Managing Complications of Fillers: Rare and Not-So-Rare

Abstract

Fillers belong to the most frequently used beautifying products. They are generally well tolerated, but any one of them may occasionally produce adverse side effects. Adverse effects usually last as long as the filler is in the skin, which means that short-lived fillers have short-term side effects and permanent fillers may induce life-long adverse effects. The main goal is to prevent them, however, this is not always possible. Utmost care has to be given to the prevention of infections and the injection technique has to be perfect. Treatment of adverse effects is often with hyaluronidase or steroid injections and in some cases together with 5-fluorouracil plus allopurinol orally. Histological examination of biopsy specimens often helps to identify the responsible filler allowing a specific treatment to be adapted.

Keywords: Complications; blindness; fillers; hyaluronic acid.

Figure 1

Over correction Tyndall effect hyaluronic acid (Courtesy Dr. M Cantisano-Zilkha)

Figure 2

Reaction after injection of a new hyaluronic acid filler (Hylacorp^®)

Figure 3

Scanning microscopy of the excision specimen of the patient shown in Figure 2

Figure 4

Medium paower histopathology photograph of the hyaluronic acid injection specimen showing clumps of basophilic hyaluronan, giant cells and huge masses of eosinophils

Figure 5

Close-up photograph of the hyaluronan granuloma with multinucleated giant cells engulfing the material as well as many eosinophils.

Figure 6

Female patient after injection of acrylic gel (Dermalive)

Figure 7

Stretching out the skin makes the granulomas more visible.

Figure 8

Some of the extirpated acrylic gel granulomas

Figure 9

Scanning microscopy of the acrylic gel granulomas

Figure 10

High magnification of an area in the granuloma showing long slender so-called cholesterol clefts in a necrotic tissue as well as smaller polyedric acrylic particles

Figure 11

Area of the granuloma with multiple acrylic gel particles

Figure 12

Mainly epithelioid cell granuloma with some giant cells and acrylic gel particles

Figure 13

Dense lymphocytic infiltrates around vessels and small silicone droplets (lower margin) reminiscent of small fat cells

Figure 14

Adverse reaction to silicone displaying small silicone droplets