Complications in orofacial harmonization procedures: a systematic review

MANGANARO, NATHALIA LOPES; PEREIRA, JULIA GABRIELA DIETRICHKEIT; SILVA, RICARDO HENRIQUE ALVES DA

doi:10.5935/2177-1235.2022RBCP0034

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Review Article • Rev. Bras. Cir. Plást. 37 (2) • Apr-Jun 2022 • https://doi.org/10.5935/2177-1235.2022RBCP0034-en linkcopy

Complications in orofacial harmonization procedures: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Currently, facial aesthetic changes and dissatisfaction with self-image are influences that motivate the search for quick, non-surgical and less invasive cosmetic procedures. For this reason, the demand for patients looking for orofacial aesthetic procedures is increasing. The objective of this study was List the complications resulting from orofacial harmonization procedures through a systematic literature review, identifying which types of complications and areas are most affected. The following databases were searched: Medline (PubMed), SciELO, Scopus, Cochrane, Lilacs and Web of Science, from March to September 2020, selecting the studies that presented the following inclusion criteria: original studies in humans, about complications after orofacial harmonization procedures. Thirty-three studies from the literature were selected that presented reports of complications in patients after the orofacial harmonization procedure in the forehead, nose, eyes, periocular region and lips. Even the execution of less invasive facial cosmetic procedures can cause possible immediate or late complications after the procedure, especially in the periocular region and eyes. It is important to make professionals aware of this possibility beforehand.

Keywords:
Esthetics; Rejuvenation; Face; Cosmetics/adverse effects; Hyaluronic acid; Skin aging

Description	Abbreviation	Components
Population	P	Humans
Intervention	I	Orofacial harmonization
Comparation	C	Aesthetic procedures
Outcomes	O	Complications

ARTICLES	TITLE	AUTHORS	YEAR	MAGAZINE
1	Complications with the Use of Botulinum Toxin Type A in Facial Rejuvenation: Report of 8 Cases¹⁹	Ferreira MC, Salles AG, Gimenez R, Soares MFD	2004	Aesthetic Plastic Surgery
2	Retinal branch artery occlusion following injection of hyaluronic acid (Restylane)²⁰	Pedro S, Mennel S	2006	Clinical and Experimental Ophthalmology
3	Surgery for foreign body reactions due to injectable fillers²¹	Wolfram D, Tzankov A, Piza-Katzer H	2006	Dermatology (Basel, Switzerland)
4	Effect of botulinum toxin type a on tear production after treatment of lateral canthal rhytids²²	Arat YO, Yen MT	2007	Ophthalmic Plastic and Reconstructive Surgery
5	Delayed immune-mediated adverse effects related to hyaluronic acid and acrylic hydrogel dermal fillers: Clinical findings, long-term follow-up and review of the literature²³	Alijotas-Reig J, Garcia GV	2008	Journal of the European Academy of Dermatology and Venereology
6	The risk of alar necrosis associated with dermal filler injection²⁴	Grunebaum LD et.al.	2009	Dermatologic surgery
7	Ocular damage secondary to intense pulse light therapy to the face²⁵	Lee WW et al.	2011	Ophthalmic plastic and reconstructive surgery
8	Exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines²⁶	Kang SM et al.	2011	Annals of Dermatology
9	Uncommon Foreign Body Reaction Caused byBotulinum Toxin²⁷	Pontes HAR et al.	2012	The Journal of Craniofacial Surgery
10	Facial blanching due to neurotoxins: proposed mechanisms²⁸	Khan TT, Herne K, Dayan SH, Woodward JA	2013	Dermatologic surgery
11	The use of hyaluronidase in complications caused by hyaluronic acid for volumization of the face: a case report²⁹	Neri SRNG, Addor FAZ, Parada MB, Schalka S	2013	Surgery cosmetic dermatology
12	Fundus artery occlusion caused by cosmetic facial injections³⁰	Chen Y et al.	2014	Chinese medical journal
13	Periorbital lipogranuloma related to fillermigration: A rare complication of facial filler³¹	Eun YS, Cho SH, Lee JD, Kim HS	2014	Journal of Cosmetic and Laser Therapy
14	Diagnosis and management of dermal filler complications in the perioral region³²	Grippaudo FR et al.	2014	Journal of cosmetic and laser therapy
15	Cosmetic facial fillers and severe vision loss³³	Carle MV, Roe R, Novack R, Boyer DS	2014	JAMA ophthalmology
16	Clinical Outcomes of Impending Nasal Skin Necrosis Related to Nose and Nasolabial Fold Augmentation with Hyaluronic Acid Fillerso³⁴	Sun ZS et al.	2015	Plastic and reconstructive surgery
17	Late-onset adverse reactions related to hyaluronic Acid dermal filler for aesthetic soft tissue augmentation³⁵	Curi MM et al.	2015	The Journal of craniofacial surgery
18	Cerebral angiographic findings of cosmetic facial fillerrelated ophthalmic and retinal artery occlusion³⁶	Kim YK, Jung C, Woo SJ, Park KH	2015	Journal of Korean Medical Science
19	Treatment of glabella skin necrosis following injection of hyaluronic acid filler using platelet-rich plasma³⁷	Kang BK, Kang IJ, Jeong KH, Shin MK.	2016	Journal of cosmetic and laser therapy
20	Retinal Branch Artery Embolization Following Hyaluronic Acid Injection: A Case Report³⁸	Chen W et al.	2016	Aesthetic surgery journal
21	Therapeutic Plasma Exchange in a rare case myasthenic crisis after Botox injection³⁹	Chegini A	2017	Atherosclerosis Supplements
22	Filler migration to the forehead due to multiple filler injections in a patient addicted to cosmetic fillers⁴⁰	Lin CH, Chiang CP, Wu BY, Gao HW	2017	Journal of cosmetic and laser therapy
23	Xanthelasma-Like Reaction to Filler Injection⁴¹	Or L et al.	2017	Ophthalmic plastic and reconstructive surgery
24	Chronic Eyelid Edema Following Periocular Hyaluronic Acid Filler Treatment⁴²	Yu JTS, Peng L, Ataullah S	2017	Ophthalmic plastic and reconstructive surgery
25	[Clinical analysis of visual loss caused by facial cosmetic fillers injection]⁴³	Hu XZ et al.	2017	Zhonghua yan ke za zhi Chinese journal of ophthalmology
26	A Histopathologic Diagnosis of Vascular Occlusion after Injection of Hyaluronic Acid Filler: Findings of Intravascular Foreign Body and Skin Necrosis⁴⁴	Maruyama S	2017	Aesthetic Surgery Journal
27	Esotropia following botulinum toxin type A injection for facial wrinkles⁴⁵	Lee SK, Jun HJ	2018	Journal of cosmetic and laser therapy
28	Vascular Complications After Chin Augmentation Using Hyaluronic Acid⁴⁶	Wang Q et al.	2018	Aesthetic plastic surgery
29	Complications from microfocused transcutaneous ultrasound: Case series and review of the literature⁴⁷	Friedmann DP et. al.	2018	Lasers in surgery and medicine
30	Ischemic oculomotor nerve palsy due to hyaluronic acid filler injection⁴⁸	Bae IH et al.	2018	Journal of cosmetic dermatology
31	Horizontal animation deformity as unusual complication of neurotoxin modulation of the gummy smile⁴⁹	Chen G et al.	2019	Dermatology online journal
32	Visual loss following cosmetic facial filler injection⁵⁰	Shoughy SS	2019	Arquivos brasileiros de oftalmologia
33	Vascular Compromise After Soft TissueFacial Fillers: Case Report and Reviewof Current Treatment Protocols⁵¹	SM, Goldsmith JL, Ferneini EM	2020	Journal of Oral and Maxillofacial Surgery

Article	n	F	M	Age	Procedure performed	Material intensity / quantity	Time elapsed from the procedure	Complications	Affected region
1	8	7	1	36-58	Injection of botulinum toxin type A in the upper and lower facial third	46 U; 10 U.	It ranged from 48 hours to 43 days.	Headache, dry eye, progressive unilateral ptosis of the forehead and eyelid associated with diplopia, loss of control of the orbicularis oris muscle, difficulty in drinking and speaking, edema, spasms of the eye and corrugator muscles and diplopia to a greater degree.	Facial muscles, eyes, eyelids, forehead and head
2	1	0	1	48	Filling hyaluronic acid in the glabellar area and eyelids for wrinkles	-	1 minute	Partial visual loss in the lower half of the visual field of the right eye and occlusion of the retinal branch artery.	Eyes
3	4	4	0	38-58	Facial fillers with polymethylmethacrylate microspheres, hyaluronic acid, hyaluronic acid plus acrylic hydrogel particles and polylactic acid	-	It ranged from 2 and 3 months to 2 years later.	Vesicular rashes on the face, granulomas, erythema, foreign body with subcutaneous and intramuscular stiffness, acute inflammation of the enlarged facial areas and also a fistula on the forehead.	Eyelids, corner of mouth, zygomatic arch, nasolabial folds, chin, neck, cheeks and upper lip.
4	13	13	0	31-58	Botulinum toxin type A in “crow’s feet” region	10 U for each side	1 week	Dry eye and effects on the production of tears.	Eyes
5	25	-	-	-	Facial filling with hyaluronic acid (n=16) and hyaluronic acid plus hydrogels (n=9)	-	1-12 months	Sensitive nodules, skin tightening, systemic manifestations and other clinical signs.	Orofacial and systemic
6	3	2	1	25-42	Nose filling (rhinoplasty) with hyaluronic acid	1 ml (n=1)	Ranged from Immediate; 12 hours after and 1 day after.	Nasal necrosis, irritation of the skin of the nose with swelling and numbness.	Nose
7	2	2	0	27-36	Facial treatment with intense pulsed light (IPL)	560 nm with an unknown IPL unit was	1 hour after	Eye pain, marked pupillary constriction and anterior	Eyes
8	4	4	0	33-49	Botulinum toxin in the forehead region	Less than 20 U	1-2 weeks after	Glabellar protrusion and deep wrinkles	Forehead
9	1	1	0	32	Botulinum toxin injection to correct gingival smile	(3 BTX injections in 2 locations)	6 months later	Nasopalatine duct cyst or lateral periodontal cyst and foreign body immersed in connective tissue of the lesion compatible with botulinum toxin.	Maxilla and central incisors
10	1	1	0	32	Injections of botulinum toxin type A in the glabella region	-	2 weeks	Pale skin overlying the frontal and glabellar areas	Forehead
11	1	1	0	35	Hyaluronic acid in the region of the zygomatic arch	18G cannula, 70mm and volume not informed	15 days after	Pain on palpation and nodules	Zygomatic arch and infra-orbital region
12	13	13	0	38-44	Facial filling with autologous fat (n=7), hyaluronic acid (n=5) and bone collagen (n=1). Frontal (n=5), periocular (n=2), temporal (n=2) and nose (n=4)	HA (0.6; 0.9 and 2.1 ml of material. Needle 27-30 G) and autologous fat: (20.0;2.0;5.0;12.0 and 0.9ml with a needle of 0,3; 1; 1,2 and 2mm in diameter and 23 G and 12G)	-	Ophthalmic artery occlusion (OAO), central retinal artery occlusion (CRAO) and anterior ischemic optic neuropathy (AION).	Eyes
13	1	1	0	74	Dermal filling with unidentified material in the forehead region	-	-	Edema and yellow discoloration of the left upper eyelid	Eyelids
14	26	26	0	28-74	Lip filling	-	-	lip volume, asymmetry, lip edema, infections, fibrosis, lumps, labial hardening, granulomatous inflammation and product migration.	Lips
15	3	2	1	30-60	Hyaluronic acid, autologous fat and microspheres of bovine collagen and polymethyl methyl acrylate on the forehead	-	Ranged from immediately to 3 weeks after	Visual Loss	Eyes
16	20	19	1	22-52	Hyaluronic acid in the Nose	-	1 day after	Cutaneous necrosis (pain, erythema and edema)	Nose
17	2	2	0	58-65	Hyaluronic acid	-	4 e 12 years later (late reaction)	Painful inflamed nodular lesions on the lip mucosa and sudden symmetrical bilateral swelling in the masseter region	Lips and masseter
18	7	7	0	24-40	Hyaluronic acid (n=4) and autologous fat (n=3) in nose and glabella	AH 0.2; 0.4 and 0.7 ml for autologous fat was not identified	4 hours	Ophthalmic artery occlusion (OAO) and skin necrosis	Eyes
19	1	1	0	46	Hyaluronic acid in the forehead and nose	-	2 days after	Redness, swelling, numerous pustules and dark regional necrosis.	Glabella, forehead and back of nose
20	1	1	0	22	Hyaluronic acid injection in the nasal dorsus	-	10 minutes after	Nasal back and erythematous glabella accompanied by diplopia, violet discoloration, orbital pain and extrabismus in the eyes.	Glabella, nose and eyes
21	1	1	0	30	A botulim toxin injections	3 injections without volume indication	-	Ptosis, diplopia, dysarthria, dysphagia, muscle weakness, progressive breathing difficulty and dyspnea	Eyes and pharynx
22	1	1	0	50	Poly-lactic acid injection (PLLA) in the cheeks	-	1 month after	Fill migration in the cheeks forming a growing nodule on the forehead	Forehead
23	7	7	0	46-57	Hyaluronic acid (n=2), synthetic calcium hydroxyapatite (n=4) and polycaprolactone microspheres (n=1)	-	12 months after	Reaction similar to xanthelasma on the lower eyelids that included swelling and yellow deposits on the lower eyelids	Lower eyelids
24	1	1	0	54	Hyaluronic acid in the eyebrow region	-	6 years after	Bilateral periorbital edema with slight blue discoloration of the skin.	Eyelids
25	18	18	0	24-45	Hyaluronic acid or autologous fat: test n=6; nose n=8; both n=4	-	-	Visual loss (absence of light perception, ischemia at the injection site, different degrees of ptosis and examination of the fundus)	Eyes
26	1	1	0	57	Hyaluronic acid in the glabella, forehead and nasolabial folds	0,1mL	2 days after	Skin necrosis, erythema, discoloration, purple, and severe pain that extends from the left glabella to the top of the forehead	Forehead, in the parietal region
27	1	1	0	36	Botulinum toxin type A on the glabella, forehead and crow’s feet	-	7 days after	Esotropia partial paralysis of the eye (presented double vision)	Eyes
28	2	2	0	24-42	Hyaluronic acid (HA)	1ml	During the procedure	Local necrosis of the chin skin, lingual paresthesia, headache and neck discomfort.	Chin and Tongue
29	5	3	2	47-53	Microfocused ultrasound (MFUS) to improve facial skin texture	4MHz / 4.5mm, 3.0mm and 1.5mm (809 lines); 7 MHz / 4.5mm and 3.0mm (318 lines) and 4MHz / 4.5mm, 7MHz / 4.5mm and 3.0mm deep (630 lines)	Minutes after procedure	Blisters, erosion / ulceration, skin and subcutaneous tissue and skin necrosis.	Facial skin
30	1	1	0	29	Hyaluronic acid (HA) in the nasal tip	-	During the procedure and after 3 days.	Severe pain, dizziness and blurred vision, limited extraocular movement, skin.	Periocular area and glabella
31	1	1	0	28	Botulinum toxin type A on the upper lip	one site per muscle, 2.5 units per site	1 week after	Appearance of depressing horizontal line when smiling	Lower facial third
32	1	1	0	36	Periocular hyaluronic acid and glabella	-	-	Loss of vision in the right eye and weakness in the left arm	Eyes and arms
33	1	1	0	52	Hyaluronic acid (HA) in the puppet lines and nasolabial folds	-	12 hours after	Bilateral painful erythematous facial edema and palpable sensitive area with hematoma and edema	Lower third of the face and lip

Article	1. Were patient’s demographic characteristics clearly described?	2. Was the patient’s history clearly described and presented as a timeline?	3. Was the current clinical condition of the patient on presentation clearly described?	4. Were diagnostic tests or assessment methods and the results clearly described?	5. Was the intervention(s) or treatment procedure(s) clearly described?	6. Was the postintervention clinical condition clearly described?	7. Were adverse events (harms) or unanticipated events identified and described?	8. Does the case report provide takeaway lessons?
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