Etiology, prevention, and treatment of dermal filler complications.
Bailey Steven H,Cohen Joel L,Kenkel Jeffrey M
Aesthetic surgery journal
The availability of dermal fillers for multiple cosmetic indications has led to a dramatic increase in their application. Although fillers are generally regarded as safe tools for soft tissue augmentation, complications can occur. Therefore, to describe and review the complications associated with the currently-available dermal filling agents, the authors conducted a literature review in peer-reviewed journals and present the reported complication rates. They also describe current strategies to avoid, diagnose, and manage complications if they do occur.
10.1177/1090820X10391083
Dermal fillers: pathophysiology, prevention and treatment of complications.
Chiang Y Z,Pierone G,Al-Niaimi F
Journal of the European Academy of Dermatology and Venereology : JEADV
Dermal fillers are increasingly used for soft tissue augmentation of the face and hands. The widespread use of dermal fillers for rejuvenation has led to a rise in reports of associated complications. Although the majority of complications are mild and transient, serious and long-lasting complications have been observed. This article discusses the key complications including pigmentary changes, hypersensitivity reactions, infections, nodule formation, granulomatous reactions, vascular occlusion and migration of filler material. A thorough literature review was performed in addition to the combined extensive authors' (GP and FA) experience. Complications from fillers are increasingly being recognized and highlighted in the literature partly reflecting the growth in the market. This article provides a comprehensive overview of the filler complications with mechanisms of prevention and treatment per complication. A thorough understanding of the preventative and management strategies for the associated dermal filler complications will help the physician to prepare the patient well, and deal with complications that may arise effectively.
10.1111/jdv.13977
Prevention and management of iatrogenic blindness associated with aesthetical filler injections.
de Lacerda Davi
Dermatologic therapy
Injectable fillers have become one of the most performed aesthetical treatments worldwide over the past two decades. They are frequently applied to the face, offering effective and safe alternatives to more invasive surgical procedures. Nevertheless, there are serious risks associated with filler-based treatment. Visual impairment stands as a rare yet catastrophic adverse event associated with intravascular embolization of injected material to the retina or other areas of the central nervous system; potentially leading to permanent visual loss. This article presents a comprehensive revision of blindness secondary to aesthetical filler injections, offering up-to-date strategies for prevention and management.
10.1111/dth.12722
PMMA Safety for Facial Filling: Review of Rates of Granuloma Occurrence and Treatment Methods.
Aesthetic plastic surgery
PMMA is composed of microspheres suspended in bovine collagen. Once injected in a dermal area, the carrier is absorbed, giving place to collagen that gives volume and maintains the spheres in the place. This process may give origin to exacerbate foreign body reaction and granuloma. The frequency of such complication is not clear. The primary objective was to review and compare the frequencies of granuloma between the published studies. The secondary aim was to compare the therapies and efficacies. The series of cases in which PMMA was used as facial filler were reviewed, and the rate of granulomas was compared; the case report studies describing those complications were also reviewed, and the therapies and outcomes were quantified. The data showed general frequency of PMMA-related complications of 4.9% and granulomas 1.9%; the incidence of granuloma was 1/2075 patients-year, and the time to development ranged from 6 to 180 months. The most used therapies were steroid, surgery or both, with satisfactory results. In conclusion, considering the actual risks and benefits of PMMA, we may affirm that it is a safe filler; doctors and patients must be conscious of potential risks when deciding for its use. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
10.1007/s00266-019-01522-2
Filler-Associated Vision Loss.
Tran Ann Q,Staropoli Patrick,Rong Andrew J,Lee Wendy W
Facial plastic surgery clinics of North America
Soft tissue fillers continue to gain popularity in addressing volume loss and changes associated with facial aging. The rare but devastating complication from iatrogenic vascular occlusion can result in irreversible vision loss. This article discusses the complications of vision loss associated with fillers and reviews applicable treatment techniques and prevention methods.
10.1016/j.fsc.2019.07.010
The use of periocular fillers in aesthetic medicine.
Mandal Priyanka,Gama Frank
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
The periocular area is the first to display signs of ageing. Dermal fillers are an increasingly popular, minimally invasive method for facial rejuvenation. The eye is anatomically delicate and complex. Therefore, special consideration must be taken if dermal fillers are employed. This article examines the literature to assess the efficacy and safety of dermal fillers around the eye as well as the management of complications secondary to dermal filler use, such as oedema, granuloma formation, filler migration, xanthelasma, skin necrosis and visual loss. Hyaluronic acid (HA) is the most popular and commonly employed dermal filler for periocular use. It is effective, with good observer improvement and patient satisfaction (p<0.0001). Ninety percent of adverse events are mild in nature and self-resolve within 1 month. Malar oedema is a delayed complication unique to the periocular area, occurring in 11% of patients. This can be managed with use of hyaluronidase if a HA filler has been employed. Other complications, such as granuloma formation, filler migration and xanthelasma, have also been reported with variable management outcomes. Vascular adverse events include skin necrosis and visual loss. No Level 1 evidence exists for the management of visual loss. Two cases of visual restoration have been identified in the literature; however, this is rare.
10.1016/j.bjps.2020.12.079
Complications of Periocular Dermal Fillers.
Wang Yao,Massry Guy,Holds John B
Facial plastic surgery clinics of North America
Dermal fillers, in particular hyaluronic acid gel (HAG) fillers, are used in the treatment of aging changes in the periocular area. Filler treatment requires in-depth knowledge of specific issues relating to product performance and administration, safety protocols, and recognition and treatment of complications. There are different approaches to treatment of the tear trough. Prior filler treatment must be suspected in patients presenting for aesthetic evaluation, and the possibility of migration with a dysmorphic appearance and/or Tyndall effect appearance always is kept in mind. Treatment with hyaluronidase injection generally is effective in reducing overcorrection or migration of HAG in this area.
10.1016/j.fsc.2021.02.001
Asymptomatic Stroke After Hyaluronic Acid Filler Injection: Case Report and Literature Review.
Moore Ryan M,Mueller Melissa A,Hu Allison C,Evans Gregory R D
Aesthetic surgery journal
Vascular compromise and blindness are reported but rare complications of facial soft tissue filler injections. Stroke is an even rarer complication resulting from intraarterial injection of fillers. We present a case of a patient suffering all 3 complications following hyaluronic acid filler injection: forehead skin vascular compromise, unilateral blindness, and ipsilateral subclinical strokes. Were it not for a stroke workup protocol, the incidental strokes may have otherwise gone undetected, suggesting the incidence of stroke from intraarterial injection may be higher than reported. Further, we review the literature and recommendations for prevention and management of threatened tissue ischemia and vision loss from facial filler injection. LEVEL OF EVIDENCE: 5:
10.1093/asj/sjaa381
Delayed-onset Nodules (DONs) and Considering their Treatment following use of Hyaluronic Acid (HA) Fillers.
Convery Cormac,Davies Emma,Murray Gillian,Walker Lee
The Journal of clinical and aesthetic dermatology
Delayed-onset nodules (DONs) represent a poorly understood and generally neglected group of complications. It is not a diagnosis. The underlying pathologies and their incidences are largely unknown due to the lack of specificity in clinical signs and the challenges in accessing diagnostic tests, cost implications, or reluctance from patients to undergo them. A lack of presumptive clinical diagnosis, coupled with management ranging from "scatter-gun" polypharmacy to clinical inertia, is believed to result in chronicity and increased morbidity. This paper provides guidance on the identification and understanding of the underlying pathologies and encourages the increased utilization of a medical model of care. The more routine adoption of histopathology, inflammatory markers, and ultrasound will permit a more targeted management and a greater understanding of the incidences and evolution of the pathologies.
Delayed-onset granulomatous reaction presenting as chronic facial edema: a review of the diagnostic and therapeutic challenges.
Carrasquillo-Bonilla Dianne,Cancel-Artau Karina J,Santos-Arroyo Aileen
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology
Injection of soft tissue fillers for esthetic purposes is considered a relatively simple, minimally invasive procedure. . We report a case of a 61 y/o male with an unusual case of foreign body granulomas arising on his forehead and periorbital region for the past 3 years. He had no drug allergies or history of trauma. He only recalled administration of "Botox" near the affected area 20 years ago, although he acknowledged being unsure of the nature of the substance. Examination showed bilateral, periorbital, edematous plaques, with subcutaneous nodules on the forehead. Punch biopsy showed multiple vacuoles surrounded by collagen bundles in the dermis, a histiocytic infiltrate, and multinucleated giant cells. Based on clinicopathological correlation, a diagnosis of foreign body granuloma related to silicone filler injections was made. He was treated with intralesional steroids and doxycycline 100 mg twice daily with complete resolution. Physicians should acknowledge this potential complication of silicone fillers and should inquire about their use with close-ended questions. We also review the diagnostic and therapeutic challenges faced by physicians when encountering this diagnosis.
10.1080/14764172.2022.2033782
Evaluating safety in hyaluronic acid lip injections.
Expert opinion on drug safety
INTRODUCTION:Soft tissue filler augmentation has become increasingly popular due to its perceived ease and impressive results. Unfortunately, although the results are impressive, so are the reported complications. This article describes complications specific to peri-oral soft tissue filler injection and then discusses evidence-based, anatomic prevention and treatment guidelines. AREAS COVERED:The authors aimed at providing an overview of the complications associated with peri-oral soft tissue filler. Hyaluronic Acid (H.A) fillers may have devastating complications which are oft undisclosed or published. This narrative review aims to describe the various complications and provide preventative strategies. EXPERT OPINION:Given the paucity of prospective, randomized clinical trials on the subject and in light of complication underreporting, the authors believe that efficacy and safety literature on the subject is lacking. Injectors must rely on the one strength which exists in the lip literature to date, that is anatomy. The basis of all successful injections is a mandatory understanding of normal as well as variations of vital structures in an area, combined with meticulous injection techniques, deposition of small aliquots of product and the ability to recognize unwanted adverse events early enough to act on them.
10.1080/14740338.2021.1962283
Cerebral Embolism as a Result of Facial Filler Injections: A Literature Review.
Aesthetic surgery journal
BACKGROUND:With the growth in the popularity of facial filler injections, increased numbers of severe adverse events, such as cerebral embolism, have been reported. OBJECTIVES:The aim of this article was to summarize the clinical manifestations and proposed mechanisms of filler-induced cerebral embolism (FICE). METHODS:A literature review was performed with the search keywords "filler injection," "hyaluronic acid," "fat graft," "cerebral infarction," "cerebral embolism," "stroke," "cerebrovascular infarction," "disorders of consciousness," and "hemiplegia." RESULTS:Among the 43 cases of FICE enrolled from 35 articles, 37 patients were female, and 6 were male. Twenty-nine of these patients had received fat grafting, and 12 hyaluronic acid injection. Most FICE patients had been injected in the glabella, followed by the temporal, forehead, and nasal areas. Among 30 patients injected under local anesthesia, 43.33% presented with neurologic symptoms during the procedure. The main symptoms were consciousness disorders and hemiplegia. Most of the embolization sites were in the middle cerebral artery, followed by frontal lobe infarction and anterior cerebral artery infarction. Three patients developed cerebral hemorrhage after embolism. Twenty-six patients presented with newly acquired vision loss. The management for FICE cases included embolectomy, thrombolysis, decompressive craniectomy, antiplatelet/anticoagulant therapy, and symptomatic and nutritional treatment. Nearly half of the patients recovered or exhibited improved neurologic manifestations but not visual loss. Five patients died. CONCLUSIONS:FICE is a severe complication following facial filler injection. Careful prevention, timely identification, and treatment are crucial to decreasing the morbidity and mortality of FICE. LEVEL OF EVIDENCE: 4:
10.1093/asj/sjab193