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Filler disasters predominantly associated with permanent materials

Article-Filler disasters predominantly associated with permanent materials

Key iconKey Points

  • Correction of adverse reactions from permanent fillers almost always requires surgical intervention, expert says
  • Any permanent fillers carry risk of complications as result of host response to the nonresorbable foreign material

Patients interested in soft-tissue augmentation with an injectable filler may consider permanency a desirable attribute. However, severe and serious adverse reactions following filler injections are most likely to occur with these nonresorbable materials, and the risk for a disastrous complication is too high to justify their use in cosmetic indications, says Firas Hamdan, M.D.

Dr. Hamdan
Speaking at the 2011 annual scientific meeting of the American Academy of Cosmetic Surgery, Dr. Hamdan noted that complications of permanent injectable fillers may be of cosmetic or medical significance and range from minor asymmetries to major disasters. In all cases, however, the solution will likely involve surgical intervention, which most patients were seeking to avoid in the first place by choosing treatment with an injectable filler. In some situations, the complication may lead to devastating consequences.

"Although patients may view permanent fillers as a more economical alternative to materials that require periodic touch-up injections, the difference in cost will be quickly offset if a complication occurs necessitating surgical intervention," says Dr. Hamdan, who is board-certified in otolaryngology and practices cosmetic surgery at the Cosmetic Surgery Clinic, Beirut, Lebanon, and at the American Academy of Cosmetic Surgery Hospital in Dubai, United Arab Emirates. "Although the risk of a serious complication with a permanent injectable filler is low, any such risk is too high for an elective cosmetic procedure."

Permanent filler injected in face for volumizing that resulted in necrotic tissue and abscess formation, necessitating surgical drainage and repair under general anesthesia. (Photos credit: Firas Hamdan, M.D.)
Dr. Hamdan says complications of permanent injectable fillers can be considered from the perspective of the patient or the surgeon. Patients may be displeased with the cosmetic outcome either early after the procedure if the achieved appearance does not match their expectations, or later on as their desired goal changes with time. In addition, with any permanent filler there is a risk for complications to develop as a result of the host response to the nonresorbable foreign material.

"The introduction of permanent fillers occurred as an industry reaction to consumer demand for a cosmetic result that would last forever, and while these products often appeared safe during short-term follow-up in clinical testing, problems began to emerge after five to seven years," Dr. Hamdan says.

Permanent filler injected in upper lip, causing cosmetic deformity, as well as functional problem of persistent capping and ulceration.
"The body forms a capsule over the injected nonresorbable filler, and as the capsule contracts or the host responds with a cellular foreign body reaction or in some cases to a localized bacterial infection, asymmetries, nodules and other complications can develop," he says.

The nodules can be cosmetically displeasing and may also have anatomic and functional consequences. Dr. Hamdan describes patients who received permanent filler injections into the lips and subsequently developed intraoral lumps that would cause them to inadvertently bite the inside of the mouth while chewing. Fibrosis developing after injection of permanent fillers to address hollowing under the eyes has not only undesirable cosmetic significance, it can also cause ectropion. Complications have also occurred with injection of permanent fillers for nonsurgical augmentation of the breast and buttocks.

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