Consensus statement on prevention and management of adverse effects following rejuvenation procedures with hyaluronic acid‐based fillers

Abstract

Facial fillers play an important role in the correction of facial changes associated with ageing. They offer quick treatments in the outpatient setting with minimal subsequent downtime that provide predictable, natural-looking, long-lasting results. Adverse reactions after hyaluronic acid injections tend to be mild or moderate and rather temporary. However, as with all injected or implanted biomaterials, severe adverse events can occur and patients must be fully informed of potential risks prior to undergoing treatment. A panel of experts from Germany (D), Austria (A) and Switzerland (CH) developed recommendations, and this study provides the 'DACH Consensus Recommendations' from this group specifically on the use of hyaluronic acid fillers. The aim is to help clinicians recognize potential risks and to provide guidance on how best to treat adverse events if they arise. Contraindications to hyaluronic acid fillers are also detailed, and ways to prevent adverse events occurring are discussed. Hyaluronic acid-based products are claimed to be very close to an ideal tissue augmentation agent; nevertheless, profound medical, anatomical and product knowledge are of paramount importance to minimize the occurrence of adverse reactions.

Severe vision loss caused by cosmetic filler augmentation: Case series with review of cause and therapy

“…Hyaluronic acid (HA) injection is a popular nonsurgical, rejuvenating procedure due to its effectiveness and reduced downtime compared to the surgical technique. Hyaluronic acid acts as a soft tissue filler due to its glycosaminoglycan structure, which allows it to retain water, and in turn, volumize the overlying skin . Soft tissue fillers, like hyaluronic acid, have become the second most frequently used cosmetic minimally invasive procedure with about 2.1 million people undergoing HA injection in 2017…”

“…As HA injection use has rapidly expanded from previous years, the number of reported adverse events has also increased. While temporary, localized injection site reactions, including limited pain, bruising, and redness continue to be the most common, more severe complications are being identified . Among these complications, the rare but most devastating one is arterial occlusion, which can result in skin necrosis or blindness.…”

Management of granulomatous foreign body reaction to fillers with methotrexate

“…Granulomatous foreign body reactions associated with fillers injections are rare with previous reported incidences in the range 0.02-2.8%. 3 Such reactions are usually delayed (up to 20 years in the literature) [3][4][5][6][7][8][9][10][11][12][13][14][15] and have been reported mainly with nonbiodegradable filling materials including PMMA microspheres, HEMA, LIS, polyacrylamide gel or polyalkylimide gel but remain unusual with hyaluronic acid (HA). 4,5,8,[12][13][14] All injection sites may be involved, although perioral involvement is among the most frequently reported sites in the literature.…”

“…13 Current treatments are based on prolonged administration of antibiotics when biofilms are suspected. 4,10,12 Oral and/or intra-lesional corticosteroids 4,5,7,8,13 or intralesional injections of 5-fluorouracil 10,12,13 are usually used when granulomas have not improved despite broad-spectrum antibiotics. Steroids may temper the inflammatory reaction but relapses are common when doses are tapered.…”

Adverse reactions to fillers should be published – on the consensus statement on adverse effects following hyaluronic acid‐based fillers

“…By Philipp-Dormston et al 1 Aesthetic procedures are two faced. On one side, we see fabulous or at least okay results and on the other side adverse reactions fromwhen it comes to fillersabscesses to blindness.…”