Dermal fillers have been injected with increasing frequency over the past three decades for soft tissue augmentation by volume expansion in the management of the aging face. Over the past several years, the number of procedures involving soft tissue fillers has increased from 1.6 million per year in 2011 to more than 2.4 million in 2015 [ 1].
The growing use of dermal fillers, specifically the use of hyaluronic acid (HA), can be explained by their effectiveness and versatility as well as their favorable safety profiles.
Although the incidence of complications is low and the majority of adverse events are mild, the increase in the number of procedures has produced the concurrent increase in the number of complications [ 2– 4]. Among these, serious occurrences are fortunately rare, although probably underreported.
It is noteworthy that proper selection and placement of product can help avoid some complications . Plastic Surgery
The classification of filler complications can be divided according to severity (mild, moderate, or severe); nature (ischemic complications and non-ischemic); or by the time of the onset (early or late) [6, 7]. A classical classification proposed by Rohrich et al. [ 8] suggested that complications should be classified as early, late, and delayed, roughly defined as less than 14, 14 days to 1 year, and more than 1 year, respectively, as these time frames correlate well with the potential underlying etiology. Although the panel proposes to classify filler complications as immediate onset (up to 24 h after procedure); early onset (24 h to 4 weeks); and delayed onset (more than 4 weeks), to facilitate the understanding and follow-up of the manuscript, the immediate- and the early-onset complications have been listed together.
Although different papers about the management of dermal filler complications have emerged in the last years [ 2– 4, 6, 7, 9– 13], optimal complication management remains an unmet need in the field of esthetic medicine. Plastic Surgery
This paper aims to describe potential adverse events associated with dermal fillers and to provide guidance on their treatment and avoidance. League City
On November 2016, a multidisciplinary group of experts in esthetic treatments, selected based on their level of expertise in this subject, convened to discuss the management of the complications associated with dermal fillers use. Among the different topics discussed in the meeting, the classification of the filler complications and the management of such complications have emerged as key issues. The authors developed this consensus paper based on those discussions and a review of the current literature.
Searches of MEDLINE (from 2000 to November 2016), the Cochrane Database (from 2000 to November 2016), and Google Scholar were conducted using the search terms “complications” OR “soft filler complications” OR “injectable complications” AND “dermal fillers” AND “Therapy”. References cited in selected articles were also reviewed to identify additional relevant reports. Limits were set for articles written in English, French, and Spanish with human subjects. Additional data were identified through bibliographic reviews. Additionally, relevant published national and international guidelines were also scrutinized.
Because of the nature of esthetic procedures, which are usually elective processes, it is not easy to devise meaningful prospective clinical trials that evaluate complications. There are a few prospective trials, but these are often not randomized or controlled. Therefore, our knowledge base mainly comprised case reports and summaries of individual practitioner’s experience.
An initial document was drafted by the Coordinating Committee, and it was reviewed by the expert panel members. The Coordinating Committee evaluated the panel’s comments and modified the draft as they considered necessary. Subsequent revisions were based on feedback from the other authors until a consensus was achieved, and the final text was then validated (Fig. 1). Plastic Surgery
The recommendations expounded in this document represent the panel’s expert opinion based on their clinical experience as well as on published data regarding dermal filler complications in esthetic procedures. League City
According to the time of onset, the panel proposes to classify filler complications as immediate onset (up to 24 h after procedure); early onset (24 h to 4 weeks); and delayed onset (more than 4 weeks). Nevertheless, to make the manuscript reading more pleasant, the immediate- and the early-onset complications have been listed together. The main types of adverse events by time of onset are illustrated in Table 1.