Filler Complications

Eckart Haneke, MD, PhD

Injections of soft tissue fillers belong to the most commonly performed beautifying measures worldwide. The number of commercially available fillers is increasing rapidly, resulting in a myriad of injection options. Novel fillers are continuously launched on the market, whereas old ones are chemically modified to increase their tolerability, ease of injection, or duration and to reduce potential side effects. The filler market is tightly regulated within the European Union and North America, but obviously not in many other countries. Apparently, low-priced products of poor quality continue to create irresistible temptation for both patients to reduce expenses and injectors to increase financial profit. Injections should exclusively be performed by trained and experienced medical doctors. However, we suspect a large number of injections being performed by nonprofessionals at low costs. The combination of unapproved products of poor and questionable quality with nonmedical injectors is particularly dangerous and can have fatal consequences. For instance, illegal cocktails of oily vitamin-containing substances applied by cosmeticians result in poor clinical outcome and regularly lead to devastating complications. But even cautious handling of fillers by professionals may result in serious adverse effects or trigger other health disorders such as herpes simplex outbreaks in a person with the history of frequent herpes simplex episodes.

It is the treating physician's obligation to inform the patient about the nature and frequency of filler-related side effects and to temper high expectations and unrealistic demands. Further, it cannot be overemphasized that clients with unrealistic expectations and body dysmorphic disorders should not be treated, as they will not be satisfied and tend to sue the treating physician. Most of these do's and don'ts are well known and redundantly repeated in the literature. However, this fundamental warning is often not respected.

This edition of Facial Plastic Surgery gives an overview of adverse filler effects and is intended to give advice on how to diagnose, avoid, and treat.