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Identification of various filler-associated adverse events.
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Knowledge of tips to prevent filler-associated adverse events.
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Recognition of vascular occlusions: how to avoid them and how to treat them.
Facial Filler Complications
Section snippets
Key points
Poor cosmetic results
Overfilled lips and nasolabial folds do not convey an aesthetically pleasing, natural, or rejuvenated face (Fig. 1). To create visually favorable results, facial fillers are often injected off-label in nonapproved facial regions. Although most fillers are FDA-approved only for nasolabial folds, Restylane and Restylane Silk are approved for lip augmentation, Juvederm Voluma for midface restoration, Sculptra and Radiesse for facial lipoatrophy, and Bellafil for acne scar modification.2, 3
Infection: biofilms
Proper topical preparation of the skin is inherently critical for prevention of infection. Topical alcohol 70% is inexpensive, readily available, and has quick onset. Topical chlorhexidine, available by swab or surgical scrub, is gaining popularity because it demonstrates a longer frame of action and tends to be nonirritating.23
Immediate bacterial infections are thought to be caused by introduction of bacteria from the surface of the skin though the injection portal sites. Such infections can
Granulomas
Foreign body granulomas present as inflamed red nodules that are culture negative (Fig. 8). Such a granuloma forms when activated macrophages engulf filler material and then secrete cytokines and inflammatory cytokines. These macrophages can coalesce to form multinucleated giant cells. Granulomatous reactions are rare and can present months to years after an injection. Intralesional steroids and 5-FU are the therapeutic mainstay to inhibit fibroblast activity. If the nodules are associated with
Vascular occlusion
One of the most devastating complications arising from facial filler injections is inadvertent intra-arterial embolization or from vascular compression, leading to localized skin necrosis or permanent vision loss (Box 2). Arterial embolization is more commonly direct anterograde with occlusion of an artery causing ischemia distal to the injection point. This direct form of occlusion usually occurs with injections to the glabellar region.26 Clinically, patients manifest with significant pain and
Prevention
As with any procedure, proper patient selection and choice of method and/or product is essential to increase the likelihood of a favorable result. HA fillers can be used in several different regions of the face and boast reversibility with the use of hyaluronidase. Semipermanent fillers, such as PMMA and PLLA, may offer greater facial scaffolding for patients who require more significant volume restoration; however, they cannot be easily corrected in the event of product migration or localized
Illegal fillers
In many parts of the world, the illegal injection market continues to grow as patients search for a quick, low-cost procedure to obtain a cosmetic rejuvenation. The injections are usually not performed in a medical setting but are done in spas or hotel rooms by a nonlicensed provider. One of the most popular illegal fillers is a type of silicone known as biopolymer. Although the patients are told that this is a medical-grade product, it is usually an industrial-grade, nonsterile type of
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Cited by (0)
Disclosures: Allergan, Galderma, Merz Aesthetics, Skin Ceuticals, Suneva (J. Woodward). None (T. Khan, J. Martin).