A Systematic Review Supporting the American Society for Dermatologic Surgery Guidelines on the Prevention and Treatment of Adverse Events of Injectable Fillers

Abstract

BACKGROUND As the use of injectable skin fillers increase in popularity, an increase in the reported adverse events is expected. OBJECTIVE This systematic review supports the development of American Society for Dermatologic Surgery practice guideline on the management of adverse events of skin fillers. METHODS AND MATERIALS Several databases for studies on risk factors or treatments of injection-related visual compromise (IRVC), skin necrosis, inflammatory events, and nodules were searched. Meta-analysis was conducted when feasible. RESULTS The review included 182 studies. However, IRVC was very rare (1–2/1,000,000 patients) but had poor prognosis with improvement in 19% of cases. Skin necrosis was more common (approximately 5/1,000) with better prognosis (up to 77% of cases showing improvement). Treatments of IRVC and skin necrosis primarily depend on hyaluronidase injections. Risk of skin necrosis, inflammatory events, and nodules may be lower with certain fillers, brands, injection techniques, and volume. Treatment of inflammatory events and nodules with antibiotics, corticosteroids, 5-FU, and hyaluronidase was associated with high response rate (75%–80%). Most of the studies were small and noncomparative, making the evidence certainty very low. CONCLUSION Practitioners must have adequate knowledge of anatomy, elicit history of skin filler use, and establish preemptive protocols that prepare the clinical practice to manage complications.

Quality-Based Evaluation of Patient-Facing Online Education Materials Regarding Facial Filler Procedures

“…Given that injection site adverse effects can occur and rare adverse effects such as vascular occlusion or blindness are devastating, the authors found it concerning that 15% of educational material did not include information on potential complications of filler. 19 The ethicality of patient-facing educational material that does not include some mention of potential adverse effects warrants consideration. In the context of ubiquitous Internet use to search for health information, the deficiency in comprehensiveness, in combination with lapses in accuracy, make it likely that a substantial portion of patients interested in facial filler injections arrive to the clinic with some degree of misunderstanding surrounding the procedure.…”

Dermal extracellular matrix response to facetem implant: a randomised controlled experimental study

“…Изменения, происходящие в дерме под влиянием Facetem, могут быть связаны с развитием в зоне введения филлера воспалительной реакции или с развитием эффекта Rooman [24,25], включающего сложный каскад факторов и клеток (рис. 13).…”

The subjectively perceived injectability as an early indicator for adverse events?

“…Soft‐tissue filler injections are one of the most popular minimally invasive aesthetic procedures with a total of 2.7 million performed procedures in 2019 in the United States alone 1 . Concurrent with the increase in performed injections, the increase of adverse events has likewise increased during the last decades 2‐5 …”

“…1 Concurrent with the increase in performed injections, the increase of adverse events has likewise increased during the last decades. [2][3][4][5] Most adverse events following soft-tissue filler injections are mild and self-limiting. A recent…”