Abstract：
As the use of injectable skin fillers increase in popularity, an increase in the reported adverse events is expected.
This systematic review supports the development of American Society for Dermatologic Surgery practice guideline on the management of adverse events of skin fillers.
Several databases for studies on risk factors or treatments of injection-related visual compromise (IRVC), skin necrosis, inflammatory events, and nodules were searched. Meta-analysis was conducted when feasible.
The review included 182 studies. However, IRVC was very rare (1-2/1,000,000 patients) but had poor prognosis with improvement in 19% of cases. Skin necrosis was more common (approximately 5/1,000) with better prognosis (up to 77% of cases showing improvement). Treatments of IRVC and skin necrosis primarily depend on hyaluronidase injections. Risk of skin necrosis, inflammatory events, and nodules may be lower with certain fillers, brands, injection techniques, and volume. Treatment of inflammatory events and nodules with antibiotics, corticosteroids, 5-FU, and hyaluronidase was associated with high response rate (75%-80%). Most of the studies were small and noncomparative, making the evidence certainty very low.
Practitioners must have adequate knowledge of anatomy, elicit history of skin filler use, and establish preemptive protocols that prepare the clinical practice to manage complications.
This systematic review supports the development of American Society for Dermatologic Surgery practice guideline on the management of adverse events of skin fillers.
Several databases for studies on risk factors or treatments of injection-related visual compromise (IRVC), skin necrosis, inflammatory events, and nodules were searched. Meta-analysis was conducted when feasible.
The review included 182 studies. However, IRVC was very rare (1-2/1,000,000 patients) but had poor prognosis with improvement in 19% of cases. Skin necrosis was more common (approximately 5/1,000) with better prognosis (up to 77% of cases showing improvement). Treatments of IRVC and skin necrosis primarily depend on hyaluronidase injections. Risk of skin necrosis, inflammatory events, and nodules may be lower with certain fillers, brands, injection techniques, and volume. Treatment of inflammatory events and nodules with antibiotics, corticosteroids, 5-FU, and hyaluronidase was associated with high response rate (75%-80%). Most of the studies were small and noncomparative, making the evidence certainty very low.
Practitioners must have adequate knowledge of anatomy, elicit history of skin filler use, and establish preemptive protocols that prepare the clinical practice to manage complications.
摘要：
随着可注射皮肤填充剂的使用日益普及，预计报告的不良事件会增加.
本系统综述支持美国皮肤外科学会关于皮肤填充物不良事件管理的实践指南的制定。
几个数据库，用于研究注射相关视力损害（IRVC）的危险因素或治疗，皮肤坏死,炎症事件，并搜索了结节。可行时进行Meta分析。
该综述包括182项研究。然而,IRVC非常罕见（1-2/1,000,000患者），但预后较差，有19％的病例有所改善。皮肤坏死更常见（约5/1,000），预后更好（高达77％的病例显示改善）。IRVC和皮肤坏死的治疗主要取决于透明质酸酶注射。皮肤坏死的风险，炎症事件，某些填充物的结核可能会更低，品牌,注射技术,和音量。用抗生素治疗炎症事件和结节，皮质类固醇,5-FU,透明质酸酶与高反应率（75％-80％）相关。大多数研究都是小规模的，非比较性的，使证据的确定性非常低。
从业者必须有足够的解剖学知识，引出皮肤填充物使用的历史，并建立先发制人的方案，为管理并发症的临床实践做好准备。
本系统综述支持美国皮肤外科学会关于皮肤填充物不良事件管理的实践指南的制定。
几个数据库，用于研究注射相关视力损害（IRVC）的危险因素或治疗，皮肤坏死,炎症事件，并搜索了结节。可行时进行Meta分析。
该综述包括182项研究。然而,IRVC非常罕见（1-2/1,000,000患者），但预后较差，有19％的病例有所改善。皮肤坏死更常见（约5/1,000），预后更好（高达77％的病例显示改善）。IRVC和皮肤坏死的治疗主要取决于透明质酸酶注射。皮肤坏死的风险，炎症事件，某些填充物的结核可能会更低，品牌,注射技术,和音量。用抗生素治疗炎症事件和结节，皮质类固醇,5-FU,透明质酸酶与高反应率（75％-80％）相关。大多数研究都是小规模的，非比较性的，使证据的确定性非常低。
从业者必须有足够的解剖学知识，引出皮肤填充物使用的历史，并建立先发制人的方案，为管理并发症的临床实践做好准备。
