Delayed-onset complications of facial soft tissue augmentation with permanent fillers in 85 patients

Jonathan A. Kadouch, Daniel J. Kadouch, Shai Fortuin, Leo van Rozelaar, Refaat B. Karim, Rick Hoekzema

Research output: Contribution to journalArticleAcademicpeer-review


To evaluate factors influencing the onset and type of adverse events in patients injected with permanent fillers in the face and to propose a therapeutic strategy for these complications. A prospectively attained series of 85 patients with delayed-onset complications after facial injection with permanent fillers underwent clinical follow-up and treatment of the complications. Lag times until onset and type of delayed-onset complication varied according to filler material. In 28% (n = 24) of the cases, patients reported the onset of complications after dental procedures, additional injections with fillers, or other invasive treatments in the facial area. Forty-eight (57%) patients required invasive treatment. Abscess formation was significantly more frequent in patients with human immunodeficiency virus infection and facial lipoatrophy (p = .001). The intrinsic characteristics of the injected filler and the immune status of the patient play important roles in the diversity of time of onset and type of delayed-onset adverse events observed. It seems that invasive facial or oral procedures in the vicinity of filler depots can provoke such complications. We propose a strategy for treating these complications and advise great caution when using permanent filling agents
Original languageEnglish
Pages (from-to)1474-1485
JournalDermatologic surgery
Issue number10
Publication statusPublished - 2013

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