Complication of Soft Tissue Fillers: Prevention and Management Review

September 2020 | Volume 19 | Issue 9 | Original Article | 829 | Copyright © September 2020

Published online August 14, 2020

Hassan Galadari MD,a George Kroumpouzos MD,b Martin Kassir MD,c Mrinal Gupta MD DNB,d Uwe Wollina,e Andreas Katsambas MD,f Torello Lotti,g Mohammad Jafferany MD,h Alexander A. Navarini MD,i Roberta Vasconcelos Berg MD,j Stephan Grabbe MD,k Mohamad Goldust MDl

aCollege of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates bDepartment of Dermatology, Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, MA cWorldwide Laser Institute, Dallas, TX dTreatwell Skin Centre, Jammu, India eDepartment of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany fUniversity of Athens, Athens, Greece gUniversity of Studies Guglielmo Marconi, Rome, Italy hCollege of Medicine, Central Michigan University, Saginaw, MI iDepartment of Dermatology, University Hospital Basel, Switzerland jDepartment of Dermatology, University Hospital Basel, Switzerland kDepartment of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany lUniversity of Rome G. Marconi, Rome, Italy; Department of Dermatology, University Medical Center Mainz, Mainz, Germany; Department of Dermatology, University Hospital Basel, Basel, Switzerland

The use of dermal fillers has increased manifold over the past decade, which has been attributed to the ever-increasing need of the population for being young. Fillers have become quite popular both among patients and treating physicians due to their quick and quite predictable results. Filler injection is a safe procedure in the hands of an experienced provider using appropriate technique. Nevertheless, various adverse effects to fillers have been reported that range from mild injection site complications, such as pain and bruising, to severe complications, like tissue necrosis, retinal artery occlusion, and infections. The esthetic provider should be aware of and be able to quickly recognize such complications, and be confident in managing them. In this article we highlight the various adverse effects noted with the use of fillers and discuss prevention and management.

J Drugs Dermatol. 2020;19(9):829-832. doi:10.36849/JDD.2020.5084


The injectable cosmetic treatments including fillers have become highly popular in recent years. Fillers are safe in the hands of an experienced provider but can be associated with side effects. Although the incidence of adverse effects to filler injection is low, the significant increase in the number of such procedures has led to an increased number of reported complications.

Fillers can be classified into permanent and biodegradable. Although these types have a similar percentage of adverse events in the first 12 months after filler injection, permanent fillers can result in severe side effects even several years after placement.1 These authors recommend use of certified fillers, which may vary from country to country. Silicone, for instance, has never been certified and should be banned for esthetic purposes.


A wide range of complications have been noted with the use of fillers, which vary from mild injection site reactions to granulomas and severe hypersensitivity reactions (Table 1). Rohrich and colleagues classified filler related complications as early, late, and delayed, on the basis of timeframe of appearance as less than 14, 14 days to 1 year, and more than 1 year, respectively.2