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Ironing out the Creases – dermal filler complications

This month Shaadi Manouchehri discusses all of the complications that can arise from dermal fillers, why they occur and how to manage them.

Starting out in a new field can be both exciting and terrifying.

A commonly occurring fear that dentist have which stops them from venturing out into the field of aesthetics is the fear of encountering complications and not being able to manage them.

At the London School of Facial Aesthetics, our goal is to empower our delegates to provide facial aesthetics treatments safely with a comprehensive knowledge of recognising and managing complications.

In last month’s column, we discussed botulinum toxin complications. This month, we are going to discuss dermal filler complications.

Dermal filler complication types

Dermal filler complications can be grouped according to the time of appearance.


  • Anaphylaxis
  • Bleeding, bruising and other injection site reactions
  • Skin changes/vascular events.


  • Infection
  • Swelling and oedema
  • Nerve damage
  • Placement related (non-inflammatory nodules, asymmetry/overcorrection, Tyndall effect).


  • Hypersensitivity-related swelling/oedema
  • Inflammatory nodules including granuloma
  • Late chronic infection
  • Product migration.

Managing the complications

As well as this, infection is rare as we follow strict aseptic protocols. But herpetic infections can occur, for example, following lip augmentation treatment with dermal filler, especially if there is a previous history of cold sores.

In addition, swelling and oedema are very common – especially in the first two weeks after treatment. These can be managed conservatively. But if there is no resolution after around two weeks, we may need to consider dissolving the filler.

Delayed Onset Nodule (DONs) formation can be inflammatory and non-inflammatory. It can occur due to poor injection technique or poor product choice for the area being treated.

In addition, poor placement issues such as Tyndall effect can occur if the product is placed too superficially and filler migration can occur if the filler is displaced to an area remote to the intended area of injection.

Conservative management such as firm massage within 14 days of treatment is advised and if there is no resolution following this, we may consider dissolving the filler.

A vascular occlusion is a rare but serious complication and can occur due to partial or complete obstruction of an artery. This will cause pain and darkening of the skin as well as tissue ischaemia and resulting hypoxia.

There is usually instant severe pain, however this may be masked by anaesthetic present in the filler. Capillary Refill Time (CRT) can be a useful parameter to assess tissue perfusion.

A retinal vascular occlusion refers to blockage of the retinal artery which can result in a lack of oxygen delivery to the retina and resulting ischaemia and visual loss. Prognosis is poor and recovery of vision is rare.

Be aware of complications

Being aware of managing complications that can arise as a result of facial aesthetics treatments is paramount in providing these treatments safely and providing the best level of care for our clients.

To find out more about managing facial aesthetics complications or to sign up for our complications masterclass please visit our website or email us at

You can also check out our Instagram and Facebook.

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