J Korean Med Sci.  2014 Nov;29(Suppl 3):S176-S182. 10.3346/jkms.2014.29.S3.S176.

Treatment Algorithm of Complications after Filler Injection: Based on Wound Healing Process

• Kim JH
• Ahn DK
• Jeong HS
• Suh IS

• KMID: 2151411
• DOI: http://doi.org/10.3346/jkms.2014.29.S3.S176

Abstract

Soft tissue filler injection has been a very common procedure worldwide since filler injection was first introduced for soft tissue augmentation. Currently, filler is used in various medical fields with satisfactory results, but the number of complications is increasing due to the increased use of filler. The complications after filler injection can occur at any time after the procedure, early and delayed, and they range from minor to severe. In this review, based on our experience and previously published other articles, we suggest a treatment algorithm to help wound healing and tissue regeneration and generate good aesthetic results with early treatment in response to the side effects of filler. Familiarity with the treatment of these rare complications is essential for achieving the best possible outcome.

Keyword

Soft Tissue Filler; Injectable; Stem Cell; Filler Complications; Treatment Algorithm

MeSH Terms

Algorithms
Biocompatible Materials/*therapeutic use
Connective Tissue/*surgery
Face/surgery
Guided Tissue Regeneration/*methods
Humans
Hyaluronic Acid/administration & dosage
Injections
Skin Aging
Surgery, Plastic/*methods
Tissue Engineering/*methods
Wound Healing
Biocompatible Materials
Hyaluronic Acid

Figure

• 

  Fig. 1 A 32-yr old woman, with filler (Restylane; Medicis, Scottsdale, Arizona) injected into the glabella, alar and dorsum of the nose. She was referred to our department 3 days after filler injection. She complained of erythema and a pustule on nose with pain resulting from inflammation. Seven days after using antibiotics and steroids, the lesions were completely healed. (A) After injection of the dermal filler, erythema and a pustule are shown at the alar and dorsum of the nose. (B) After steroid and antibiotic treatment, the symptoms improved.

• 

  Fig. 2 A 25-yr old woman who had a filler (Artecoll; Artes Medical, San Diego, California) injected into her forehead and nose. She suffered pain that was accompanied by pus discharge and skin necrosis after 5 days. The adipose-derived stem cells were abstracted and injected into the damaged area on the nose tip. (A) The patient came to the clinic with a pustule and necrosis after filler injection. (B) Two days after adipose-cell derived stem cell injection. (C) Ten days after adipose-derived stem cell injection. The necrotic area shows nearly complete re-epithelization. (D) Six months after adipose-derived stem cell injection. The necrotic lesion was healed without scarring or pigmentation. (E) One year after stem cell injection. There were no demonstrable findings other than a small linear scar.

• 

  Fig. 3 A 53-yr old female who had a filler (Cutegel; Hyaluronic acid, BNC Korea Inc., Seoul) injected into her nasal tip. After 10 days, skin necrosis through the full skin layers of the nose developed. She underwent debridement of the necrotic tissue on the nose and injection of adipose-derived stem cells. One year after the operation, nasal deviation and asymmetry were shown due to scar contracture and the defect. Therefore, a composite graft on both alar rims with conchal cartilage was placed. (A) Skin necrosis occurred after filler injection. (B) In the operation, the necrotic area shows a raw surface after debridement and adipose-derived stem cell injection. (C) The day after the operation. Some areas show epithelization. (D) Fifteen days after the operation. Almost all of the area shows near re-epithelization except the small area of the nasal alar. (E) Deformity caused by the skin defect and scar contracture after total healing of the raw surface. (F) Asymmetry and deformity are improved after applying the composite graft.

• 

  Fig. 4 The treatment algorithm of the early and late complications.

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