Global Aesthetics Consensus: Avoidance and Management of Complications from Hyaluronic Acid Fillers—Evidence- and Opinion-Based Review and Consensus Recommendations

Abstract

Background:Although the safety profile of hyaluronic acid fillers is favorable, adverse reactions can occur. Clinicians and patients can benefit from ongoing guidance on adverse reactions to hyaluronic acid fillers and their management.Methods:A multinational, multidisciplinary group of experts in cosmetic medicine convened the Global Aesthetics Consensus Group to review the properties and clinical uses of Hylacross and Vycross hyaluronic acid products and develop updated consensus recommendations for early and late complications associated with hyaluronic acid fillers.Results:The consensus panel provided specific recommendations focusing on early and late complications of hyaluronic acid fillers and their management. The impact of patient-, product-, and technique-related factors on such reactions was described. Most of these were noted to be mild and transient. Serious adverse events are rare. Early adverse reactions to hyaluronic acid fillers include vascular infarction and compromise; inflammatory reactions; injection-related events; and inappropriate placement of filler material. Among late reactions are nodules, granulomas, and skin discoloration. Most adverse events can be avoided with proper planning and technique. Detailed understanding of facial anatomy, proper patient and product selection, and appropriate technique can further reduce the risks. Should adverse reactions occur, the clinician must be prepared and have tools available for effective treatment.Conclusions:Adverse reactions with hyaluronic acid fillers are uncommon. Clinicians should take steps to further reduce the risk and be prepared to treat any complications that arise.

<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…”

“…In case of infection antibiotic treatment: clarithromycin 500 mg plus moxifloxacin 400 mg twice daily for 10 days, or ciprofloxacin 500-750 mg twice daily for 2-4 weeks, or minocycline 100 mg once daily for 6 months. 99 Philipp-Dormston et al If no resolution biofilm has to be considered and treatment with antibiotics a quinolone and third generation macrolide, 5-FU or excision to be performed (Continued) is a last resort, because of the difficulty of removing the granuloma completely, given its spreading contour, and the risk of infection and scars. The treatments of granuloma after injection with another polymer-based collagen stimulator (Polylactic acid -PLLA), often reported before the proposed dilution protocol, are detailed in the American and European recommendations, 113,118 and follow similar modalities.…”

Severe vision loss caused by cosmetic filler augmentation: Case series with review of cause and therapy

“…In addition, the proper selection of patients and the monitoring during the procedure are also crucial. 4 The golden period to reverse retinal artery occlusion is 90 minutes. 5 The patient should be transferred to the specialist as soon as possible.…”

Risk Comparison of Filler Embolism Between Polymethyl Methacrylate (PMMA) and Hyaluronic Acid (HA)

“…There are few methods available to treat this complication. Most experts agree that anatomical knowledge and injection technology are important to prevent vascular complications [2]. As far as we know, there is no animal experimental evidence that different fillers have different risks of intravascular embolism.…”

“…Hyaluronic acid (HA) is a popular filler. It has been associated with vascular complications and more serious complications, such as blindness or paralysis [2–4]. The main ingredient of HA filler is the viscous sodium hyaluronate gel; therefore, the clinical complications may be related to the high hydrophilicity and high viscosity of HA [5], which make it more difficult to disperse with blood flow.…”