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Fillers belong to the most frequently used beautifying products. They are generally well tolerated, but any one of them may occasionally produce adverse side effects. Adverse effects usually last as long as the filler is in the skin, which means that short-lived fillers have short-term side effects and permanent fillers may induce life-long adverse effects.

The main goal is to prevent them, however, this is not always possible. Utmost care has to be given to the prevention of infections and the injection technique has to be perfect. Treatment of adverse effects is often with hyaluronidase or steroid injections and in some cases together with 5-fluorouracil plus allopurinol orally. Histological examination of biopsy specimens often helps to identify the responsible filler allowing a specific treatment to be adapted. Duration of the adverse effect: Generally, adverse effects last as long as the desired filler effects.

This is true for most of the fillers. However, with collagen they may persist. A middle-aged woman was seen developing stone-hard swellings at each point where she was injected with bovine collagen, even at the test site, and despite all treatments these granulomas did not regress. Collagen injections have a risk of approximately 6% to produce granulomatous reactions and usually respond to corticosteroid injections within a few weeks.

Adverse side effects to hyaluronic acid fillers were frequently seen at the beginning of their use, probably due to the protein moiety that is part of the biosynthetic production procedure. These swellings commonly remained at the site of injection and disappeared with adequate treatment; however they are now infrequent. Clumping of a filler causes lumps and bumps that usually have to be surgically removed. Permanent fillers cause permanent side effects.

Time course of adverse filler effects: The time course is divided into reversible or temporary (caused by collagen and hyaluronic acid); late and long-term (caused by poly-L-lactic acid (PLLA), calcium hydroxylapatite, alginate, and dextranomer beads in hyaluronic acid); and delayed and permanent (caused by vaseline, paraffin, silicone oil, hydroxyethyl methacrylate fragments, polymethylmethacrylate beads, polyacrylamide, and polyalkylimide gels). There is a general misconception that temporary fillers rarely provoke side effects; the frequency is comparable to that induced by long-term and permanent fillers but their duration is shorter and hence, they are less serious. COMPLICATIONS Early side effects include erythema, edema, and bruising; they are in fact a normal physiological reaction to the injection of a foreign substance and can often be mitigated by cooling the injected area. Pain is reduced by slow injection and administration of local anesthetics in small volumes. Bruises are said to be reduced by using arnica, aloe vera, or vitamin K creams. Greenstreet Software 1000 Professional Fonts. Allergies may occur within hours in cases where the patient has been sensitized before. Lumps and bumps occur when an unsuitable filler is injected superficially or in the wrong location.

These may occur immediately or develop from clumping of the substance due to muscle activity. Vascular compromise becomes evident within a day in case of arterial occlusion due to inadvertent intravascular injection or compression by the filler volume. Using a blunt cannula instead of a sharp injection needle prevents inadvertent intravascular injection.[] This is particularly dangerous for the glabella, inner corner of the eye, and ala nasi, and is reported to cause skin necrosis and even blindness.[,] A review of the world literature on eye complications from filler injections identified 98 cases in English-language journals []. Most cases were due to autologous fat ( n=47), hyaluronic acid ( n=23) and collagen ( n=8), whereas all other substances used as fillers were below 5%. Fifty-nine cases were reported from South Korea where the data were collected from the major retinal centres.[] Whenever blanching is seen during the injection, it must be stopped immediately.[] Hyaluronidase is injected around the vessel in order to prevent the side effects caused by hyaluronic acid filler. Aggressive massage, warm compresses, and topical nitroglycerin are further supportive measures.[,,].