Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science




Thomas Colletti, DHSc, PA-C, DFAAPA



Purpose: This clinical review article aims to perform an analysis of the current literature and identify, summarize, and outline the most up-to-date management algorithms for adverse events associated with the administration of hyaluronic acid (HA) dermal fillers.

Methods: A cursory search and review of the current published literature from the past five years in such databases as PubMed, Google Scholar, and Cochrane Reviews utilizing key words of hyaluronic acid, dermal fillers, soft tissue fillers, injections, injectable fillers, complications, side effects, and adverse events was performed. A total of 14 articles were identified and reviewed to support this research that will help guide best practice amongst the next generation of aesthetic clinicians.

Results: Although adverse effects secondary to HA dermal fillers' administration are uncommon, being familiar with the most up-to-date management recommendations should be of the utmost importance to any clinician performing these procedures. Guidance for treating complications is hindered because most are based solely on expert opinions. There are exceptionally few controlled studies, primarily because clinical trials are challenging to conduct as patients are usually treated in private practices and do not want to be burdened with participation in a clinical study.Adverse event management algorithms that detail treatments in a stepwise manner are essential for injectors to be familiar.

Conclusion: The rising popularity of HA dermal fillers, and the associated surge in the number of procedures performed, have increased the number of complications. Adverse events involving HA dermal fillers are reported and quantified through the Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database.Lack of appropriate and thorough informed consent has been the most commonly cited factor by plaintiffs in adverse event cases that pursued litigation. This fact highlights the importance of experience and knowledge of underlying anatomy that aesthetic clinicians must possess to prevent and manage complications that may arise. Aesthetic clinicians should provide a thorough review of expectations, potential complications, and offer easy-to-understand informed consent to avoid medicolegal litigation.


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