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Dermal Fillers and Associated Complications: A Review of the Literature and Case Series.

Elliott Freudenburg

University of Texas Medical Branch


Introduction: According to the American Society of Plastic Surgeons (ASPS) in 2017, soft tissue fillers are the second most common minimally invasive cosmetic procedure with 2.7 million injections performed every year. Yet as the variety and use of dermal fillers rises in popularity, the need to study and understand potential complications remains vital. The purpose of our case report and review is to demonstrate a few rare adverse effects of filler injections and explore the treatment modalities available. Methods: We present two patients who experienced immune mediated adverse reactions after filler injections. A literature review regarding types of dermal fillers, complications, and treatments was performed using PubMed and Science Direct databases from 1969 to 2018. Results: The first patient, a 58-year-old female presented with complaints of bilateral eyelid swelling following Restylane® (QMed, Uppsala, Sweden) injection of the palpebromalar groove. The patient showed minimal improvement after a course of oral steroids, antihistamines, head elevation, warm compresses and NSAIDs. The symptoms were resolved with injections of hyaluronidase at the sites of inflammation. The second patient, a 72-year-old female, exhibited a heterotrophic ossified mass likely due to filler migration after multiple infraorbital filler injections: Juvéderm Voluma XC® (Allergan Inc., Irvine, CA, U.S.A.) on two occasions followed by Radiesse® (Merz Aesthetics, Franksville, U.S.A) twice within one year. She remained under observation, and a reduction is mass size was observed at 6 months following the use of NSAIDs. Literature review revealed a number of case reports documenting similar adverse reactions as those presented, showing improvement in symptoms with the use of antihistamines and corticosteroids. Conclusion: The potential for adverse reactions, albeit rare, should be taken into consideration. Adverse reactions can be treated with various methods dependent on the type of filler utilized and reaction elicited.

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