TABLE 1.
Summary of cases with lip filler-related complications
| PAPER | CASE | FILLER MATERIAL | TREATMENT SITE | COMPLICATION | SIGNS & SYMPTOMS | MANAGEMENT | OUTCOME |
|---|---|---|---|---|---|---|---|
| Eversole et al, 20135 | 1 | Collagen | Lower lip | Nodule | Visible/palpable nodule/raised plaque | Not mentioned | Not mentioned |
| 2 | HA | Lower Lip | Nodules and migration | Multiple nodules in labial vestibule, these had migrated from original vermillion border filler injection. | Not mentioned | Not mentioned | |
| 3 | HA | Lower Lip | Nodules and migration | White colored nodules in mandibular sulcus migrated from lower lip | Not mentioned | Not mentioned | |
| 4 | CaHA | Lower Lip | Nodule | Visible/palpable nodule/raised plaque | Not mentioned | Not mentioned | |
| 5 | CaHA & HA | Lower Lip | Mass and migration | White colored mass in mandibular sulcus migrated from lower lip | Not mentioned | Not mentioned | |
| 6 | CaHA | Lips | Mass and migration | Small mass which had migrated to buccal mucosa. | Not mentioned | Not mentioned | |
| 7 | Poly-L-Lactate | Lower lip | Nodule | Visible/palpable nodule/raised plaque | Not mentioned | Not mentioned | |
| 8 | Poly-L-Lactate | Lower lip | Nodule and migration | Visible nodule in mandibular sulcus migrated from lower lip | Not mentioned | Not mentioned | |
| 9 | Hydroxyethyl methacrylate | Lower lip | Nodule | Visible/palpable nodule/raised plaque | Not mentioned | Not mentioned | |
| Requena et al, 20118 | 10 | HA | Right side of Upper lip | Granulomatous foreign body reaction with surrounding leukocytes. | Lumps | Intralesional hyaluronidase injections | Not mentioned |
| 11 | CaHA | Lower lip | Nodules | Lumps | Not mentioned | Not mentioned | |
| Artzi et al, 20169 | 12 | HA | Lips | Cutaneous inflammatory nodules, discolouration. | Painful multiple small nodules which developed 12 weeks after HA filler in lips. Purple/brown discolouration of skin and tender, warm skin which developed into a large nodule in 7 days. | Oral ciprofloxacin (500–750mg twice a day) for three to four weeks. Hyaluronidase intralesional injections. Recurrence– ciprofloxacin or rifampicin for a minimum of 3 weeks. Also tried oral and intralesional corticosteroid treatment. |
3 months to full resolution |
| 13 | HA | Lips | Cutaneous inflammatory nodules, discolouration. | Painful multiple small nodules which developed 9 weeks after HA filler in lips. Purple/brown discolouration of skin and tender, warm skin which developed into a large nodule in 7 days. | Oral ciprofloxacin (500–750mg twice a day) for three to four weeks. Hyaluronidase intralesional injections. Recurrence treated with ciprofloxacin or rifampicin for a minimum of 3 weeks. Also tried oral and intralesional corticosteroid treatment. |
3 months to full resolution with 1 recurrence in between | |
| 14 | HA | Lips | Cutaneous inflammatory nodules, discolouration | Painful multiple small nodules which developed 9 weeks after HA filler in lips. Purple/brown discolouration of skin and tender, warm skin which developed into a large nodule in 7 days. | Oral ciprofloxacin (500–750 mg twice a day) for three to four weeks. Hyaluronidase intralesional injections Recurrences treated with ciprofloxacin or rifampicin for a minimum of 3 weeks Also tried oral and intralesional corticosteroid treatment. |
6 months to full resolution with 4 recurrences in between. | |
| 15 | HA | Lips | Cutaneous inflammatory nodules, discolouration | Painful multiple small nodules which developed 4 weeks after HA filler in lips. Purple/brown discolouration of skin and tender, warm skin which developed into a large nodule in 7 days. | Oral ciprofloxacin (500–750 mg twice a day) for three to four weeks. Hyaluronidase intralesional injections. Also tried oral and intralesional corticosteroid treatment. |
6 weeks to full resolution | |
| Alijotas-Reig et al, 201310 | 16 | HA | Lips | Angiodema | Swelling one hour after treatment | Intramuscular dexamethasone and a 6-day oral prednisone taper | 5 days to full resolution |
| 17 | HA | Lips | Nodules | Eczematous changes and lumps 6 weeks after lip augmentation with fillers | Not mentioned | Not mentioned | |
| Owosho et al, 201411 | 18 | Unknown | Lower lip | 2cm mass | Not mentioned | Not mentioned | Not mentioned |
| 19 | Unknown | Lower lip | Yellow lesion | Not mentioned | Not mentioned | Not mentioned | |
| 20 | Unknown | Lower lip | Mobile submucosal mass | Not mentioned | Not mentioned | Not mentioned | |
| 21 | CaHA | Lower lip | Soft yellow lesion | Not mentioned | Not mentioned | Not mentioned | |
| 22 | Collagen and HA | Lower lip | Red ovoid fluctuant lesions | Not mentioned | Not mentioned | Not mentioned | |
| Shahrabi-Farahani et al, 201412 | 23 | CaHA | Upper lip | Mass and migration | First noticed painless swelling 6 months after lip filler treatment, migration of filler into upper labial mucosa with a 1.5cm sized mass. | Not mentioned | Not mentioned |
| 24 | CaHA | Lower lip | Mass and migration | First noticed 5 months after lip filler treatment and presented as a painless swelling. Migration of the filler to lower labial mucosa with a 1cm swelling/mass. | Not mentioned | Not mentioned | |
| 25 | Poly-L-Lactate | Lower lip | Nodule and migration | First noticed painless, firm yellow nodule 9 months after lip filler treatment. Migration into the mandibular vestibule. | Not mentioned | Not mentioned | |
| 26 | Poly-L-Lactate | Lip | Masses and migration | 2 firm, painless moveable masses noticed first 7 months after lip filler treatment. Migration into left maxillary vestibule. | Not mentioned | Not mentioned | |
| Conrad et al, 201513 | 27 | HA | Lower lip | Abscess | Abscess developed on day 7 after treatment | Hyaluronidase, I&D x4 times over 6 months, antibiotics | Full resolution at 12 months |
| 28 | HA | Upper and lower lip | Abscesses | Abscess developed one month after treatment with recurrence | I&D x2 over 2 months | Full resolution after second I&D | |
| Shahrabi- Farahani et al, 201214 | 29 | HA | Upper lip | Nodule | Not mentioned | Biopsy- Hstopathologically diagnosed as “inert foreign material consistent with hyaluronic acid filler | Not mentioned |
| 30 | HA | Lower lip | Nodule | Not mentioned | Biopsy- Hstopathologically diagnosed as “inert foreign material consistent with hyaluronic acid filler | Not mentioned | |
| 31 | HA | Lower lip | Nodule | Not mentioned | Biopsy- Hstopathologically diagnosed as “inert foreign material consistent with hyaluronic acid filler | Not mentioned | |
| Van Dyke et al, 201015 | 32 | HA | Upper and lower lips | Nodules and oedema | Recurrence of nodules and oedema at lip filler treatment site. | Oral steroids, expression of filler through stab incisions, oral antibiotics. | Complete resolution |
| Lucas-Herald et al, 201216 | 33 | HA | Both lips | Pancreatitis | Acute onset epigastric pain and vomiting | MRCP | Not mentioned |
| Yazdanparast et al, 20176 | 34 | HA | Upper lip | Lumps | Not mentioned | Hyaluronidase | Not mentioned |
| Bachmann et al, 201117 | 35 | HA and Poly-L-lactic acid over two sittings | Upper lip | Nodules | Presentation over 2 weeks post treatment with lumps. | Not mentioned | Not mentioned |
| 36 | HA x2 and Poly-L-lactic acid over multiple sittings | Upper lip | Abscess, nodules. | Presented after two weeks with lumps. | Not mentioned | Not mentioned | |
| 37 | Collagen (non-permanent) x2 and Poly-L-lactic acid (x2) over multiple sittings | Upper lip | Pruritus and nodules | Itching and lumps 2 weeks after treatment. | Not mentioned | Not mentioned | |
| 38 | Collagen and Poly-L-lactic acid x2 over multiple sittings | Upper lip | Nodules, erythema | Pain, lumps and redness two weeks after treatment | Not mentioned | Not mentioned | |
| 39 | Collagen and Poly-L-lactic acid over two sittings | Upper lip | Nodules | Lumps two weeks after treatment | Not mentioned | Not mentioned | |
| 40 | Hydroxyethyl methacrylate and collagen over multiple sittings | Upper lip | Pruritus, nodules | Itching, pain and lumps 2 weeks after treatment. | Not mentioned | Not mentioned | |
| 41 | Hydroxyethyl methacrylate and HA over multiple sittings | Upper lip | Nodules, erythema, delayed swelling | Lumps, redness and swelling 2 weeks after treatment. | Not mentioned | Not mentioned | |
| 42 | Collagen and Polymathic-methacrylate microspheres over multiple sittings | Upper lip | Nodule, erythema, delayed swelling, discolouration | Two weeks after treatment, developed redness, lump, swelling and decolourisation | Not mentioned | Not mentioned | |
| 43 | HA over two sittings | Upper and lower lip | Nodules | Lumps two weeks post-treatment | Not mentioned | Not mentioned | |
| 44 | HA and polyacrylic acid over multiple sittings | Upper and lower lip | Erythema, delayed swelling, nodules, discoloration, abscess formation, pain | Two weeks post treatment, developed redness, swelling, nodules, an abscess, pain and tenderness. | Not mentioned | Not mentioned | |
| Cox and Adigun, 201118 | 45 | HA | Upper lip | Angioedema immediately post-lip filler treatment | Swelling of lips and oral mucosa | Self-resolving | Resolved by day 12 |
| 46 | HA | Upper lip | Herpetic outbreak | Vesicles and pain | Antivirals | Not mentioned | |
| Bulam et al, 201519 | 47 | HA | Upper and lower vermillion border | Severe angioedema type acute hypersensitivity | Progressive oedema within minutes– lip volume x4 in 1 hour, swelling progressed during first 12 hours– localised to lips | Monitored for 2 hours + IV antihistamine (slow infusion 2ml 45.5mg/2ml pheniramine maleate). After 3 hours, sent home with oral antihistamine (5mg desloratadine BD) | Oedema began resolving 48 hours from start of reaction and fully resolved by 7th day |
| Lanteri et al, 201220 | 48 | HA | Upper and lower lip | Lower lip necrosis | Severe pain, blanching of lower lip | Antibiotics + topical nitro paste 2% applied every 8 hours + elective excision of devitalised tissue with wedge resection | Full resolution following surgery but scar evident |
| Van Dyke et al, 201015 | 49 | HA | Upper and lower lips | Severe oedema + recurring nodules | Nodules of pus and product, oedema following resolution of initial post treatment swelling | Oral steroids but no effect – filler removed via extraction via “stab incision” + AB therapy – product and pus continued to be removed up to 2 months after | Full resolution |
| Cohen et al, 201521 | 50 | HA | Lips | Necrosis | Not mentioned | Hyaluronidase (smaller volume for restylane than juvederm)– advise 200U– 1injection per 3-4cm of skin affected + massage– if no improvement within 60 mins, inject more (repeat 3-4 cycles), warm compress 5-10mins every 30-60 mins. NTG also an option. Oral aspirin. Routine wound care, hydration, wound debridement | Not mentioned |
| DeLorenzi 201322 | 51 | HA | Lips | Nodule | Submucosal nodule following 1 month after treatment | Puncture – incision and drainage with 21G needle | Not mentioned |
| Turkmani et al, 20197 | 52 | HA | Lips | Delayed onset inflammatory reaction following flu-like illness | Swelling 4 months after initial lip filler treatment | Prednisolone | Fully resolved |
| 53 | HA | Upper lip | Delayed onset inflammatory reaction following flu-like illness | Swelling 6 months after initial lip filler treatment | Prednisolone and hyaluronidase | Fully resolved |