Differentiating Nonpermanent Injectable Fillers: Prevention and Treatment of Filler Complications

Abstract

Though the incidence of complications and adverse events with dermatological fillers is inherently low, practitioners should be well versed in both prevention of filler complications and the treatment algorithms for addressing "granulomas," nodules, infection, and vascular compromise. Appropriate preventative measures, coupled with timely and effective treatment, are critically important for patient safety and satisfaction. In addition to the preventive measures and treatment algorithms outlined here, the authors emphasize that the broad classification and treatment of nodules as "granulomas" is likely to lead to ineffective treatment, or worse, unnecessary exposure to incorrect treatment. In practice, nodules are classified and treated based on clinical manifestation (eg, late vs early or noninflammatory vs inflammatory) rather than on histology. Indeed, classification of a nodule as a granuloma requires a histological examination, rarely available (or necessary) in clinical practice to guide treatment. Thus, the apparent inflammatory nature of the nodule and the time of onset should drive treatment approach. The treatment algorithms presented here are based on these clinically meaningful parameters.

<p>Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics</p>

“…Many experts and experts' panels have provided recommendations for treating adverse events, offering guidance for management that physicians should use in their daily clinical practice and eventually adapt according to their patients' condition and response to treatment. [89][90][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105] First, it is important to be able to identify and localize the culprit product. The PCL filler has been recently identified by ultrasound, presenting a specific sonographic morphology characterized by a deposit showing a hypoechoic matrix…”

Beauty is only mucosa deep: a retrospective analysis of oral lumps and bumps caused by cosmetic fillers

“…Our cases showed a similar variety of presentations as previously described in the literature. It is worthwhile considering infections and abscesses in the differential diagnosis however bilateral nodules at multiple sites (with a clinical history of a filler injection) are likely to be indicative of a foreign body response (3,4). Infections may present either early or late, potentially months after the filler was used which further complicates diagnosis (4).…”

“…Temporary filler materials such as hyaluronic acid gels have a minimal foreign body response (3, 13) with a lower chance of significant adverse effects and can be managed more easily with hyaluronidase (11). Permanent fillers, such as PMMA and especially silicones, are much more likely to elicit a long lasting and strong foreign body reaction (3,13,14). Silicone gels may also leave permanent scars and disfigurement which are often resistant to treatment (4,6).…”

“…There is some evidence to suggest that some reactions may be due to bacterial biofilms around the gel particles (13). It is therefore important to ensure sterile, aseptic technique, avoid injections during active infections and thorough cleaning of the skin before injection (3,4).…”

“…More frequently, many dentists are providing this service or are seeing patients with cosmetic filler related oral lesions highlighting that they should be able to recognize such lesions and be aware of the adverse effects of fillers to avoid this diagnostic pitfall. The management of filler related lesions is often difficult and protracted (3)(4)(5) especially for permanent fillers such as silicones which may never resolve (6).…”