. 2023 Aug 2;9(3):227–235. doi: 10.1002/wjo2.126

Table 3.

Complications of filler injection and management strategies.

Complication	Incidence ²⁵ , ²⁶	Management
Mild/temporary
Local edema	0.26–0.44	Skin massage, ⁸ hyaluronidase, ⁸ , ²⁷ , ²⁸ ice packs, ²⁷ , ²⁸ , ²⁹ intralesional steroids, ²⁸ oral steroids ⁸ , ²⁸ , ²⁹
Injection site pain	0.20–0.38	Ice packs ²⁹
Ecchymosis	0.23–0.35	Ice packs, ²⁹ firm pressure, ²⁷ vascular lasers, ²⁷ , ²⁸ , ²⁹ topical arnica ³⁰
Erythema	0.19–0.33	Hyaluronidase, ⁸ , ²⁷ ice packs, ²⁷ topical steroids ²⁹
Tyndall effect	0.03–0.11	Hyaluronidase, ²⁷ , ²⁸ , ²⁹ minimal stab incision with evacuation of residual filler if persistent ²⁸
Skin paresthesia	0.01–0.35	Hyaluronidase, ²⁹ intralesional steroids ²⁹
Filler migration	0.01–0.17	Removal of filler material ²⁷
Nodules or granulomas	0.01–0.10	Skin massage, ²⁷ , ²⁸ hyaluronidase, ²⁹ intralesional steroids +/− 5‐FU, ²⁷ , ²⁸ , ²⁹ oral steroids, ²⁷ , ²⁸ , ²⁹ oral antibiotics, ²⁸ , ²⁹ minimal stab incision with evacuation, ²⁸ excision ⁸ , ²⁸ , ²⁹
Local infection	0.01–0.03	Oral antibiotics, ⁸ , ²⁷ , ²⁸ , ²⁹ acyclovir if herpetic vesicles, ⁸ , ²⁸ , ²⁹ avoid hyaluronidase until infection cleared ²⁷
Severe/permanent
Vascular occlusion	0–0.02	Hyaluronidase, ⁸ , ²⁷ aspirin, ⁸ , ²⁷ skin massage, ²⁷ warm compresses, ⁸ , ²⁷ topical nitroglycerin paste ⁸ , ²⁷
Skin necrosis	0–0.02	Antibacterial ointment, ⁸ , ³¹ daily local wound care regimen with debridement, ⁸ , ³¹ hyperbaric oxygen ⁸
Ophthalmoplegia	Case reports	Retrobulbar space injection of hyaluronidase and corticosteroids, ⁸ , ³² oral steroids ⁸ , ³¹
Decreased visual acuity or vision loss	Case reports	Ophthalmic arterial injection of hyaluronidase and urokinase, ⁸ , ²⁷ , ³² retrobulbar space injection of corticosteroids and tobramycin, ⁸ , ²⁷ , ³² ocular massage, ³² intravenous mannitol, ³² acetazolomide, ³² anterior chamber paracentesis, ⁸ , ³¹ , ³² hyperbaric oxygen ⁸ , ³¹