THE COMPLICATIONS OF FILLER

Along with the increase in aesthetic medicine treatments with hyaluronic acid fillers, the incidence of post-filler complications has also increased. Below, we analyze the major complications that occur after treatments with hyaluronic acid fillers, on the face. You can also go and read more about this topic in the article we wrote in our scientific blog Aesthetic Facts.

EMATOMA

L’ematoma post filler è una raccolta di sangue localizzata nella zona di iniezione o nelle aree limitrofi al trattamento. In seguito alla puntura di un vaso, il sangue fuoriesce e si accumula nel tessuto, rendendosi visibile. Post-filler hematoma is a collection of blood located in the injection area or in the areas close to the treatment. After a vessel is punctured, blood flows out and accumulates in the tissue, making it visible.

POST-FILLER EDEMA

Edema is swelling caused by the accumulation of fluids in the interstitial spaces of the tissue. Every time there is a traumatic event or the injection of a substance that attracts water (such as hyaluronic acid filler) we will have edema. Its extent and duration are individual.

ERYTHEMA

The erythema consists of a transient reddening of the skin. Immediately after the injection, redness of the skin may occur. It resolves spontaneously: over a period of time ranging from a few hours to a few days.

INFECTION

The infection is caused by a pathological increase of bacteria in a specific region of the body. The part is red, very hot and painful. Some fever lines may also appear.

HERPES SIMPLEX

The so-called Cold sores is a viral infection due to the local activation of the herpes simplex virus type 1. It manifests itself with small whitish|yellowish vesicles (with or without border of erythema), filled with serum. The associated cardinal symptoms are burning and soreness.

PARESTHESIA

Paresthesia is characterized by impaired sensitivity. Sensitivity is altered to the touch and to various sensory stimulus. It is usually transient.

NODULES | GRANULOMAS

The nodules are accumulations of gel in the area of ​​tissue affected by the injection of the filler. They can affect the anatomical plane of injection or be located in another plane. They are one of the most common complications associated with hyaluronic acid filler infiltrations.

VASCULAR OCCLUSION

Vascular compromise can occur at both arterial and venous levels.

ARTERIAL OCCLUSION The arterial occlusion occurs when the filler accidentally gets into the lumen of the artery, causing it to become blocked (embolism) and interrupting normal blood flow.

VENOUS COMPRESSION The venous compression occurs when there is excessive placement of filler near a vein, causing it to be squeezed from the outside. This compression prevents the normal outflow of blood.

PIGMENTED LESIONS

This is the posthumous formation of "spots" (pigmented lesions, ed), in the injection treatment area. They can be divided into three types: neovascularized lesions, hyperpigmentation, Tyndall effect.

1 Fernando Urdiales, Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations received: 25 September 2017 / Accepted: 17 December 2017 / Published online: 5 January 2018
2 Funt D, Pavicic T (2015) Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Plast Surg Nurs 35:13–32
3 Christensen LH (2009) Host tissue interaction, fate, and risks of degradable and non-degradable gel fillers. Dermatol Surg 35:1612–1619
4 De Boulle K, Heydenrych I (2015) Patient factors influencing dermal filler complications: prevention, assessment, and treatment. Clin Cosmet Investig Dermatol 8:205–214
5 Fitzgerald R, Bertucci V, Sykes JM, Duplechain JK (2016) Adverse reactions to injectable fillers. Facial Plast Surg 32(5):532–555
6 Glass GE, Tzafetta K (2014) Optimising treatment of Bell’s Palsy in primary care: the need for early appropriate referral. Br J Gen Pract 64(629):e807–e809
7 http://biblioteca.asmn.re.it/allegati/parestesie3_110726024255.pdf
8 Rohrich RJ, Nguyen AT, Kenkel JM (2009) Lexicon for soft tissue implants. Dermatol Surg 35(Suppl 2):1605–1611
9Sclafani AP, Fagien S (2009) Treatment of injectable soft tissue filler complications. Dermatol Surg 35:1672–1680
10 Rzany B, DeLorenzi C (2015) Understanding, avoiding, and managing severe filler complications. Plast Reconstr Surg 136(5 Suppl):196S–203S
11 Bailey SH, Cohen JL, Kenkel JM (2011) Etiology, prevention and treatment of dermal filler complications. Aesthetic Surg J 31:110–121
12 Park SW, Woos SJ, Park KH, Huth JW, Jung C, Kwon OK (2012) Iatrogenic retinal artery occlusion caused by cosmetic facial filler inyections. Am J Ophthalmol 154(4):653–662
13 Loh KT, Chua JJ, Lee HM, Lim JT, Chuah G, Yim B, Puah BK (2016) Prevention and management of vision loss relating to facial filler injections. Singap Med J 57(8):438–443
14 Carruthers JD, Fagien S, Rohrich RJ, Weinkle S, Carruthers A (2014) Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg 134(6):1197–1201
15Hayreh SS, Zimmerman MB (2005) Central retinal artery occlusion: visual outcome. Am J Ophthalmol 140(3):376–391
16 Funt D, Pavicic T (2015) Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Plast Surg Nurs 35:13–32
17 DeLorenzi C (2013) Complications of injectable fillers, part I. Aesthet Surg J 33(4):561–575
18 Hirsch RJ, Narurkar V, Carruthers J (2006) Management of injected hyaluronic acid induced Tyndall effects. Lasers Surg Med 38(3):202–204
19 Rousso JJ, Pitman MJ (2010) Enterococcus faecalis complicating dermal filler injection: a case of virulent facial abscesses. Dermatol Surg 36(10):1638–1641
20 Dayan SH, Arkins JP, Brindise R (2011) Soft tissue fillers and biofilm. Facial Plast Surg 27:23–28
21 Lemperle G, Gauthier-Hazan N, Wolters M, Eisemann-Klein M, Zimmermann U, Duffy DM (2009) Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes. Plast Reconstr Surg 123(6):1842–1863

1 Fernando Urdiales, Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations received: 25 September 2017 / Accepted: 17 December 2017 / Published online: 5 January 2018
2 Funt D, Pavicic T (2015) Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Plast Surg Nurs 35:13–32
3 Christensen LH (2009) Host tissue interaction, fate, and risks of degradable and non-degradable gel fillers. Dermatol Surg 35:1612–1619
4 De Boulle K, Heydenrych I (2015) Patient factors influencing dermal filler complications: prevention, assessment, and treatment. Clin Cosmet Investig Dermatol 8:205–214
5 Fitzgerald R, Bertucci V, Sykes JM, Duplechain JK (2016) Adverse reactions to injectable fillers. Facial Plast Surg 32(5):532–555
6 Glass GE, Tzafetta K (2014) Optimising treatment of Bell’s Palsy in primary care: the need for early appropriate referral. Br J Gen Pract 64(629):e807–e809
7 http://biblioteca.asmn.re.it/allegati/parestesie3_110726024255.pdf
8 Rohrich RJ, Nguyen AT, Kenkel JM (2009) Lexicon for soft tissue implants. Dermatol Surg 35(Suppl 2):1605–1611
9Sclafani AP, Fagien S (2009) Treatment of injectable soft tissue filler complications. Dermatol Surg 35:1672–1680
10 Rzany B, DeLorenzi C (2015) Understanding, avoiding, and managing severe filler complications. Plast Reconstr Surg 136(5 Suppl):196S–203S
11 Bailey SH, Cohen JL, Kenkel JM (2011) Etiology, prevention and treatment of dermal filler complications. Aesthetic Surg J 31:110–121
12 Park SW, Woos SJ, Park KH, Huth JW, Jung C, Kwon OK (2012) Iatrogenic retinal artery occlusion caused by cosmetic facial filler inyections. Am J Ophthalmol 154(4):653–662
13 Loh KT, Chua JJ, Lee HM, Lim JT, Chuah G, Yim B, Puah BK (2016) Prevention and management of vision loss relating to facial filler injections. Singap Med J 57(8):438–443
14 Carruthers JD, Fagien S, Rohrich RJ, Weinkle S, Carruthers A (2014) Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg 134(6):1197–1201
15Hayreh SS, Zimmerman MB (2005) Central retinal artery occlusion: visual outcome. Am J Ophthalmol 140(3):376–391
16 Funt D, Pavicic T (2015) Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Plast Surg Nurs 35:13–32
17 DeLorenzi C (2013) Complications of injectable fillers, part I. Aesthet Surg J 33(4):561–575
18 Hirsch RJ, Narurkar V, Carruthers J (2006) Management of injected hyaluronic acid induced Tyndall effects. Lasers Surg Med 38(3):202–204
19 Rousso JJ, Pitman MJ (2010) Enterococcus faecalis complicating dermal filler injection: a case of virulent facial abscesses. Dermatol Surg 36(10):1638–1641
20 Dayan SH, Arkins JP, Brindise R (2011) Soft tissue fillers and biofilm. Facial Plast Surg 27:23–28
21 Lemperle G, Gauthier-Hazan N, Wolters M, Eisemann-Klein M, Zimmermann U, Duffy DM (2009) Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes. Plast Reconstr Surg 123(6):1842–1863