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Delayed-Onset Complications of Facial Soft Tissue Augmentation with Permanent Fillers in 85 Patients


  • The authors have indicated no significant interest with commercial supporters.

Address correspondence and reprint requests to: Jonathan A. Kadouch, MD, Department of Dermatology, VU Medical Centre, Room 3A85, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands, or e-mail:



To evaluate factors influencing the onset and type of adverse events in patients injected with permanent fillers in the face and to propose a therapeutic strategy for these complications.


A prospectively attained series of 85 patients with delayed-onset complications after facial injection with permanent fillers underwent clinical follow-up and treatment of the complications.


Lag times until onset and type of delayed-onset complication varied according to filler material. In 28% (n = 24) of the cases, patients reported the onset of complications after dental procedures, additional injections with fillers, or other invasive treatments in the facial area. Forty-eight (57%) patients required invasive treatment. Abscess formation was significantly more frequent in patients with human immunodeficiency virus infection and facial lipoatrophy (= .001).


The intrinsic characteristics of the injected filler and the immune status of the patient play important roles in the diversity of time of onset and type of delayed-onset adverse events observed. It seems that invasive facial or oral procedures in the vicinity of filler depots can provoke such complications. We propose a strategy for treating these complications and advise great caution when using permanent filling agents.