Complications of hyaluronic fillers

Background Nonsurgical facial rejuvenation has become increasingly popular between dermatologic and plastic surgery offices. Hyaluronic acid (HA), a naturally produced polysaccharide in the human body is used in the esthetic field to restore facial volume loss. Injectors must have a keen understanding of facial anatomy and the properties behind HA soft‐tissue filler injections to minimize the likelihood of an adverse event. The objective of this article is to outline the complications that arise with HA soft‐tissue filler injectables and provide information on potential agents that can aid in reducing both short and long‐term adverse events. Materials and Methods PubMed search terms were utilized for this article. Results HA adverse events can be classified under early onset versus delayed onset depending when patients and providers first notice signs and symptoms. The early onset complications can be identified as erythema, pain, ecchymosis, nodules, the tyndall effect, and vascular occlusion. Late onset complications can be seen as biofilm and granulomas. Conclusions Though a plethora of complications can arise from HA filler, many are self‐resolving and do not leave the patient with any long‐term complications. As the arsenal of soft‐tissue injectables continues to expand, it is acutely important to understand the various properties of each soft‐tissue filler, its use, and where anatomically it is best suited. Moreover, injectors and providers must have a thorough understanding and ability to conceptualize facial anatomy and understand proper injection technique as well as correct planes of injection. This is the foundation to successful HA injection and patients must be aware of the risks associated with HA facial rejuvenation. Employing an aseptic cleansing technique, proper injection protocol, and early recognition and intervention should an adverse event occur, can decrease the risk of long‐term complications in this patient population.