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Late-Onset Inflammatory Adverse Reactions Related to Soft Tissue Filler Injections

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Abstract

An ever-increasing number of persons seek medical solutions to improve the appearance of their aging skin or for aesthetic and cosmetic indications in diverse pathological conditions, such as malformations, trauma, cancer, and orthopedic, urological, or ophthalmological conditions. Currently, physicians have many different types of dermal and subdermal fillers, such as non-permanent, permanent, reversible, or non-reversible materials. Despite the claims of manufacturers and different authors that fillers are non-toxic and non-immunogenic or that complications are very uncommon, unwanted side effects do occur with all compounds used. Implanted, injected, and blood-contact biomaterials trigger a wide variety of adverse reactions, including inflammation, thrombosis, and excessive fibrosis. Usually, these adverse reactions are associated with the accumulation of large numbers of mononuclear cells. The adverse reactions related to fillers comprise a broad range of manifestations, which may appear early or late and range from local to systemic. Clinicians should be aware of them since the patient often denies the antecedent of injection or is unaware of the material employed. Most of these adverse effects seem to have an immunological basis, the fillers acting more as adjuvants than as direct T-cell activators, on a background of genetic predisposition. Their treatment has not been the subject of well-designed studies; management of both acute and systemic reactions is often difficult, and requires anti-inflammatory and occasionally immunosuppressive therapy. The clinical, pathological, and therapeutic aspects of inflammatory and immune-mediated late-onset adverse reactions related to soft tissue filler injections are thoroughly reviewed herein.

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Authors and Affiliations

  1. Ageing and Systemic Autoimmune Diseases Research Unit, Service of Internal Medicine-I, Aging Basic Research Unit, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d’Hebron University Hospital, Barcelona, Spain

    Jaume Alijotas-Reig

  2. Department of Medicine, Universitat Autonoma, Barcelona, Spain

    Jaume Alijotas-Reig, Maria Teresa Fernández-Figueras & Lluís Puig

  3. Pathology Department, Trias i Pujol University Hospital, Barcelona, Spain

    Maria Teresa Fernández-Figueras

  4. Dermatology Department, Sant Pau University Hospital, Barcelona, Spain

    Lluís Puig

  5. Josep Ma. de Segarra, 2-F, 08190 Sant Cugat del Vallés, Barcelona, Spain

    Jaume Alijotas-Reig

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  1. Jaume Alijotas-Reig
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  2. Maria Teresa Fernández-Figueras
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  3. Lluís Puig
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Correspondence to Jaume Alijotas-Reig.

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The contents of the manuscript have not been previously published and are not being considered by any other journal elsewhere at this time.All authors agree with the contents of the article and also having their names included in the list of authors. All authors have contributed in the conception, acquisition, and interpretation of data, and revision of the manuscript. JAR and LP drafted the paper, and MFF built tables and figures.The authors also state that they do not have any commercial or any other type of interest that may have influenced the drawing up and the results of this paper.

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Alijotas-Reig, J., Fernández-Figueras, M.T. & Puig, L. Late-Onset Inflammatory Adverse Reactions Related to Soft Tissue Filler Injections. Clinic Rev Allerg Immunol 45, 97–108 (2013). https://doi.org/10.1007/s12016-012-8348-5

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