Fillers: Complications and Their Management

  • Meire Brasil ParadaEmail author
  • João Paulo Junqueira Magalhães Afonso
  • Nilceo Schwery Michalany
Living reference work entry

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Part of the Clinical Approaches and Procedures in Cosmetic Dermatology book series (CAPCD)


The fillers are emerging minimal invasive technique for rejuvenation. As the use and application of fillers grow, it is also important to know how to manage possible complications of the procedures. This chapter describes fillers’ immediate, early, and late complications and also suggestions of management based on evidences and author’s experience.


Complications Fillers Granuloma Hyaluronic acid Infection Management Nodules Treatment Vascular occlusion 


  1. Alam M, Dover JS. Management of complications and sequelae with temporary injectable fillers. Plast Reconstr Surg. 2007;120(6 Suppl):98S–105S.PubMedCrossRefGoogle Scholar
  2. Amin SP, Marmur ES, Goldberg DJ. Complications from injectable polyacrylamide gel, a new nonbiodegradable soft tissue filler. Dermatol Surg. 2004;30(12 Pt 2):1507–9.PubMedGoogle Scholar
  3. Bailey SH, Cohen JL, Kenkel JM. Etiology, prevention, and treatment of dermal filler complications. Aesthet Surg J. 2011;31(1):110–21.PubMedCrossRefGoogle Scholar
  4. Brennan C. Avoiding the “danger zones” when injecting dermal fillers and volume enhancers. Plast Surg Nurs. 2014;34(3):108–11.PubMedCrossRefGoogle Scholar
  5. Brody HJ. Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement. Dermatol Surg. 2005;31(8 Pt 1):893–7.PubMedCrossRefGoogle Scholar
  6. Cavallini M, Gazzola R, Metalla M, Vaienti L. The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers. Aesthet Surg J. 2013;33(8):1167–74.PubMedCrossRefGoogle Scholar
  7. Christensen L. Normal and pathologic tissue reactions to soft tissue gel fillers. Dermatol Surg. 2007;33(Suppl 2):S168–75.PubMedGoogle Scholar
  8. Cohen JL, Dayan SH, Brandt FS, Nelson DB, Axford-Gatley RA, Theisen MJ, Narins RS. Systematic review of clinical trials of small- and large-gel-particle hyaluronic Acidinjectable fillers for aesthetic soft tissue augmentation. Dermatol Surg. 2013;39(2):205–31.PubMedCrossRefGoogle Scholar
  9. Cox SE, Adigun CG. Complications of injectable fillers and neurotoxins. Dermatol Ther. 2011;24(6):524–36.PubMedCrossRefGoogle Scholar
  10. Dadzie O, Mahalingam M, Parada M, El Helou T, Philips T, Bhawan J. Adverse cutaneous reactions to soft tissue fillers – a review of the histological features. J Cutan Pathol. 2008;35:536–48.PubMedCrossRefGoogle Scholar
  11. DeLorenzi C. Complications of injectable fillers. Part I. Aesthet Surg J. 2013;33(4):561–75.PubMedCrossRefGoogle Scholar
  12. Di Girolamo M, Mattei M, Signore A, Grippaudo FR. MRI in the evaluation of facial dermal fillers in normal and complicated cases. Eur Radiol. 2015;25(5):1431–42.PubMedCrossRefGoogle Scholar
  13. Duffy DM. Complications of fillers: overview. Dermatol Surg. 2005;31(11 Pt 2):1626–33.PubMedCrossRefGoogle Scholar
  14. El-Khalawany M, Fawzy S, Saied A, Al Said M, Amer A, Eassa B. Dermal filler complications: a clinicopathologic study with a spectrum of histologic reaction patterns. Ann Diagn Pathol. 2015;19(1):10–5.PubMedCrossRefGoogle Scholar
  15. Engelman DE, Bloom B, Goldberg DJ. Dermal fillers: complications and informed consent. J Cosmet Laser Ther. 2005;7(1):29–32.PubMedCrossRefGoogle Scholar
  16. Fischer J, Metzler G, Schaller M. Cosmetic permanent fillers for soft tissue augmentation: a new contraindication for interferon therapies. Arch Dermatol. 2007;143(4): 507–10.PubMedCrossRefGoogle Scholar
  17. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Plast Surg Nurs. 2015;35(1):13–32.PubMedCrossRefGoogle Scholar
  18. Gilbert E, Hui A, Meehan S, Waldorf HA. The basic science of dermal fillers: past and present. Part II: adverse effects. J Drugs Dermatol. 2012;11(9):1069–77.PubMedGoogle Scholar
  19. Goldan O, Georgiou I, Grabov-Nardini G, Regev E, Tessone A, Liran A, Haik J, Mendes D, Orenstein A, Winkler E. Early and late complications after a nonabsorbablehydrogel polymer injection: a series of 14 patients and novelmanagement. Dermatol Surg. 2007;33(Suppl 2):S199–206. ; discussion S206PubMedGoogle Scholar
  20. Hirsch R, Stier M. Complications and their management in cosmetic dermatology. DermatolClin. 2009;27(4): 507–20. , viiGoogle Scholar
  21. Jones DH, Carruthers A, Fitzgerald R, Sarantopoulos GP, Binder S. Late-appearing abscesses after injections of nonabsorbable hydrogel polymer for HIV-associated facial lipoatrophy. Dermatol Surg. 2007;33(Suppl 2):S193–8.PubMedGoogle Scholar
  22. Kleydman K, Cohen JL, Marmur E. Nitroglycerin: a review of its use in the treatment of vascular occlusion after soft tissue augmentation. Dermatol Surg. 2012;38(12):1889–97.PubMedCrossRefGoogle Scholar
  23. Lee HJ, Kang IW, Won SY, Lee JG, Hu KS, Tansatit T, Kim HJ. Description of a novel anatomic venous structure in the nasoglabellar area. J Craniofac Surg. 2014;25(2):633–5.PubMedCrossRefGoogle Scholar
  24. Lemperle G, Rullan PP, Gauthier-Hazan N. Avoiding and treating dermal filler complications. Plast Reconstr Surg. 2006;118(3 Suppl):92S–107S.PubMedCrossRefGoogle Scholar
  25. Lowe NJ, Maxwell CA, Patnaik R. Adverse reactions to dermal fillers: review. Dermatol Surg. 2005;31(11 Pt 2):1616–25.PubMedGoogle Scholar
  26. Parada M, Michalany N, Hassun K, Bagatin E, Talarico S. A histologic study of adverse effects of different cosmetic skin fillers. Skinmed. 2005:345–9.Google Scholar
  27. Park TH, Yeo KK, Seo SW, Kim JK, Lee JH, Park JH, Rah DK, Chang CH. Clinical experience with complications of hand rejuvenation. J Plast Reconstr Aesthet Surg. 2012;65(12):1627–31.PubMedCrossRefGoogle Scholar
  28. Requena L, Requena C, Christensen L, Zimmermann US, Kutzner H, Cerroni L. Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol. 2011;64(1):1–34. quiz 35–6PubMedCrossRefGoogle Scholar
  29. Sánchez-Carpintero I, Candelas D, Ruiz-Rodríguez R. Dermal fillers: types, indications, and complications. Actas Dermosifiliogr. 2010;101(5):381–93.PubMedCrossRefGoogle Scholar
  30. Sclafani AP, Fagien S. Treatment of injectable soft tissue filler complications. Dermatol Surg. 2009;35(Suppl 2):1672–80.PubMedCrossRefGoogle Scholar
  31. Sherman RN. Avoiding dermal filler complications. Clin Dermatol. 2009;27:S23–32.CrossRefGoogle Scholar
  32. Winslow CP. The management of dermal filler complications. Facial Plast Surg. 2009;25(2):124–8.PubMedCrossRefGoogle Scholar
  33. Zimmermann U, Clerici T. The histological aspects of fillers complications. Semin Cutan Med Surg. 2004;23:241–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Meire Brasil Parada
    • 1
    Email author
  • João Paulo Junqueira Magalhães Afonso
    • 1
  • Nilceo Schwery Michalany
    • 1
  1. 1.Universidade Federal de São PauloSão PauloBrazil

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