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      Dermal fillers in aesthetics: an overview of adverse events and treatment approaches

      review-article
      1 , 2
      Clinical, Cosmetic and Investigational Dermatology
      Dove Medical Press
      aesthetic medicine, complications

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          Abstract

          Background

          The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase.

          Objective

          To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance.

          Methods

          Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors’ extensive experience, recommendations for avoiding and managing complications are provided.

          Results

          Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique.

          Conclusion

          For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications.

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          Most cited references73

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          Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes.

          Genuine granuloma formation following implantation of injectable dermal fillers is a rare complication, with incidences ranging from one in 100 patients (1 percent) to one in 5000 (0.02 percent). Foreign body granulomas occur several months to years after injection at all implantation sites at the same time. Without treatment, they may grow to the size of beans, remain virtually unchanged for some years, and then resolve spontaneously. Three clinical and histologic types of foreign body granulomas can be distinguished:Permanent implants are not characterized by a higher rate of foreign body granuloma per se than temporary implants; however, their clinical appearance is more pronounced and their persistence longer if not treated adequately.
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            Treatment of injectable soft tissue filler complications.

            Increasing use of dermal fillers, especially with the U.S. introduction of long-term and permanent fillers, is expected to increase the number of complications seen after treatment with these materials. To provide physicians with an overview for treatment of dermal filler complications. Complications of dermal filler use can be treated successfully based on a firm understanding of the mechanisms and limitations of filler action and wound healing. Complications can be classified as immediate, early, or delayed onset; available treatment options are presented. Short- and long-term dermal fillers are increasingly becoming popular treatment options for signs of facial aging. Complications, although not common, can be treated effectively and excellent outcomes achieved.
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              Host tissue interaction, fate, and risks of degradable and nondegradable gel fillers.

              A constantly increasing number of gel fillers for aesthetic and reconstructive purposes have been introduced during the last 20 years. Most of the new ones are modified versions of the original collagen and hyaluronic acid gels. They have been reconstructed, often by adding cross-bindings to the polymer in order to obtain a more dense molecular structure, which will prolong degradation and filling effect of the gel. Other gel fillers contain particles of organic (poly-lactic acid) or inorganic (calcium hydroxylapatite) material, which have been used in human tissue for other purposes (degradable suture material and bone cement, respectively). The permanent fillers (silicone oil and polyacrylamide gel) have been used for many years, silicone mainly in the US and polyacrylamide gel in most countries outside the US and Canada. Complications occur, and they appear to be more frequent with particulated fillers, polyacrylamide gel and silicone oil. However, these complications differ in nature and depend on the filler type used. This overview presents the different gel filler types, how they interact with host tissue, and what can go wrong. The results and conclusion are based on experimental and clinical observations coupled with a search of the literature. Complications following homogenous hydrogels are caused by infection with bacteria, which have been inserted into the gel during injection. If not treated with relevant antibiotics (but instead steroids or large doses of NSAIDs) the bacteria form a biofilm, which gives rise to a low-grade chronic infection that is resistant to antibiotics. Complications following particulated gels and silicone oil are not known, but bacteria in a biofilm and/or endotoxins released by these is a possibility which deserves further investigations, primarily by using the fluorescence in situ hybridization (FISH) technique.
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                Author and article information

                Journal
                Clin Cosmet Investig Dermatol
                Clin Cosmet Investig Dermatol
                Clinical, Cosmetic and Investigational Dermatology
                Clinical, Cosmetic and Investigational Dermatology
                Dove Medical Press
                1178-7015
                2013
                12 December 2013
                : 6
                : 295-316
                Affiliations
                [1 ]Mount Sinai Hospital, Department of Plastic Surgery, New York, NY, USA
                [2 ]Department of Dermatology and Allergy, Ludwig-Maximilian University of Munich, Munich, Germany
                Author notes
                Correspondence: Tatjana Pavicic, Department of Dermatology and Allergology, Ludwig Maximilian University of Munich, Frauenlobstrasse 9-11, 80337 Munich, Germany, Tel +49 89 5160 6010, Email tatjana.pavicic@ 123456email.de
                David Funt, 19 Irving Place, Woodmere, New York, NY 11598, USA, Tel +1 516 295 0404, Email DKFMD@ 123456aol.com
                Article
                ccid-6-295
                10.2147/CCID.S50546
                3865975
                24363560
                9f3e95c8-9a40-410a-a176-e20738b12cca
                © 2013 Funt and Pavicic. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Review

                Dermatology
                complications,aesthetic medicine
                Dermatology
                complications, aesthetic medicine

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