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 MDa, George Krompouzos MDb, Martin Kassir MDc, Mrinal Gupta MD DNBd, Uwe Wollina e, Andreas Katsambas MDf, Torello Lotti g, Mohammad Jafferany MDh, Alexander A. Navarini MDI, Roberta Vasconcelos Berg MDj, Stephan Grabbe MDk, 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

Staphylococcal and streptococcal infections can lead to abscesses and cellulitis, which require a broad spectrum oral antibiotic therapy (Figure 6). Mycobacterium chelonae and Mycobacterium abscesses infection have also been shown after using contaminated fillers and usually documented as delayed onset infections.21,22 Biofilm formation over the dermal fillers has also been demonstrated and can lead to a variety of side effects including cellulitis, nodules, abscesses, or granulomatous inflammation, which can present even years after dermal filler injections. Infections may also result from recent medical or dental procedures in the vicinity of dermal filler injection area. For instance, dental root infections or professional tooth cleaning can cause filler complications, such as infections that can mimic a dental infection.23

Empiric antibiotic therapy with two or three classes of antibiotics is recommended in cases of suspected biofilms while waiting for the PCR.24 Another treatment option for the management of biofilm is low doses of triamcinolone with 5-fluorouracil injected into the lesion, which has been hypothesized to act by interacting with AriR, a regulatory gene that inhibits the formation of biofilm.6 The risk of infection with filler injection can be minimized by using an aseptic injection, using the smallest gauge needle possible technique, reducing the number of piercings while injecting, and avoiding injecting into infected or inflamed skin, and avoiding injecting through previously injected filler.25 Systemic Reactions PMMA-induced hypercalcemia is a potentially deadly adverse event that has been reported with high volume injections even years after filler placement. Clinical symptoms resemble those of rheumatic disorders and includemyalgia, arthralgia, and fatigue. 26


As esthetic procedures are increasingly being used by dermatologists and other esthetic providers, their reported adverse effects are also bound to increase. Henceforth, it is important that the treating provider is very familiar with the various complications and their management as some of the complications can be devastating. Proper patient selection, choosing the proper filler material, using appropriate injection technique, and having a good understanding of facial anatomy are crucial to minimizing complications.


The authors have no relevant conflicts to report.


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Mohamad Goldust MD