Serious Complications of Hyaluronic Acid Fillers - A Retrospective Study of 290,307 Cases

Abstract

Background: Hyaluronic acid (HA) injection as a facial filler is widely used for facial contouring and is generally believed to be safe and effective. Although extremely rare, serious complications, such as infection, skin necrosis due to vascular occlusion, and blindness, sometimes occur. No study has examined the rate of severe complications in high-volume cases in a single center. We analyzed large-scale data from a group of clinics throughout the country to evaluate the rate of severe complications associated with HA injections. Methods: This retrospective study included the data of 209,083 patients (290,307 injection sites) from our database between October 2020 and April 2024. We analyzed 12 cases of serious complications, such as infection and vascular obstruction. Results: There were 290,307 HA injections, including 2 cases of infection and 10 cases of vascular obstruction. The incidence of severe complications was 0.0041%. There was one case each of infection of the chin and nasolabial folds (NLF), 1 case of vascular embolization of the NLF and nose, and 8 cases of vascular embolization of the forehead. Conclusions: The rate of severe complications associated with HA injections was low. However, more attention is necessary to further lower the complication rates.