Adverse Events in Nonsurgical Facial Aesthetic Procedures: A Systematic Review and Meta-Analysis

Abstract

Objective: To determine the prevalence and clinical profile of treatment-related adverse events (TRAE) associated with: (1) botulinum toxin in the upper face; (2) hyaluronic acid fillers in the lower face and nasolabial folds; and (3) nonsurgical facelifts with absorbable threads. Methods: Searches were conducted in five electronic databases and gray literature. Proportion meta-analyses were performed to estimate the prevalence of TRAE for each type of aesthetic procedure. Results: 42 studies were included. TRAEs were reported in 34.8% of included patients. The highest TRAEs prevalence was associated with hyaluronic acid fillers (63.0%, 95% CI: 35%–84%), followed by nonsurgical facelifts with absorbable threads (20.0%, 95% CI: 8%–41%) and botulinum toxin in the upper face (18.0%, 95% CI: 10%–32%). The most frequently reported TRAEs were swelling (22.4%) and pain (19.0%) for hyaluronic acid fillers; pain (31.5%) and bruising (23.4%) for nonsurgical facelifts with threads; and headache for botulinum toxins. Hyaluronic acid fillers accounted for 67.3% of all TRAEs (n = 3729/4971). Conclusions: The overall prevalence of adverse events was low for botulinum toxin and thread lifts, but high for hyaluronic acid fillers. Future studies should report all adverse events, expected and not expected, detailing the number of patients affected, total events, onset and recovery times, severity, and provider category.