Adverse Events in Nonsurgical Facial Aesthetic Procedures: A Systematic Review and Meta-Analysis

Area of Science:

• Dermatology
• Aesthetic Medicine
• Evidence-Based Medicine

Background:

• Non-surgical aesthetic procedures are increasingly popular.
• Understanding treatment-related adverse events (TRAEs) is crucial for patient safety and informed consent.
• Botulinum toxin, hyaluronic acid fillers, and absorbable threads are common aesthetic treatments.

Purpose of the Study:

• To determine the prevalence and clinical profile of TRAEs associated with upper face botulinum toxin, lower face/nasolabial fold hyaluronic acid fillers, and nonsurgical facelifts with absorbable threads.
• To synthesize existing data on adverse events from these popular aesthetic procedures.

Main Methods:

• Systematic literature search across five electronic databases and gray literature.
• Proportion meta-analyses were conducted to estimate TRAE prevalence for each procedure type.
• Included 42 studies reporting on TRAEs in aesthetic treatments.

Main Results:

• Overall TRAEs reported in 34.8% of patients.
• Hyaluronic acid fillers showed the highest TRAE prevalence (63.0%), followed by absorbable threads (20.0%) and botulinum toxin (18.0%).
• Common TRAEs included swelling and pain for fillers; pain and bruising for threads; and headache for botulinum toxin. Hyaluronic acid fillers accounted for 67.3% of all reported TRAEs.

Conclusions:

• The prevalence of adverse events is low for botulinum toxin and thread lifts but high for hyaluronic acid fillers.
• Standardized reporting of all adverse events, including onset, recovery, severity, and provider details, is recommended for future studies.
• This meta-analysis highlights the need for careful patient selection and counseling regarding risks associated with hyaluronic acid fillers.