Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review

Alper Geyik; Ahmet Özdemir; Hasan Basri Çağlı; Safa Eren Atalmış

doi:10.18614/dehm.1813966

Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review

Abstract

Complications of soft tissue fillers (STFs) are rare, but infections and foreign body reactions can be serious and difficult to manage. This retrospective case series and narrative literature review aimed to provide an overview of inflammatory complications associated with STFs and to compare our clinical management approach with the available literature. Ten patients with inflammatory complications related to STFs were retrospectively evaluated. In addition, a narrative literature search was performed in PubMed using the following Boolean search terms: ((infection) OR (biofilm) OR (foreign body reaction)) AND ((soft tissue filler) OR (dermal filler)). The time interval between filler injection and the onset of the inflammatory reaction ranged from 2 days to 84 months and most culture results were negative. When evaluated together with the literature, antibiotic treatment appears to be more effective in acute infectious complications, whereas delayed complications may be less responsive because of biofilm formation. In late inflammatory nodules, non-surgical treatments such as hyaluronidase, intralesional triamcinolone and 5-fluorouracil may be used; however, these treatments remain controversial, and surgical excision may be required for persistent lesions.

Keywords

Supporting Institution

The authors declare that there are no conflicts of interest and no sources of funding related to this study.

Ethical Statement

The study has been approved by the Dokuz Eylül University Ethics Committee under decision no. 2025/34-16.

References

1. Klein AW, Elson ML. The history of substances for soft tissue augmentation. Dermatol Surg. 2000; 26:1096-1105.
2. Monheit GD, Rohrich RJ. The nature of long-term fillers and the risk of complications. Dermatol Surg 2009: 35:1598-1604.
3. Tabatabaei FS, Azimi A, Tabatabaei SS, Pakdaman H. Recovery of acute ophthalmoplegia after hyaluronic acid filler injections to the temples. A Case Report and Review of the Literature. Arch Plast Surg 2023; 50(2):148-152.
4. Lee SK, Kim SM, ChoSH, Lee JD, Kim HS. Adverse reactions to injectable soft tissue fillers: Memorable cases and their clinico-pathological overview. Journal of Cosmetic and Laser Therapy 2014; 17(2):102–08.
5. Rohrich RJ, Nguyen AT, Kenkel JM. Lexicon for soft tissue implants. Dermatol Surg 2009; 35:1605-11.
6. Sclafani AP, Fagien F. Treatment of injectable soft tissue filler complications. Dermatol Surg 2009; 35 Suppl 2:1672-80..
7. Bjarnsholt T, Tolker-Nielsen T, Givskov M, Janssen M, Christensen LH. Detection of bacteria by fluorescence in situ hybridization in culture-negative soft tissue filler lesions. Dermatol Surg 2009; 35:1620–24.
8. Alhede M, Bjarnsholt T. Are biofilms responsible for the adverse effects experienced following soft-tissue fillers? Future Microbiol 2014; 9:931–33.

9. American Society of Plastic Surgeons. Report of the 2022 Statistics. National Clearinghouse of Plastic Surgery Statistics. Arlington Heights, IL: American Society of Plastic Surgeons; 2022.
10. Grippaudo FR, Pacilio M, Di Girolamo M, Dierckx RA, Signore A. Radiolabelled White blood cell scintigraphy in the work-up of dermal filler complications. European Journal of Nuclear Medicine and Molecular Imaging 2012; 40:418–25.
11. Christensen LH. Normal and pathologic tissue reactions to soft tissue gel fillers. Dermatol Surg 2007; 33:168-75.
12. Andre P, Lowe NJ, Parc A, Clerici TH, Zimmermann U. Adverse reactions to dermal fillers: a review of European experiences. J Cosmet Laser Ther 2005;7:171-176.
13. Zielke H, Wölber L, Wiest L, Rzany B. Risk profiles of different injectable fillers: results from the injectable filler. Safety study (IFS Study). Dermatol Surg 2008;34(3):326–35.
14. Clark NW, Pan DR, Barrett DM. Facial fillers: nelevant anatomy, injection techniques, and complications. World J Otorhinolaryngol Head Neck Surg 2023; 9(3):227-235.
15. Murthy R, Eccleston D, Mckeown D, Parikh A, Shotter S. Improving aseptic injection standards in aesthetic clinical practice. Dermatol Ther 2021;34(1):e14416.
16. Urdiales-Gálvez F, Delgado NE, Figueiredo V, et al. Treatment of soft tissue filler complications: expert consensus recommendations. Aesthetic Plast Surg 2018; 42:498–510.
17. Dayan SH, Arkins JP, Brindise R. Soft tissue fillers and biofilms. Facial Plast Surg 2011;27(1):23-8. .
18. Dumitraşcu DI, Georgescu AV. The management of biofilm formation after hyaluronic acid gel filler injections: a review. Clujul Medical 2013; 86(3), 192.
19. Kulichova D, Borovaya A, Ruzicka T, Thomas P, Gauglitz GG. Understanding the safety and tolerability of facial filling therapeutics. Expert Opin Drug Saf 2014;13(9):1215-26.
20. Ibrahim O, Overman J, Arndt KA, Dover JS. Filler nodules: inflammatory or infectious? A review of biofilms and their implications on clinical practice. Dermatol Surg 2018; 44(1), 53-60.
21. Singh K, Nooreyezdan S. Nonvascular complications of injectable fillers—prevention and management. Indian Journal of Plastic Surgery 2020; 53(03), 335-343.
22. Saththianathan M, Johani K, Taylor A, et al. The role of bacterial biofilm in adverse soft-tissue filler reactions: a combined laboratory and clinical study. Plast Reconstr Surg 2017;139(3):613–621.
23. Schütz P, Ibrahim HH, Hussain SS, Ali TS, El-Bassuoni K, Thomas J. Infected facial tissue fillers: case series and review of the literature. J Oral Maxillofac Surg 2012; 70(10):2403-12.
24. Cox SE, Adigun CG. Complications of injectable fillers and neurotoxins. Dermatol Ther 2011; 24(6):524-36.
25. DeLorenzi C. Complications of injectable fillers, part I. Aesthetic Surgery Journal 2013; 33(4), 561-575.
26. Ledon JA, Savas JA, Yang S, Franca K, Camacho I, Nouri K. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options. Am J Clin Dermatol 2013; 14(5):401-11.
27. Chiang YZ, Pierone G, Al-Niaimi F. Dermal fillers: pathophysiology, prevention and treatment of complications. J Eur Acad Dermatol Venereol 2017; 31(3):405-413.
28. Galadari H, Krompouzos G, Kassir M, et al. Complication of Soft Tissue Fillers: Prevention and Management Review. J Drugs Dermatol 2020; 19(9):829-832.
29. Hexsel D,de Morais MR. Management of complications of injectable silicone. Facial Plastic Surgery 2014; 30(06),623-627.
30. Ono S, Ogawa R, Hyakusoku H. Complications after polyacrylamide hydrogel injection for soft-tissue augmentation. Plast Reconstr Surg 2010; 126(4),1349-1357.
31. Wang C, Sun T, Yu N, Wang X. Herpes reactivation after the injection of hyaluronic acid dermal filler: A case report and review of literature. Medicine (Baltimore) 2020; 99(24):e20394.
32. Davies E, Vaghela D, Convery C, Walker L, Murray G. Guideline for the Prevention, diagnosis, and management of acute bacterial soft tissue infections following nonsurgical cosmetic procedures. J Clin Aesthet Dermatol 2021; 14(9 Suppl 1):S29-S35.

Details

Primary Language

English

Subjects

Clinical Sciences (Other)

Journal Section

Case Report

Authors

Alper Geyik
0000-0002-5447-1591
Türkiye

Ahmet Özdemir ^*
0009-0007-0692-0552
Türkiye

Hasan Basri Çağlı
0000-0001-5504-0868
Türkiye

Safa Eren Atalmış
0000-0003-1848-0404
Türkiye

Publication Date

October 26, 2026

Submission Date

April 9, 2026

Acceptance Date

July 27, 2026

Published in Issue

Year 2026 Volume: 40 Number: 4

DOI

https://doi.org/10.18614/dehm.1813966

IZ

https://izlik.org/JA65ES97FG

Cite

RIS / Bibtex

APA

Geyik, A., Özdemir, A., Çağlı, H. B., & Atalmış, S. E. (2026). Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review. Developments and Experiments in Health and Medicine, 40(4), 561-573. https://doi.org/10.18614/dehm.1813966

AMA

1.Geyik A, Özdemir A, Çağlı HB, Atalmış SE. Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review. Dev Exp Health Med. 2026;40(4):561-573. doi:10.18614/dehm.1813966

Chicago

Geyik, Alper, Ahmet Özdemir, Hasan Basri Çağlı, and Safa Eren Atalmış. 2026. “Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review”. Developments and Experiments in Health and Medicine 40 (4): 561-73. https://doi.org/10.18614/dehm.1813966.

EndNote

Geyik A, Özdemir A, Çağlı HB, Atalmış SE (October 1, 2026) Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review. Developments and Experiments in Health and Medicine 40 4 561–573.

IEEE

[1]A. Geyik, A. Özdemir, H. B. Çağlı, and S. E. Atalmış, “Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review”, Dev Exp Health Med, vol. 40, no. 4, pp. 561–573, Oct. 2026, doi: 10.18614/dehm.1813966.

ISNAD

Geyik, Alper - Özdemir, Ahmet - Çağlı, Hasan Basri - Atalmış, Safa Eren. “Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review”. Developments and Experiments in Health and Medicine 40/4 (October 1, 2026): 561-573. https://doi.org/10.18614/dehm.1813966.

JAMA

1.Geyik A, Özdemir A, Çağlı HB, Atalmış SE. Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review. Dev Exp Health Med. 2026;40:561–573.

MLA

Geyik, Alper, et al. “Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review”. Developments and Experiments in Health and Medicine, vol. 40, no. 4, Oct. 2026, pp. 561-73, doi:10.18614/dehm.1813966.

Vancouver

1.Alper Geyik, Ahmet Özdemir, Hasan Basri Çağlı, Safa Eren Atalmış. Inflammatory Complications of Soft Tissue Fillers: A Retrospective Case Series and Narrative Literature Review. Dev Exp Health Med. 2026 Oct. 1;40(4):561-73. doi:10.18614/dehm.1813966