Dermal Fillers in Facial Aesthetic Procedures - a systematic review of the rarer but more severe complications

Abstract

Background: The use of dermal fillers in facial aesthetic procedures has become increasingly popular worldwide. Although generally safe, filler injections carry risks, and some complications can result in serious consequences for patients. There is lack of a structured database and reliable data on complications and their incidence rates. This systematic review aimed to investigate the rarer but more severe complications of facial fillers, as well as the details associated with these complications, such as onset time, treatment, and outcomes. Methods: A literature review was preformed through PubMed, Web of Science, and Scopus databases. Information was collected and it included study design, number of patients, sex, age, type of filler used, injection site, number of injections, complications, time of onset of the complications, treatment performed, follow-up time, and outcomes. Results: Forty-three studies were considered adequate and included in this systematic review. A total of 9632 patients received one or more facial filler injections out of a total of 9836 injections, 99,75% were hyaluronic acid injections. A total of 701 patients developed 1166 complications. Regarding outcomes, 78.39% patients had complete resolution of symptoms, and 21.61% had sequelae such has blindness and visible scar. Conclusions: Complications of facial fillers related to vascular compromise are the most severe and have the worst outcome. A thorough understanding of the facial anatomy is crucial to minimize the risk, and further investigation is needed to determine the optimal management strategies for vascular complications to improve patient outcomes.