Facial Filler

Hyaluronic Acid (HA) is the most widely used injectable facial filler, but there remains no consensus on how to address issues of safety and adverse events.  A European study is one of the first attempts to provide standardized guidelines on the complications of HA use.


The continuing popularity of Hyaluronic Acid (HA) as a facial filler is a testament to its long-lasting results and convenience. Using HA to fill in the creases and furrows of the aging face simply entails a quick office procedure; and as opposed to most surgical procedures, infiltration or injections of HA are indeed minimally invasive in nature.  However, this increasing number of those availing of these “facial rejuvenation” procedures have also resulted in the prominence of possible complications arising from HA infiltration.

A panel of experts across Europe developed recommendations on the use of HA as a facial filler, with the aim of recognizing potential areas of risk and more importantly how to manage ensuing complications.  These complications (termed adverse events) range from local skin reactions that are temporary in nature, unsightly lumps and nodules that may persist after injection, or to more serious consequences like bacterial infections, or even actual damage to the skin and surrounding tissue like blood vessels.  The causes for these adverse events have been classified by the panel into three categories:  those arising from the HA itself, the method of delivery of HA, and patient’s individual response to the filler.

Even with its high safety profile, HA itself can cause complications, which are sometimes related to the manufacturing process. Clinicians should only source HA from reputable companies that adhere to the strictest standards of hygiene and sterility, as befits any substance that will be introduced into the human body.

The manner of delivery is also identified as a potential cause for adverse events.  There are subsequent recommendations on proper handling and delivery of HA; these include which specific areas of the face should be targeted, regulating amounts of HA to be injected, as well as the correct technique of infiltration.

Finally, clinicians are enjoined to be aware that there are patients who have an innate reaction to HA.  While relatively rare, doctors should be vigilant in testing potential patients for any allergic reactions to the filler. This is easily done by injecting a tiny amount of HA into a hidden area of the body prior to the actual procedure.

These proposed guidelines are significant because there are still no established standards for the use of HA and the management of complications arising from its use.  As more clinicians use HA, and more indications for its use are envisioned, this standardization can hopefully address these complications, no matter how infrequently they occur.


Written By: Jay Martin, M.D.

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