Management of Complications of Facial Fillers

The use of facial soft tissue fillers is increasing with Hyaluronic acid fillers dominating the market. Any injectable filler may elicit moderate to severe adverse events ranging from nodules to infections and vascular occlusion. As Hyaluronic acid is a ubiquitous, biodegradable, non-species-specific substrate with limited potential for immunogenic reactions, poor aesthetic outcomes are far more common than severe adverse events. This chapter reviews current understanding of the principal complications, recommendations for prevention and their management. Contamination or subsequent immune stimulation can trigger delayed-onset inflammatory reactions. Though minor vascular occlusions are not uncommon, cases of vision loss secondary to facial filler injections are thought to be rare. Timely enzymatic degradation with injectable hyaluronidase can be effective in the treatment of some such complications. However, recent studies demonstrate lack of penetration through the optic nerve sheath, casting doubt on the role of retrobulbar hyaluronidase in the management of vision loss because of embolism with hyaluronic acid filler.