Complication of Filler Procedures

  • Giwoong HongEmail author
  • Seungmin Oh
  • Bongcheol Kim
  • Yongwoo Lee


As filler procedures become more popular, the frequency and types of side effects are increasing and becoming more diverse. Prior to the popularization of filler procedures, foreign body reactions and cases of granulomas caused by illegal procedures were reported as side effects. Since filler procedures have become more popular, skin necrosis and more recently, blindness has become issue due to vascular complications.


  1. 1.
    Fraser JRE, et al. Turn over and metabolism of hyaluronan. The biology of hyaluronan. CibaFound Symp. 1989;143:41–59.Google Scholar
  2. 2.
    DeLorenzi C. Transarterial degradation of hyaluronic acid filler by hyaluronidase. Dermatol Surg. 2014;40:832–41.CrossRefGoogle Scholar
  3. 3.
    Kho I-S, Lee W. Hyaluronic acid filler and hyaluronidase Filler Complications Spingernature, pp 27–40.Google Scholar
  4. 4.
    Narins, et al. Clinical conference: management of rare events following dermal fillers-focal necrosis and angry red bumps. Dermatol Surg. 2006;32(3):426–34.PubMedGoogle Scholar
  5. 5.
    Hanke CW, et al. abscess formation and local necrosis after treatment with Zyderm or Zyplast collagen implants. J Am Acad Dermatol. 1991;25(2 pt 1):319–26.CrossRefGoogle Scholar
  6. 6.
    Hirsh et al. Successful management of an unusual presentation of impending necrosis following a hyaluronic acid injection embolus and proposed algorithm for management with hyaluronidase. Dermatol Surg 2007;33(3):357–360.PubMedGoogle Scholar
  7. 7.
    Glaish AS. Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers. Dermatol Surg. 2006;32:276–81.Google Scholar
  8. 8.
    kim et al. Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management. J Plastic Reconstr Aesthet Surg 2011;64:1590–1595.CrossRefGoogle Scholar
  9. 9.
    Joel L, et al. treatment of hyaluronic acid filler-induced impending necrosis with hyaluronidase: consensus recommendation. Aesthetic Surg J. 2015;35(7):844–9.CrossRefGoogle Scholar
  10. 10.
    Stern R. Hyaluronan catabolism: a new metabolic pathway. Eur J Cell Biol. 2004;83:317–25.CrossRefGoogle Scholar
  11. 11.
    Stern R, Kogan G, Jedrzejas M, _Solt_es L. The many ways to cleave hyaluronan. Biotechnol Adv 2007;25:537–57.CrossRefGoogle Scholar
  12. 12.
    Fraser JRE, Laurent TE. Turnover and metabolism of hyaluronan. In: Evered D, Wheelan J (eds) The Biology of hyaluronan. Ciba Found Symp; 1989;143: 41–59.Google Scholar
  13. 13.
    Kim HJ et al. The duration of hyaluronidase and optimal timing of hyaluronic acid (HA) filler reinjection after hyaluronidase injection. J Cosmet Laser Ther 20:1, 52–57.CrossRefGoogle Scholar
  14. 14.
    King M, et al. The use of hyaluronidase in aesthetic practice(v.2.4) J Clin Aesthet Dermatol 2018;11(6):E61–E68.Google Scholar
  15. 15.
    Buhren BA, et al. Hyaluronidase: from clinical applications to molecular and cellular mechanism Eur J Med Res. 2016;21:5.Google Scholar
  16. 16.
    Lee W, et al. Effectiveness of retrobulbar hyaluronidase injection in an iatrogenic blindness Rabbit model. Plast Reconstru Surg. 2019;144:137.Google Scholar
  17. 17.
    Lee W, et al. Comparative effectiveness of different interventions of perivascular hyaluronidase PRS-D-19-01428R2.Google Scholar
  18. 18.
    Baley-Spindel I et al. Perivascular hyaluronidase with Alteplase as treatment for hyaluronic acid filler. Aesthet Surg J, sjz101,
  19. 19.
    Tansatit T, Apinuntrum P, Phetudom T. A dark side of the cannula injections: how arterial wall perforations and emboli occur. Aesthet Plast Surg. 2016;41(1):221–7.CrossRefGoogle Scholar
  20. 20.
    Henderson R, Reilly DA, Cooper JS (2018) Hyperbaric oxygen for ischemia due to injection of cosmetic fillers. Plastic Reconstr Surg Global Open. 6(1):e1618–3.CrossRefGoogle Scholar
  21. 21.
    DeLorenzi C. New high dose pulsed hyaluronidase protocol for hyaluronic acid filler vascular adverse events. Aesthet Surg J. 2017;37(7):814–25.CrossRefGoogle Scholar
  22. 22.
    Zhu GZ, Sun ZS, Liao W-X, Cai B, Chen C-L, Zheng H-H, et al. Efficacy of retrobulbar hyaluronidase injection for vision loss resulting from hyaluronic acid filler embolization. Aesthet Surg J. 2017;1–11.Google Scholar
  23. 23.
    Hwang K (2016) Hyperbaric oxygen therapy to avoid blindness from filler injection. J Craniofacial Surg, 1–3.Google Scholar
  24. 24.
    Carruthers J, Fagien S, Dolman P. Retro or PeriBulbar injection techniques to reverse visual loss after filler injections. Dermatol Surg. 2015;41:S354–7.CrossRefGoogle Scholar
  25. 25.
    Hwang CJ, Morgan PV, Pimentel A, Sayre JW, Goldberg RA, Duckwiler G. Rethinking the role of nitroglycerin ointment in ischemic vascular filler complications. Ophthalmic Plast Reconstr Surg. 2016;32(2):118–22.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Giwoong Hong
    • 1
    Email author
  • Seungmin Oh
    • 2
  • Bongcheol Kim
    • 3
  • Yongwoo Lee
    • 4
  1. 1.SAMSKIN Plastic SurgerySeoulKorea (Republic of)
  2. 2.ON ClinicSeoulKorea (Republic of)
  3. 3.Lamar Clinic Isu BranchSeoulKorea (Republic of)
  4. 4.LIKE Plastic SurgerySeoulKorea (Republic of)

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