food and Drug Administration (FDA) warned the public and healthcare professionals not to use needle-free devices to inject hyaluronic acid or other lip and facial fillers. According to the communication, the agency has not evaluated the safety and effectiveness of these devices for any filler and has not approved their marketing for this purpose. Approved fillers are designed to be given on prescription, with a syringe fitted with a needle or cannula.

In the same communication the FDA stated that it was aware of reports of serious injuries to the skin, lips and eyes, and in some cases irreversible damage, after lip and facial filler given with needle-free devices. The two basic problems the agency emphasises are these:

• The problem of control: a pressure device does not give enough control over where in the tissue, and to what depth, the substance goes.
• The problem of the product: filler products sold online directly to consumers may be contaminated with chemicals or microorganisms.

The other possible risks listed in the communication include bleeding and bruising, bacterial, fungal or viral infection, transmission of disease between people who use the same device, tissue death due to blockage of a blood vessel, loss of vision or stroke, scarring, pressure-related damage to the eye, lumps in the skin, discolouration and allergic reaction. It is also stated that some complications may not resolve.

The FDA communication relates to the USA and does not give the number of cases reported; for this reason it is not known how often the problems occur. The legal status of the products may be different in other countries. However, the grounds on which the communication is based, namely lack of control and product safety, do not depend on the country.

Can I buy filler or botulinum toxin online and inject it myself?

No; of all at-home treatments, this is the riskiest. The FDA clearly advises people not to buy fillers online and not to inject filler into themselves or anyone else with any device. The agency's page on fillers states that no filler has been approved for over-the-counter sale and that products bought online may be counterfeit.

• With filler, the most serious risk is the substance entering a blood vessel or pressing on a vessel. This can lead to tissue loss and, very rarely, loss of vision; it needs to be recognised and treated within minutes. At home there is no one to recognise and treat it.
• With botulinum toxin, the problem is the dose. With a product of unknown origin it is impossible to know how much active substance it contains; the effect can spread beyond the treatment area.
• A technique learned from a video does not replace knowledge of facial anatomy. The position of blood vessels and nerves varies from person to person.
• An injection given in non-sterile conditions paves the way for infections that can appear even weeks later.

These risks are not zero in treatments carried out by a physician either; the difference is that the risk is reduced and that immediate treatment is possible if a problem arises. You can find the warning signs in our article “After Fillers: When Is It an Emergency?” and the details specific to the lips in our article “Lip Filler”.

Are at-home laser and IPL hair removal devices safe?

Home-use light-based hair removal devices are the relatively low-risk group among the treatments in this article. The reason is that devices sold to consumers work at markedly lower energy than those used in clinics and do not puncture the skin. Most of the devices use intense pulsed light (IPL) technology.

A systematic review of these devices reported that a short-term reduction in hair was achieved after repeated treatments, but that the studies were uncontrolled and small and that the results varied greatly with the device and the person. The most common side effect is redness; less commonly, swelling, blistering, crusting and discolouration have also been reported. So 'relatively low risk' does not mean that there are no side effects.

• Follow the skin colour and hair colour chart in the device's instructions for use. The risk of burns and pigmentation increases in darker skin and tanned skin; with fair, red or white hair, no effect is expected.
• Do not use it around the eyes and do not look directly at the light.
• Do not go over moles, tattoos, wounds or areas with active skin disease.
• Do not use it on recently sun-exposed skin, or while taking a medicine that can cause sensitivity to light, without consulting your physician.
• In women, new and rapidly increasing hair growth on the face, chin or trunk may be due to a hormonal cause; an examination is needed first.

We have explained how treatment in a clinic works in our article “Laser Hair Removal”. If blistering or discolouration occurs after treatment, our article “Burns and Pigmentation Changes after Laser and IPL” may guide you.

Is using a needle roller at home harmful?

Two separate groups of products need to be distinguished here. Some are products that do not puncture the skin and only stimulate the surface gently. The others are rollers and motorised pens whose needles truly puncture the skin. The American Academy of Dermatology states that products sold for home use are not designed to puncture the skin and that their effects are therefore less noticeable than treatment by a physician.

The problem begins when the product punctures the skin or is pressed too hard:

• Infection: needles cannot be reliably sterilised at home. Every puncture is a point of entry for microorganisms.
• Spread: a roller can carry a viral infection such as a cold sore or wart to other areas of the face.
• Scarring and pigmentation: too much pressure, or needles that have become blunt or bent, can leave scratches, scars and discolouration on the skin.
• Irritation: frequent use can make the problem you want to improve look worse.
• Sharing: using the same product with someone else is risky with regard to blood-borne diseases. The FDA states that reusing needle tips is not safe, even if they have been cleaned.

These products should not be used on active spots, cold sores, eczema or open wounds. Cosmetic products applied immediately after treatments that puncture the skin may pass through the skin more; this raises the risk of irritation and allergy. If you are considering it for a problem such as acne scars, you can find how the method is carried out by a physician in our article “Microneedling”.

Why is it risky to use high-concentration peeling acids at home?

Cosmetic products containing acids at low concentration and a chemical peel carried out by a physician are not the same thing. Products made for daily care and used according to the instructions on the label are relatively low-risk. The risk begins when high-concentration solutions prepared for professional use are bought online and applied at home.

In a warning published in July 2024, the FDA advised consumers not to buy or use peeling products containing high concentrations of substances such as trichloroacetic acid, glycolic acid, salicylic acid and lactic acid without appropriate professional supervision. The agency stated that it has not approved any chemical peel product, and reported that these products can cause chemical burns, pain, swelling, infection, changes in skin colour and disfiguring scars.

How deep the acid goes into the skin depends not only on the concentration but also on how many layers are applied and how long it stays on the skin. A physician adjusts these variables according to skin type and stops the procedure when necessary; at home this control is absent. The risk of pigmentation is also particularly high in darker skin. For details of treatment by a physician, see our article “Chemical Peels”.

Which are relatively low-risk, and which should not be done?

This table is a general framework; it is not individual advice. In people with a skin condition, in pregnancy, in those on regular medication and in darker skin, treatments regarded as 'relatively low-risk' can also cause problems. If you are not sure, consult your physician first.

Which symptoms after an at-home treatment are an emergency?

1. Stop the treatment. If you used a product containing acid, rinse the area with plenty of lukewarm water for a long time.
2. Do not squeeze or rub the area, and do not try to drain it with a needle or to 'fix' it at home.
3. If your symptoms are in the lists above, call 112 or go to an emergency department.
4. Take the product's box, label, order record and the device with you, or show a photograph of them.
5. Explain clearly what you did. The healthcare team asks not in order to judge, but to start the right treatment quickly.

For the general steps to follow in situations that are not an emergency but that worry you, see our article “What Should You Do If a Complication Occurs after an Aesthetic Treatment?”.

Questions you can ask yourself before deciding

• Does this treatment puncture the skin, deliver a substance under the skin or burn the skin?
• Who made the product, what is in it, and does it come with manufacturer details and instructions for use in the language of the country where it is sold (in Turkey, in Turkish)?
• If there is a problem, who will recognise it and treat it?
• Is the video I saw an advertisement? Do I know what happened to the person in the video afterwards?
• Could I achieve the same result in a safer way, with a physician's examination?

The appeal of an at-home treatment is most often convenience. But in a procedure that punctures or burns the skin, convenience does not replace safety.