Complications of Hyaluronic Acid Fillers

ABSTRACT

Hyaluronic acid filler use, user groups, and indications have expanded significantly in the past several years. This group of fillers is extremely safe in experienced hands. Complications are infrequent but can be devastating. There can be no substitution for recognized and specific training. Prompt recognition and proper treatment of serious complication can moderate and even prevent serious sequelae. This article describes the most frequent and serious complications, their prevention, and treatment.

KEYWORDS

Hyaluronic acid complications - dermal fillers - hyaluronidase

REFERENCES

• 1 Matarasso S L, Carruthers J D, Jewell M L. Restylane Consensus Group . Consensus recommendations for soft-tissue augmentation with nonanimal stabilized hyaluronic acid (Restylane).  Plast Reconstr Surg. 2006;  117(3 Suppl) 3S-34S
• 2 McCracken M S, Khan J A, Wulc A E et al.. Hyaluronic acid gel (Restylane) filler for facial rhytids: lessons learned from American Society of Ophthalmic Plastic and Reconstructive Surgery member treatment of 286 patients.  Ophthal Plast Reconstr Surg. 2006;  22 188-191
• 3 Lemperle G. Avoidance and treatment of complications after dermal filler injections. In: Cohen SR, Born TM Facial Rejuvenation with Fillers. Maryland Heights, MO; Saunders Elsevier 2009: 135-154
• 4 Glogau R G, Kane M A. Effect of injection techniques on the rate of local adverse events in patients implanted with nonanimal hyaluronic acid gel dermal fillers.  Dermatol Surg. 2008;  34(Suppl 1) S105-S109
• 5 Gladstone H B, Cohen J L. Adverse effects when injecting facial fillers.  Semin Cutan Med Surg. 2007;  26 34-39
• 6 Bertucci V. Injectable filler complications. In: Beer K, Roberts W, Narurkar U, Lupo M Cosmetic Bootcamp Primer. London, UK; Informa Publishing 2010
• 7 DeLorenzi C, Weinberg M, Solish N, Swift A. Multicenter study of the efficacy and safety of subcutaneous non-animal-stabilized hyaluronic acid in aesthetic facial contouring: interim report.  Dermatol Surg. 2006;  32 205-211
• 8 Pierre A, Levy P M. Hyaluronidase offers an effiacious treatment for inaesthetic hyaluronic acid overcorrection.  J Cosmet Dermatol. 2007;  6 159-162
• 9 Hirsch R J, Brody H J, Carruthers J DA. Hyaluronidase in the office: a necessity for every dermasurgeon that injects hyaluronic acid.  J Cosmet Laser Ther. 2007;  9 182-185
• 10 Alam M, Gladstone H, Kramer E M American Society for Dermatologic Surgery et al. ASDS guidelines of care: injectable fillers.  Dermatol Surg. 2008;  34(Suppl 1) S115-S148
• 11 Lemperle G, Gauthier-Hazan N, Wolters M, Eisemann-Klein M, Zimmermann U, Duffy D M. Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes.  Plast Reconstr Surg. 2009;  123 1842-1863
• 12 Narins R S, Jewell M, Rubin M, Cohen J, Strobos J. Clinical conference: management of rare events following dermal fillers—focal necrosis and angry red bumps.  Dermatol Surg. 2006;  32 426-434
• 13 Friedman P M, Mafong E A, Kauvar A N, Geronemus R G. Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation.  Dermatol Surg. 2002;  28 491-494
• 14 Inoue K, Sato K, Matsumoto D, Gonda K, Yoshimura K. Arterial embolization and skin necrosis of the nasal ala following injection of dermal fillers.  Plast Reconstr Surg. 2008;  121 127e-128e
• 15 Hirsch R J, Stier M. Complications of soft tissue augmentation.  J Drugs Dermatol. 2008;  7 841-845
• 16 McCleve D E, Goldstein J C. Blindness secondary to injections in the nose, mouth, and face: cause and prevention.  Ear Nose Throat J. 1995;  74 182-188 , review
• 17 Egidio J A, Arroyo R, Marcos A, Jimenez-Alfaro I. Middle cerebral artery embolism and unilateral visual loss after autologous fat injection into the galbellar area.  Stroke. 1993;  24 615-616
• 18 Hanke C W, Higley H R, Jolivette D M, Swanson N A, Stegman S J. Abcess formation and local necrosis after treatment with Zyderm or Zyplast collagen implant.  J Am Acad Dermatol. 1991;  25 319-326
• 19 Woffles T L. Periorbital rejuvenation with injectable fillers. In: Cohen SR, Born TM Facial Rejuvenation with Fillers. Maryland Heights, MO; Saunders Elsevier 2009: 93-105