Adverse Events Reported From Hyaluronic Acid Dermal Filler Injections to the Facial Region: A Systematic Review and Meta-Analysis

Abstract

Dermal filler injections are one of the most popular cosmetic procedures in the United States. Of the many options available, hyaluronic acid (HA) dermal fillers like Juvederm or Restylane are often used. Despite their use and popularity, adverse events are known to occur from these procedures. Although most outcomes may be mild and resolve over time, rare instances of severe complications cannot be ignored, as these effects may be irreversible. Healthcare practitioners and patients must be aware of these risks, as these cosmetic procedures can affect the patient’s quality of life. The aim of this study was to evaluate the incidence of adverse events (AEs) reported from the use of hyaluronic acid dermal fillers in the facial region. A systemized search of randomized controlled trials was conducted using Cochrane Central, Embase, Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Web of Science databases. After screening for eligibility and conducting a critical appraisal of the articles, 19 studies were retained for the final review. The meta-analysis results included different side effects by facial location, i.e., nasolabial fold (NLF) vs. other (midface, perioral line, and lip region). The midface includes the anteromedial cheek region, the zygomaticomalar region, and the submalar region. The adverse events were swelling, pain, erythema, bruising, lumps and bumps, firmness, tenderness, itching, and skin discoloration. A significant difference was found in individuals experiencing swelling, lumps or bumps, and firmness at the midface, perioral line, and lip region versus the nasolabial fold site. There was no significant difference in the proportion of individuals experiencing pain, erythema, bruising, tenderness, itching, or skin discoloration at the nasolabial fold site versus the other sites. The study highlights the prevalence of common AEs that can result from HA dermal fillers like Juvederm or Restylane, thus emphasizing the importance of healthcare professionals explaining the risk and benefits to patients.

Filler Migration after Facial Injection—A Narrative Review

“…Due to the variability in clinical presentation, the range of possible differential diagnoses is broad. They include soft tissue infections including abscess and cellulite (erysipelas), atypical mycobacterial infections, herpes zoster, and mycetoma [4,12,15,18]. Non-infectious differential diagnoses include sarcoidosis, scars, xanthelasma, temporal arteritis, neurogenic ulcer, and keratoacanthoma [16,25,28].…”

“…Intravascular injections have not been considered in this review since they are acute adverse events in contrast to the other mechanisms of filler migration [15,25]. Here, we present suggested mechanisms of migration or displacement in special areas, corresponding to anatomy:…”

“…More often around the eyes [15] Cerebral infarction and stroke Most common after accidental injection in the ophthalmic angiosome [16,17] Delayed-onset nodules Various pathologies for inflammatory to infectious or filler migration [18] Discoloration More often seen around the eyes, sometimes due to Tyndall effect, sometimes due to post-inflammatory pigmentary changes [19] Dizziness and pain Unmeet hygienic standards, contaminated filler material [30] Tongue necrosis After injection into the chin, vascular compromise [31] Visual loss Most often after injection into glabella or nose with acute ocular pain, lid ptosis, and ophthalmoplegia due to vascular compromise [32] Vitiligo Reported after polycaprolactone injection [33]…”

Efficacy of a New Hyaluronic Acid Dermal Filler on Nasolabial Folds Correction: A Prospective, Comparative, Double-Blinded Clinical Trial

“…The complications resulting from dermal filler injections have been suggested to be directly related to the injection site technique rather than the type of HA filler. 13,14 In this study, EST LF was compared with RES L , which is a well-established option for antiwrinkle treatment and has been used in various trials as a reference treatment to investigate the clinical efficacy of other HA-based fillers. [15][16][17][18][19] RES L and EST LF present several similarities in terms of composition, biocompatibility, and indication.…”

Comprehensive Evaluation of Injectability Attributes in OxiFree™ Dermal Fillers: MaiLi® Product Variants and Clinical Case Reports

“…In the case of a homogeneous hydrogel system presenting smooth injection force plateaus (e.g., MaiLi ® variants), the clinician may expect no or low levels of jerking/indentation-like behaviour of the plunger rod during filler administration (Figures 3 and S2-S5). Thereby, the risk of clinically injecting excess hydrogel amounts or of shallow product placement (i.e., potential nodule creation or Tyndall effect) is diminished [31,32].…”