Complications of Nonpermanent Facial Fillers: A Systematic Review

Abstract

Background: A variety of complications after injection of nonpermanent fillers for facial rejuvenation have been reported so far. However, to date, the overall complication rate is still a matter of debate. The aim of this study was to perform a systematic review of literature to assess the type and severity of associated complications following injections in different anatomical regions of the face. Methods: The entire PubMed/Medline database was screened to identify case reports and clinical studies describing complications that have occurred after injection of nonpermanent fillers in the face. These complications have been reviewed and analyzed according to their occurrence in different anatomical regions of the face. Results: Forty-six articles including a total of 164 patients reported on a total of 436 complications during the time period between January 2003 and February 2020. The majority of the complications were reported after injections to the nose and the nasolabial fold (n = 230), the forehead and the eyebrows (n = 53), and the glabellar region (n = 36). Out of 436 complications, 163 have been classified as severe or permanent including skin necrosis (n = 46), loss of vision (n = 35), or encephalitis (n = 1), whereas 273 complications were classified as mild or transient, such as local edema (n = 74), skin erythema (n = 69), and filler migration (n = 2). The most severe complications were observed in treatments of nose, glabella, and forehead. Conclusions: Nonpermanent facial fillers are associated with rare but potentially severe complications. Severity and impact of complications depend on the anatomical region of the face and eventually require profound knowledge of facial anatomy.

Aesthetic Surgical Pathway in Permanent Facial Filler Removal

“…3,5 For these reasons, many patients are not satisfied with the long-term results following nonresorbable filler injections and years after implantation request removal of the products. 3,5,[7][8][9][10][11] The use of permanent fillers is totally or partially forbidden in some European countries such as the Netherland and Poland, especially for the challenge to face their surgical removal. 12 Several nonsurgical managements have been introduced to treat permanent filler complications, as systemic antibiotic therapy, intralesional injections of corticosteroid, and/or 5-fluorouracil, needle aspiration, surgical drainage, and laser therapy, [7][8][9][10][11] although none of those techniques is able to totally remove previously injected permanent fillers.…”

An Update on the Clinical Efficacy and Safety of Collagen Injectables for Aesthetic and Regenerative Medicine Applications

“…Apart from the selected collagen formulation, as with any surgical or minimally invasive procedure, the result obtained with the injection therapy heavily depends on proper patient selection, expertise in performing the procedure, adequate knowledge of facial or other site’s anatomy, and use of specialized equipment [ 13 , 123 ]. Only recently, the development of adequate implantation protocols permitted re-evaluation of collagen-based injectable therapies as a minimally invasive and effective strategies for the treatment of different types of diseases.…”

“…Iatrogenic blindness is a rare but possible risk caused by misplaced intravascular injection. The risk is correlated to the complex vascular anatomy of the face interconnecting the extracranial and intracranial vascular network [ 13 ]. This tragic complication occurs when the filler is wrongly injected in the ophthalmic artery.…”

“…Non-resorbable solutions (e.g., silicone, poly(methyl methacrylate), polyvinylpyrrolidone, polyacrylamide), are permanent (last more than 2 years) but usually suffer from mild-severe adverse reactions (i.e., granuloma, implant encapsulation, persistent pain or rejection) that limit patient satisfaction and could require implant removal surgery [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Contrarily, resorbable formulations are usually based on natural biomaterials (i.e., collagen, hyaluronic acid, calcium hydroxyl apatite) and last 6–18 months [ 13 , 14 , 15 , 16 ]. Their durability depends on many factors such as the raw material type, product cross-linking degree, lost tissue extension, disease site and etiology, and patient metabolism, age and co-morbidities.…”

Early warm compress treatment can promote recanalization of vascular embolisms and reduce tissue necrosis after polymethyl methacrylate injection

“…Mild or transient complications related to filler injection include swelling, edema, erythema, skin paraesthesia, and local infection. Severe or permanent complications include skin necrosis, vision loss, and blepharoptosis 6 . Complications classified as severe or permanent are mainly caused by vascular compromise, which may be induced by partial or complete vascular occlusion caused by the intravascular injection of filler 7 .…”