Surgery for Foreign Body Reactions due to Injectable Fillers

<i>Background:</i> 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. <i>Objective:</i> 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. <i>Results:</i> Surgical intervention led to good aesthetic and functional results after multiple unsuccessful conservative therapies. <i>Conclusion:</i> 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.