Background: An increasing number of soft tissue fillers have been introduced to the beauty market and these filler substances are widely used as non-toxic, non-immunogenic and relatively harmless injectable alternatives to surgical rejuvenation. Generally, facial fillers are injectable – or surgically insertable – products that are used to fill up the volume loss in the aging face. Depending on bioavailability, chemical composition and degradation, fillers can be classified as temporary or permanent, organic or inorganic and autologous or heterologous. Objective: A plethora of new products has swamped the beauty market since face rejuvenation has become socially acceptable as well as affordable to a wider population, but adverse reactions cannot be excluded. We present 4 patients with complications after injection of facial fillers [including Artecoll®(polymethylmethacrylate microspheres), Restylane® (hyaluronic acid), DermaLive® (hyaluronic acid plus acrylic hydrogel particles) and Newfill® (polylactic acid)] and surgical correction. Results: Surgical intervention led to good aesthetic and functional results after multiple unsuccessful conservative therapies. Conclusion: We recommend that only physicians familiar with the injection techniques and the biological and chemical characteristics of the various injectable products should perform such interventions. Especially permanent fillers should be used with utmost reticence in cosmetic surgery and we would recommend their application only in reconstructive procedures. Additionally, documentation and reporting of all adverse effects must be mandatory.

Krauss MC: Recent advances in soft tissue augmentation. Semin Cutan Med Surg 1999;18:119–128.
Requena C, Izquierdo MJ, Navarro M, et al: Adverse reactions to injectable aesthetic microimplants. Am J Dermatopathol 2001;23:197–202.
Klein AW: Collagen substances. Facial Plast Surg Clin North Am 2001;9:205–218.
Pollack SV: Some new injectable dermal filler materials: Hylaform, Restylane and Artecoll. J Cutan Med Surg 1999;(suppl 4):527–532.
Lowe NJ, Maxwell CA, Patnaik R: Adverse reactions to dermal fillers: review. Dermatol Surg 2005;31:1616–1625.
Bergeret-Galley B, Latouche X, Illouz Y-G: The value of new filler material in corrective and cosmetic surgery: Dermalive and DermaDeep. Aesthetic Plast Surg 2001;25:249–255.
Lemperle G, Romano JJ, Busso M: Soft tissue augmentation with Artecoll: 10-year history, indications, techniques, and complications. Dermatol Surg 2003;29:573–587.
Lemperle G, Morhenn V, Charrier U: Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthetic Plast Surg 2003;27:354–366.
Lowe NJ, Maxwell CA, Lowe P, et al: Hyaluronic acid skin fillers: adverse reactions and skin testing. J Am Acad Dermatol 2001;45:930–933.
Cotran RS, Kumar V, Robbins SL: Pathologic Basis of Disease, ed 5. Philadelphia, Saunders, 1994.
Duranti F, Salti G, Bivani B, et al: Injectable hyaluronic gel for soft tissue augmentation. Dermatol Surg 1998;24:1317–1325.
Hill SL, Landavere MG, Rose NR: The adjuvant effect of silicone gel and silicone elastomer particles in rats. Curr Top Microbiol Immunol 1996;210:123–137.
Naim JO, Ippolito KM, van Oss CJ: Adjuvancy effect of different types of silicone gel. J Biomed Mater Res 1997;37:534–538.
Ficarra G, Mosqueda-Taylor A, Carlos R: Silicone granuloma of the facial tissues: a report of seven cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:65–73.
Senet P, Bachelez H, Ollivaud L, et al: Minocycline for the treatment of cutaneous silicone granulomas. Br J Dermatol 1999;140:985–987.
Gupta S, Kalra A: Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology 2002;204:130–132.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.