FACIAL OVERFILLED SYNDROME: A REVIEW OF PATHOGENESIS, CLINICAL PRESENTATION AND MANAGEMENT
Abstract
Facial overfilled syndrome is becoming an increasingly common complication in the field of aesthetic medicine. It may result from repeated and excessive filler injections, the use of improperly selected products, or their placement in inappropriate areas of the face. Although fillers are generally considered safe, their use can lead to a variety of complications. To prevent and manage potential issues, it is crucial that practitioners performing these procedures fully understand the extent and types of adverse events that may occur. This article provides a review of current literature on the concept of facial overfilled, including its pathogenesis, clinical presentation, and treatment options.
Objective: To review selected articles, literature and recent reports on the pathogenesis, clinical presentation and treatment of facial overfilled syndrome (FOS).
Material and Methods: A literature review from PubMed and Google Scholar.
References
Tingsong Lim, Facial Overfilled Syndrome, Dermatologic Clinics, 2024 Jan;42(1):121-128. doi: 10.1016/j.det.2023.06.007
Henryk Witmanowski, Katarzyna Błochowiak, Another face of dermal fillers, Advances in Dermatology and Allergology, 2020 Oct;37(5):651-659. doi: 10.5114/ada.2019.82859.Epub 2019 Feb 11
Schelke L, Harris S, Cartier H, et al.Treating facial overfilled syndrome with impaired facial expression—Presenting clinical experience with ultrasound imaging. J Cosmet Dermatol.2023;22:3252-3260. doi:10.1111/jocd.16013
Hong, Gi-Woong, Hyewon Hu, Kathleen Chang, Youngjin Park, Kar Wai Alvin Lee, Lisa Kwin Wah Chan, and Kyu-Ho Yi. 2024. "Review of the Adverse Effects Associated with Dermal Filler Treatments: Part I Nodules, Granuloma, and Migration" Diagnostics 14, no. 15: 1640. https://doi.org/10.3390/diagnostics1415164
Woodward J, Khan T, Martin J. Facial filler complications. Facial Plast Surg Clin North Am. 2015;23(4):447–458. doi:10.1016/j.fsc.2015.07.006
Lim TS, Wanitphakdeedecha R, Yi KH. Exploring facial overfilled syndrome from the perspective of anatomy and the mismatched delivery of fillers. J Cosmet Dermatol. 1964-1968, 2024. https://doi.org/10.1111/jocd.16244
Cotofana, S., Gotkin, R. H., Frank, K., Lachman, N., & Schenck, T. L. (2019). Anatomy Behind the Facial Overfilled Syndrome. Dermatologic Surgery, 1. doi: 10.1097/DSS.0000000000002236
Lim TS. Facial overfilled syndrome complications of inappropriate filler delivery. PRIME J. 2018. Available from: https://www.prime-journal. com/facial-overfilled-syndrome-complications-of-inappropriate-filler- delivery/. Accessed April 9, 2019.
Urdiales-Gálvez F, Delgado NE, Figueiredo V. et al. Treatment of soft tissue filler complications: expert consensus recommendations. Aesthetic Plast Surg 2018; 42 (02) 498-510 https://doi.org/10.1007/s00266-017-1063-0
Cavallini, M., Gazzola, R., Metalla, M., & Vaienti, L. (2013). The Role of Hyaluronidase in the Treatment of Complications From Hyaluronic Acid Dermal Fillers. Aesthetic Surgery Journal, 33(8), 1167–1174.doi:10.1177/1090820x13511970
Hong G-W, Yi K-H. Skin & SMAS layer remodeling technique (SSRT): Achieving both volume and lifting effects with filler treatments. Skin Res Technol2024;30:e13809. https://doi.org/10.1111/srt.13809
Kroumpouzos G, Treacy P. Hyaluronidase for dermal filler complications: review of applications and dosage recommendations. JMIR Dermatol. 2024;7: e50403. doi:10.2196/50403
Tal, S., Maresky, H.S., Bryan, T. et al. MRI in detecting facial cosmetic injectable fillers. Head Face Med 12, 27 (2016). https://doi.org/10.1186/s13005-016-0124-y
Clark NW, Pan DR, Barrett DM. Facial fillers: relevant anatomy, injection techniques, and complications. World J Otorhinolaryngol Head Neck Surg 2023;9:227-235. doi:10.1002/wjo2.126
Trinh, L. N., & Gupta, A. (2021). Hyaluronic Acid Fillers for Midface Augmentation: A Systematic Review. Facial Plastic Surgery. doi:10.1055/s-0041-1724122
Chiang, Y. Z., Pierone, G., & Al-Niaimi, F. (2016). Dermal fillers: pathophysiology, prevention and treatment of complications. Journal of the European Academy of Dermatology and Venereology, 31(3), 405–413.doi:10.1111/jdv.13977
Signorini, M., Liew, S., Sundaram, H., De Boulle, K. L., Goodman, G. J., Monheit, G., Vieira Braz, A. (2016). Global Aesthetics Consensus. Plastic and Reconstructive Surgery,137(6),961e–971e.doi:10.1097/prs.0000000000002184
SCLAFANI, A. P., & FAGIEN, S. (2009). Treatment of Injectable Soft Tissue Filler Complications. Dermatologic Surgery, 35, 1672–1680.doi:10.1111/j.1524-4725.2009.01346.x
Harrar, H., Myers, S. & Ghanem, A. Art or Science? An Evidence-Based Approach to Human Facial Beauty a Quantitative Analysis Towards an Informed Clinical Aesthetic Practice.Aesth Plast Surg 42, 137–146 (2018). https://doi.org/10.1007/s00266-017-1032-7
Abatangelo, G., Vindigni, V., Avruscio, G., Pandis, L., & Brun, P. (2020). Hyaluronic Acid: Redefining Its Role. Cells, 9(7), 1743. doi:10.3390/cells9071743
Kroumpouzos G, Treacy P. Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations. JMIR Dermatol. 2024 Jan 17;7:e50403. doi: 10.2196/50403. PMID: 38231537; PMCID: PMC10836581
Quach B, Clevens RA. Complications of Injectables. Atlas Oral Maxillofac Surg Clin North Am. 2024 Mar;32(1):57-63. doi: 10.1016/j.cxom.2023.10.005. Epub 2023 Nov 24. PMID: 38307636.
Farollch-Prats L, Braz A, Urdiales-Gálvez F, de la Guardia C, Nazari A. Profiloplasty and facial contouring with injectables: A holistic, practical, and user-friendly approach. J Cosmet Dermatol. 2024 Oct;23(10):3158-3172. doi: 10.1111/jocd.16375. Epub 2024 May 20. PMID: 38769652.
Ho WWS. Achieving the Attractive Asian Midface Profile with Hyaluronic Acid-Based Fillers. Dermatol Clin. 2024 Jan;42(1):113-120. doi: 10.1016/j.det.2023.06.013. Epub 2023 Aug 1. PMID: 37977677.
Tolker-Nielsen T. Biofilm Development. Microbiol Spectr. 2015 Apr;3(2):MB-0001-2014. doi: 10.1128/microbiolspec.MB-0001-2014. PMID: 26104692.
de la Guardia C, Virno A, Musumeci M, Bernardin A, Silberberg MB. Rheologic and Physicochemical Characteristics of Hyaluronic Acid Fillers: Overview and Relationship to Product Performance. Facial Plast Surg. 2022 Apr;38(2):116-123. doi: 10.1055/s-0041-1741560. Epub 2022 Feb 3. PMID: 35114708; PMCID: PMC9188840.
Urdiales-Gálvez F, Delgado NE, Figueiredo V, Lajo-Plaza JV, Mira M, Ortíz-Martí F, Del Rio-Reyes R, Romero-Álvarez N, Del Cueto SR, Segurado MA, Rebenaque CV. Preventing the Complications Associated with the Use of Dermal Fillers in Facial Aesthetic Procedures: An Expert Group Consensus Report. Aesthetic Plast Surg. 2017 Jun;41(3):667-677. doi: 10.1007/s00266-017-0798-y. Epub 2017 Apr 14. PMID: 28411354; PMCID: PMC5440530.
Choi SY, Ko EJ, Kim BJ, Song KY, Kim WS. Lump on the lower eyelid due to hyaluronic acid filler. Clin Exp Dermatol. 2016 Jan;41(1):94-5. doi: 10.1111/ced.12653. Epub 2015 Mar 26. PMID: 25808639.
Casabona G, Marchese PB, Montes JR, Hornfeldt CS. Durability, Behavior, and Tolerability of 5 Hyaluronidase Products. Dermatol Surg. 2018 Nov;44 Suppl 1:S42-S50. doi: 10.1097/DSS.0000000000001562. PMID: 29894436.
Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. J Plast Reconstr Aesthet Surg. 2023 Sep;84:656-669. doi: 10.1016/j.bjps.2023.01.048. Epub 2023 Mar 7. PMID: 37002059
Views:
36
Downloads:
39
Copyright (c) 2025 Katarzyna Skibicka, Joanna Kryślak, Szymon Szabelski, Adam Solarz, Estera Graczyk, Maciej Sokołowski, Karolina Oskroba, Jakub Filip Turcza
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
