Dermal fillers in aesthetics: an overview of adverse events and treatment approaches

Abstract

Background: The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase.

Objective: To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance.

Methods: Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors' extensive experience, recommendations for avoiding and managing complications are provided.

Results: Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique.

Conclusion: For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications.

Keywords: aesthetic medicine; complications.

Figure 1

Bruising may be immediate or worsen over 3 days.

Figure 2

Acute generalized facial edema.

Figure 3

Malar edema.

Figure 4

The anatomic basis of malar edema. Notes: Pessa JE, Garza JR., Aesthet Surg J. 17(1):11–17. Copyright © 1997 by MOSBY, INC. Reprinted by Permission of SAGE Publications.

Figure 5

Erythema at site of injection.

Figure 6

Dyschromia and visible material.

Figure 7

Dermal filler injection leading to herpes virus reactivation.

Figure 8

Noninflammatory nodule.

Figure 9

Inflammatory foreign body granuloma before and after treatment with an antibiotic, 5-FU, triamcinolone, and local anesthetic. Abbreviation: 5-FU, 5-fluorouracil.

Figure 10

Nodularity that proved to be foreign body granuloma on surgical biopsy.

Figure 11

Facial artery anatomy illustrating the most common sites of vascular occlusion. Notes: Reproduced with permission. Copyright © 2009, John Wiley and Sons. Grunebaum LD, Bogdan Allemann I, Dayan S, Mandy S, Baumann L. The risk of alar necrosis associated with dermal filler injection. Dermatol Surg. 2009;35 Suppl 2:1635–1640.

Figure 12

Retinal artery occlusion as a result of calcium hydroxylapatite in the central retinal artery.

Figure 13

Skin necrosis after dermal filler injection.

Figure 14

Examples of tissue necrosis after vascular compromise.

Figure 15

Progression of vascular compromise after an embolic event.