Adverse reactions and complications caused by hyaluronic acid injections in the face: A scoping review

This scoping review identified and mapped the adverse reactions and complications associated with the use of hyaluronic acid (HA) dermal fillers in facial aesthetic procedures. This scoping review was reported according to the PRISMA-ScR. Searches were conducted in three electronic databases (PubMed, Scopus, and Web of Science). Randomized clinical trials, cross-sectional studies, retrospective or prospective cohort studies, case series, or case reports published until 2024 that assessed or reported the use of HA for facial filling in healthy adult patients and documented any adverse reaction or complication were included. Study selection was conducted independently by two researchers. Data extraction was performed on half of the included studies by each reviewer, with cross-checking by a third reviewer. A descriptive analysis of the data was performed, considering the different study designs and the complications and adverse reactions reported. Data were presented in tables and graphs. Fifty-five studies met the eligibility criteria and were included. Most studies were case series and case reports (67.3%). Sample sizes ranged from 1 to 5,000, and participant ages ranged from 18 to 78 years. The most reported adverse reactions among the included studies were bruising (56.4%), ischemia (45.4%), and edema (41.81%), with itching less frequent (3.6%). The most severe complications reported were tissue necrosis (29.1%) and tissue embolism (20%), with some cases leading to blindness or stroke. Bruising and ischemia were the most frequently reported adverse reactions, while tissue necrosis was the most common severe complication reported.

Key Words:
Hyaluronic acid; Dermal filler; Complications; Adverse reactions; Facial harmonization; Necrosis