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Introduction-Injection of dermal fillers into orofacial tissues is becoming increasingly popular for cosmetic purposes, in particular for lip augmentation. Both natural and synthetic filler materials are available, producing a spectrum of clinical and histological appearances. Aims-The aim of this study was to review the clinicopathological characteristics of dermal filler cases from 2006-2016 reported at a specialist Oral Pathology unit. Methods-An archival search of the Pathology database was performed to retrieve cases reported as being consistent with cosmetic fillers. Results-10 cases of orofacial cosmetic fillers were retrieved. 100% of these cases were from female patients and the mean age of presentation was 47.6 years (range 24-68 years). The lips were the most frequently involved site (80%, n=8). The majority of provisional diagnoses were related to salivary gland disease including neoplasms (30%, n=3), cysts (20%, n=2) or inflammatory disease (10%, n=1). Only two cases (20%) were clinically thought to be related to previous cosmetic injections. A variety of filler materials were seen, including collagen, hydroxyapatite and silicone, however hyaluronic acid-based materials were the most common (50%, n=5). Conclusions-Complications of cosmetic dermal fillers are becoming frequently more common and should be considered within a differential diagnosis for unusual orofacial swellings. In brief points: • Cosmetic fillers can migrate away from the original site of injection and cause unusual and varied clinical presentations resembling other oral lesions • All filler material types, including natural material, were associated with host inflammatory responses • Cosmetic fillers should be included in a differential diagnosis of peri-oral swellings

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