Patient factors influencing dermal filler complications: prevention, assessment, and treatment

Koenraad De Boulle, Izolda Heydenrych, Koenraad De Boulle, Izolda Heydenrych

Abstract

While rare, complications do occur with the esthetic use of dermal fillers. Careful attention to patient factors and technique can do much to avoid these complications, and a well-informed practitioner can mitigate problems when they do occur. Since cosmetic surgery is usually an elective process, requested by the patient, clinical trials are complex to organize and run. For this reason, an international group of practicing physicians in the field of esthetics came together to share knowledge and to try and produce some informed guidance for their colleagues, considering the literature and also pooling their own extensive clinical experience. This manuscript aims to summarize the crucial aspects of patient selection, including absolute contraindications as well as situations that warrant caution, and also covers important considerations for the pre- and posttreatment periods as well as during the procedure itself. Guidance is given on both immediate and long-term management of adverse reactions. The majority of complications are related to accepting patients inappropriate for treatment or issues of sterility, placement, volume, and injection technique. It is clear that esthetic practitioners need an in-depth knowledge of all aspects of treatment with dermal fillers to achieve optimal outcomes for their patients.

Keywords: assessment; complications; dermal fillers; patient factors; prevention; treatment.

References

    1. Requena L, Requena C, Christensen L, Zimmermann US, Kutzner H, Cerroni L. Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol. 2010;64:1–34.
    1. De Boulle K. Management of complications after implantation of fillers. J Cosmet Dermatol. 2004;3:2–15.
    1. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Invest Dermatol. 2013;6:295–316.
    1. Sperling B, Bachmann F, Hartmann V, Erdmann R, Wiest L, Rzany B. The current state of treatment of adverse reactions to injectable fillers. Dermatol Surg. 2010;36:1895–1904.
    1. Vedamurthy M, Vedamurthy A, Nischal KC. Dermal fillers: do’s and dont’s. J Cutan Aesthet Surg. 2010;3:11–15.
    1. Bailey SH, Cohen JL, Kenkel JM. Etiology, prevention and treatment of dermal filler complications. Aesthetic Surg J. 2011;31:110–121.
    1. de Bree R, Middelweerd MJ, van der Waal I. Severe granulomatous inflammatory response induced by injection of polyacrylamide gel into the facial tissue. Arch Facial Plast Surg. 2004;6(3):204–206.
    1. Micheels P, Sarazin D, Besses S, Sundaram H, Flynn TC. A blanching technique for intradermal injection of the hyaluronic acid Belotero. Plast Reconstruct Surg. 2013;132(4 Suppl 2):59S–68S.
    1. Lemperle G, Rullan PP, Gautier-Hazan N. Avoiding and treating dermal filler complications. Plast Reconstr Surg. 2006;118(3 Suppl):92S–107S.
    1. Lafaille P, Benedetto A. Fillers: contraindications, side effects and precautions. J Cutan Aesth Surg. 2010;3:16–19.
    1. Narins RS, Jewell M, Rubin M, Cohen J, Strobos J. Clinical conference: management of rare events following dermal fillers – focal necrosis and angry red bumps. Dermatol Surg. 2006;32:426–434.
    1. Narins RS, Coleman WP, Glogau RG. Recommendations and treatment options for nodules and other filler complications. Dermatol Surg. 2009;35:1667–1671.
    1. Chen K, Huang J, Gong W, Iribarren P, Dunlop NM, Wang JM. Toll-like receptors in inflammation, infection and cancer. Int Immunopharmacol. 2007;7(10):1271–1285.
    1. Lowe NJ, Maxwell CA, Patnaik R. Adverse reactions to dermal fillers: review. Dermatol Surg. 2005;31:1616–1625.
    1. Alam M, Gladstone H, Kramer EM, et al. American Society for Dermatologic Surgery ASDS guidelines of care: injectable fillers. Dermatol Surg. 2008;34:S115–S148.
    1. Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: prevention and management. J Cutan Aesthet Surg. 2012;5:121–132.
    1. Kraft CT, Bellile E, Baker SR, Kim JC, Moyer JS. Anticoagulant complications in facial plastic and reconstructive surgery. JAMA Facial Plast Surg. 2014 Epub ahead of print.
    1. Brown DG, Wilkerson EC, Love WE. A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons. J Am Acad Dermatol. 2014;72(3):524–534.
    1. Gladstone HB, Cohen JL. Adverse events when injecting facial fillers. Semin Cutan Med Surg. 2007;26(1):34–39.
    1. Glogau RG, Kane MA. Effect of injection techniques on the rate of local adverse events in patients implanted with non-animal hyaluronic acid gel fillers. Dermatol Surg. 2008;34:S105–S109.
    1. Carruthers J, Glogau R, Blitzer A, Facial Aesthetics Consensus Group Faculty Advances in facial rejuvenation: botulinum toxin type A, hyaluronic acid dermal fillers, and combination therapies – consensus recommendations. Plast Reconstruc Surg. 2008;121:5–30.
    1. Hermesch CB, Hilton TJ, Biesbrock AR, et al. Perioperative use of 0.12% chlorhexidine gluconate for the prevention of alveolar osteitis: efficacy and risk factor analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:381–387.
    1. Baima J, Isaac Z. Clean versus sterile technique for common joint infections: a review from the physiatry perspective. Curr Rev Musculoskeletal Med. 2008;1:88–91.
    1. Kim YS, Choi DY, Gil YC, Hu KS, Tansatit T, Kim HJ. The anatomical origin and course of the angular artery regarding its clinical implications. Dermatol Surg. 2014;40(10):1070–1076.
    1. Yang HM, Lee JG, Hu KS, et al. New anatomical insights on the course and branching patterns of the facial artery: clinical implications of injectable treatments to the nasolabial fold and nasojugal groove. Plast Reconstr Surg. 2014;133(5):1077–1082.
    1. Kim DW, Yoon ES, Ji YH, Park SH, Lee BI, Dhong ES. Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management. J Plast Reconstr Aesthet Surg. 2011;64:1590–1595.
    1. Sclafani AP, Fagien S. Treatment of injectable soft tissue filler complications. Dermatol Surg. 2009;35:1672–1680.
    1. Cohen JL. Understanding, avoiding and managing dermal filler complications. Dermatol Surg. 2008;34(Suppl 1):S92–S99.
    1. Zeichner JA, Cohen JL. Using blunt-tipped cannulas in specific regions for soft-tissue augmentation. J Drugs Dermatol. 2012;11:40–41.
    1. Cassuto D. Blunt-tipped microcannulas for filler injection: an ethical duty? J Drugs Dermatol. 2012;11:S42.
    1. Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilm. Fac Plast Surg. 2011;27:23–28.
    1. Hirsch RJ, Cohen JL, Carruthers JD. Successful management of an unusual presentation of impending necrosis following a hyaluronic acid injection embolus and a proposed algorithm for management with hyaluronidase. Dermatol Surg. 2007;33:357–360.
    1. Peter S, Mennel S. Retinal branch artery occlusion following injection of hyaluronic acid (Restylane) Clin Experiment Ophthalmol. 2006;34(4):363–364.
    1. Hwang YH, Hwang JH, Kim JS. Branch retinal artery occlusion after periocular dermal filler injection. Retin Case Brief Rep. 2008;2:338–341.
    1. Lazzeri D, Agostini T, Figus M, Nardi M, Pantaloni M, Lazzeri S. Blindness following cosmetic injections of the face. Plas Reconstruct Surg. 2012;129:995–1012.
    1. 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;38:1889–1897.
    1. Ozturk CN, Li Y, Tung R, Parker L, Piliang MP, Zins JE. Complications following injection of soft tissue fillers. Aesth Surg J. 2013;33:862–877.
    1. Brody HM. Relevance of cosmeceuticals to the dermatologic surgeon. Dermatol Surg. 2005;31:796–798.
    1. Feighery C, McCoy EP, Johnson PB, Armstrong DKB. Delayed hypersensitivity to hyaluronidase (Hyalse™) used during cataract surgery. Contact Dermatitis. 2007;57:343.
    1. Reidl MA, Casillas AM. Adverse drug reactions: types and treatment options. Am Fam Physician. 2003;68:1781–1790.
    1. Sánchez O, Rodríguez-Sureda V, Domínguez C, et al. Study of biomaterial-induced macrophage activation, cell-mediated immune response and molecular oxidative damage in patients with dermal bioimplants. Immunology. 2012;217(1):44–53.
    1. Moody BR, Sengelmann RD. Topical tacrolimus in the treatment of bovine collagen hypersensitivity. Dermatol Surg. 2001;27:789–791.
    1. Christensen LH. Host tissue interaction, fate, and risks of degradable and non-degradable gel fillers. Dermatol Surg. 2009;35:1612–1619.
    1. Pecharki D, Petersen FC, Scheie AA. Role of hyaluronidase in Streptococcus Iintermedius biofilm. Microbiology. 2008;154:932–938.
    1. Nyhlen A, Ljungberg B, Nilsson-Ehle I, Odenholt I. Bactericidal effect of combinations of antibiotic and antineoplastic agents against Staphylococcus aureus and Escherichia coli. Chemotherapy. 2002;48:71–77.
    1. Cassuto D, Marangoni O, De Santis G, Christensen L. Advanced laser techniques for filler-induced complications. Dermatol Surg. 2009;35:1689–1695.
    1. Cassuto D, Sundaram H. A problem-oriented approach to nodular complications from hyaluronic acid and calcium hydroxyapatite fillers: classification and recommendations for treatment. Plast Reconstr Surg. 2013;132:48S–58S.
    1. Ledon JA, Savas JA, Yang S, Franca K, Camacho I, Nouri K. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options. Am J Clin Dermatol. 2013;14:401–411.
    1. Lemperle G, Gauthier-Hazan N. Foreign body granulomas after all injectable fillers: part 2. Treatment options. Plast Reconstr Surg. 2009;123:1864–1873.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel