What Are the Most Commonly Reported Complications With Cosmetic Botulinum Toxin Type A Treatments?

PURPOSE

The purpose of the present study was to determine the most commonly reported complications with cosmetic botulinum toxin type A (BTX-A) treatments.

MATERIALS AND METHODS

The present study was a cross-sectional review of the US Food and Drug Administration (FDA) Adverse Event Reporting System. From January 2014 through September 2019, records were included in the study sample if they implicated Botox (onabotulinumtoxinA), Dysport (abobotulinumtoxinA), Xeomin (incobotulinumtoxinA), or Jeuveau (prabotulinumtoxinA-xvfs), and if the indication for use had been to perform a cosmetic skin procedure. The study predictors included patient (ie, age, weight, gender) and treatment (ie, product, country of treatment, 10 most common reactions) characteristics. The study outcome was the frequency of serious events as defined by the standard FDA definition for biologic products. A multivariate logistical regression model was created for the study outcome using all significant univariate predictors.

RESULTS

The final sample included 10,577 reports detailing 29,471 adverse events and covering 1,473 reactions. The mean patient age was 48.4 ± 11.2 years, and nearly all patients were women (95.0%). The most commonly reported events were pain (9.3%), swelling (6.4%), and eyelid/brow ptosis (6.1%). Serious outcomes occurred in 13.5% of patients. In the multivariate model, serious outcomes were independently associated with older age, heavier weight, headache, allergy, vision changes, fatigue, facial paresis, and dizziness but notably were not associated with pain, swelling, or ptosis.

CONCLUSIONS

A wide range of alleged complications have been reported to the FDA, many of which were likely not mediated through injection or direct toxin effects. Patients may have inaccurately attributed some of their symptoms to BTX-A, and providers should be prepared to dispel any misinformation. Local complications such as pain, swelling, and ptosis were the most common reactions but were not associated with serious patient outcomes. However, constitutional symptoms should be approached more carefully.

Vascular Compromise After Soft Tissue Facial Fillers: Case Report and Review of Current Treatment Protocols

The use of facial fillers for soft tissue augmentation is becoming a mainstream treatment modality for patients. Owing to the relative ease of administration, as well as the lucrative nature of such procedures, the number of providers offering facial fillers has been expanding. Although many adverse effects of facial fillers are minor and localized to the site of injection, 1 potential serious, albeit uncommon, adverse effect of facial filler treatment is avascular necrosis. In this article, we review soft tissue filler complications and describe the case of a 52-year-old female patient in whom vascular compromise developed after facial filler administration. In addition to reviewing complications and best practices for treatment management, we discuss anatomic considerations, present an overview of the most common filler materials, describe histologic changes with dermal fillers, and discuss litigation consequences with the use of these minimally invasive procedures. Although facial filler treatment is regarded as a minimally invasive and extremely safe procedure, it is not without complications. Avascular necrosis after soft tissue augmentation with facial fillers is exceedingly rare, with only a few cases reported in the literature, but practitioners who offer this procedure need to be well versed in treatment protocols.

An Overview of Infections Associated With Soft Tissue Facial Fillers: Identification, Prevention, and Treatment

PURPOSE

The purpose of this study was to provide an overview of infections associated with facial soft tissue fillers.

MATERIALS AND METHODS

A literature review was performed which evaluated infections associated with facial soft tissue fillers.

RESULTS

Infection rates with soft tissue fillers are low and are estimated at 0.04 to 0.2%. Most of these infections arise when skin contaminants infiltrate the injection site at the time of injection. These infections can occur early, up to several days after treatment, or delayed, occurring weeks to years after treatment. Reactions vary based on the filler absorbability and duration. Early recognition and treatment are important factors in managing our cosmetic surgery patients.

CONCLUSION

Although facial fillers are safe and predictable, infections can still occur. Oral and maxillofacial surgeons need to be able to prevent, recognize, and properly manage infections related to these popular injections.

An Overview of Vascular Adverse Events Associated With Facial Soft Tissue Fillers: Recognition, Prevention, and Treatment

Minimally invasive facial cosmetic surgery procedures have seen an exponential increase in numbers over the past decade. The most commonly performed procedures are neuromodulator and soft tissue filler procedures. Although soft tissue fillers have a high safety and predictability profile, these procedures recently have been associated with serious and dire adverse events. This article will discuss some of the vascular complications associated with facial soft tissue fillers. Management and prevention of these adverse events also will be discussed.

Complications Associated with Facial Soft-Tissue Fillers

Minimally invasive facial cosmetic surgery procedures have seen an increase in numbers over the past decade. The two most common procedures are Botulinum toxin type A injection and soft-tissue fillers. Although soft-tissue fillers have a high safety profile, these materials have been recently associated with serious and irreversible complications. This article reviews complications associated with facial soft-tissue fillers and their management. In addition, ways to prevent these unwanted complications are discussed.

A Review of New Facial Filler Techniques for Facial Rejuvenation

Introduction:

Over the recent years, the use of facial fillers for rejuvenation of the aging face has continued to increase in popularity. As the demand for noninvasive cosmetic enhancements increases, so does the need for new cosmetic techniques that will increase patient satisfaction while decreasing complications. In the past, facial fillers were mostly used for lip augmentation, nasolabial folds, and marionette lines. However, because of advances in cosmetic techniques and types of dermal fillers, cosmetic surgeons today are able to correct lines, wrinkles, and volume loss seen in crow's feet, around the eyes, chin, and cheeks.

Materials and Methods:

A literature search was performed from 2006 to 2013 to determine new cosmetic techniques used for facial rejuvenation of the aging face.

Results:

Advances in facial rejuvenation are helping to give cosmetic surgeons better results with little discomfort when using dermal fillers around the eyes, cheeks, and chin to improve the overall look of wrinkles and volume loss.

Conclusions:

The development of new techniques and injectable dermal fillers will continue to advance with the increasing demand for a youthful appearance. Up until recently, facial fillers were used mainly to improve the effects of aging seen around the lips, nasolabial folds, and marionette lines. Today, because of advances in the type of facial filler and used techniques, facial fillers can be used to improve volume loss, lines, and wrinkles around the eyes, cheeks, and chin.