Injectable Safety: New Concepts and Best Practices in Hyaluronic Acid Filler Safety

Background: As the hyaluronic acid industry evolves and new products are introduced, it is crucial for injectors to be educated on local anatomy, accurate injection techniques, the physicochemical properties of products, and evolving trends in the aesthetic injectable industry that influence patient safety and satisfaction. Methods: A comprehensive literature search was conducted using Ovid and MEDLINE/PubMed databases. Keywords used were “filler,” “hyaluronic acid,” “complications,” “injection,” “technique,” “migration,” “safety,” “needle,” “cannula,” “rheology,” “face,” and “facial.” Results: A total of 3980 were retrieved and filtered for publications from 2020 to 2025, yielding 1220 results. Limiting the search to original research articles, 882 were returned. Applying the keywords “face” and “facial” reduced the number to 660, and limiting the search to reviews, original research, and reports narrowed it to 562. After manually screening titles and abstracts, 100 publications were selected, and 20 were included in the final review. An additional 14 articles were included using snowball methodology. Conclusions: As more hyaluronic acid products enter the market, the importance of a comprehensive understanding of the crosslinking technology, a thorough knowledge of the complex facial anatomy, and proper injector experience and technique are key factors in reducing the incidence of complications.