Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes

Abstract

BACKGROUND In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations. OBJECTIVE Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes. MATERIALS AND METHODS A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison. RESULTS Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae. CONCLUSION Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.

Social Media in Aesthetic Dermatology: Analysis of the Users Behind the Top Filler Posts

“…19 Vascular occlusion leading to necrosis has been documented in all regions of the face, but the risks for even more serious sequelae, such as blindness or stroke, are much higher in certain regions, such as the forehead, glabella, nasolabial folds, nasal dorsum, and periorbital region. [19][20][21][22][23][24][25] It is therefore even more concerning that over half of the posts displaying off-label use of filler were performed in these areas, and most were performed by nonphysicians. In addition, several users falsely presented themselves as physicians through Instagram handle name or Instagram biography.…”

“…7,[10][11][12][13]15,28 Numerous studies have demonstrated that the risks associated with soft tissue augmentation are reduced when the procedure is performed by an experienced board-certified dermatologist. 19,25,29…”

Adverse events seen with fillers

“…Adverse events include swelling and tenderness at the injection site, allergic reactions, cutaneous necrosis, blindness, and even stroke. 4 Although the incidence of adverse events is low, the risk is still present. Much of the adverse events seen with dermal fillers can be avoided with appropriate knowledge of the anatomy of the face and use of correct instruments.…”

“…Adverse events include swelling and tenderness at the injection site, allergic reactions, cutaneous necrosis, blindness, and even stroke 4 . Although the incidence of adverse events is low, the risk is still present.…”

Cutaneous Vascular Compromise and Resolution of Skin Barrier Breakdown After Dermal Filler Occlusion—Implementation of Evidence-Based Recommendations Into Real-World Clinical Practice

“…V ascular occlusions that risk compromising a patient's vision secondary to injection of dermal filler while extremely rare are a devastating complication. 1 Every practitioner who performs procedures involving dermal fillers should be an expert in recognizing and treating such a catastrophic adverse event from such a common dermatologic procedure, especially treating the more common adverse event of vascular occlusions threatening skin barrier integrity. The authors, who all practice at a large, multiphysician cosmetic dermatology practice, provide their expertise in a unifying protocol to recognize and treat cutaneous vascular compromise and skin barrier breakdown.…”