Compared to many other scar revision treatments, augmentation carries a relatively low risk of side effects. If side effects do occur, they are often mild and transient.4
The charts below show the chances of developing various side effects from augmentation. For some side effects, we currently do not have enough data to provide a percentage.
Certain/Likely Side Effects (% = Incidence)
SHORT TERM Mild to severe pain at injection site | up to 100% |
Possible/Rare Side Effects
SHORT TERM Redness (erythema) at injection site* | up to 12% |
SHORT TERM Swelling at injection site*† | up to 11% |
SHORT TERM Bruising at injection site* | up to 6.7% |
SHORT TERM Acne after injection | 4.5% |
SHORT TERM or LONG TERM Color (pigmentation) change at injection site | 4.5% |
SHORT TERM or LONG TERM Nodule at injection site‡ | 4.5% |
SHORT TERM Raised (hypertrophic) scarring‡ | incidence not known |
SHORT TERM Swelling of scar tissue inside skin (granuloma)‡ | incidence not known |
SHORT TERM or LONG TERM Swelling of clotted blood inside skin (hematoma) | incidence not known |
SHORT TERM Itching (pruritus) | incidence not known |
SHORT TERM or LONG TERM Skin discoloration | incidence not known |
SHORT TERM Infection | incidence not known |
SHORT TERM or LONG TERM Migration of filler§ | incidence not known |
SHORT TERM Increased skin sensitivity (hypersensitivity) | incidence not known |
*Redness, swelling, and bruising at the injection site: These side effects should disappear within 14 days of treatment.4
†Swelling: To reduce swelling after treatment, you can apply ice to the treated skin.4
‡Nodule, raised (hypertrophic) scar, and/or swelling of scar tissue (granuloma) at the injection site: These side effects are more likely with permanent fillers.
§CAUTION. Filler migration: In some cases, the filler may migrate from the intended location–in other words, it may move from the location of the scar to a different spot and create an unwanted bump in the skin. In the case of temporary and semi-permanent fillers, the body will eventually break the filler down and remove it from the skin. When it comes to permanent fillers, however, the filler will stay in the wrong location permanently.
ǁCAUTION. Silicone fillers: Because of safety concerns with silicone fillers, these types of fillers have not been tested in clinical studies with patients. Therefore, we do not have enough information on the side effects that silicone fillers may cause. Some research suggests that silicone fillers may carry an increased risk of nodules and swellings of scar tissue (granulomas). The FDA (Food and Drug Administration) has not approved silicone fillers for skin augmentation.2
Studies:
Seven studies have looked at the side effects of augmentation.
- Study 1:
- Authors: Karnik et al.4
- Total # of patients: 147
- # of female patients: 90
- # of male patients: 57
- Age of patients: Average: 44
- Filler type: PMMA-collagen
- Duration of treatment and follow-up: 1 or 2 injections, follow-up at 1, 3, and 6 months
- Side effects:
- Pain at injection site: 2%
- Bruising at injection site: 2%
- Swelling at injection site: 1%
- Acne at injection site: 1%
- Study 2:
- Authors: Nofal et al.5
- Total # of patients: 15
- # of female patients: (not reported)
- # of male patients: (not reported)
- Age of patients: Average: 25.1
- Filler type: Platelet-rich plasma (PRP)
- Duration of treatment and follow-up: 3 sessions, follow-up at 2 weeks
- Side effects:
- Mild bruising: 6.7%
- Mild pain: 40%
- Moderate to severe pain: 60%
- Study 3:
- Authors: Munavalli et al.6
- Total # of patients: 99
- # of female patients: 62
- # of male patients: 47
- Age of patients: Average: 42
- Filler type: Autologous fibroblast suspension (patient’s own cells that make collagen)
- Duration of treatment and follow-up: 4 sessions, follow-up at 4 months
- Side effects:
- Mild to moderate erythema (redness): 12%
- Mild to moderate swelling: 11%
- Study 4:
- Authors: Sapra et al.7
- Total # of patients: 22
- # of female patients: 13
- # of male patients: 9
- Age of patients: Average: 37.6
- Filler type: Poly-L lactic acid (PLLA)
- Duration of treatment and follow-up: 3-4 sessions, follow-up at 6 months
- Side effects:
- Non-visible nodule at injection site: 4.5%
- Acne: 4.5%
- Post-inflammatory pigmentation (color) change: 4.5%
- Study 5:
- Authors: Nilforoushzadeh et al.9
- Total # of patients: 9
- # of female patients: (not reported)
- # of male patients: (not reported)
- Age of patients: (not reported)
- Filler type: Autologous fat
- Duration of treatment and follow-up: 1 session, follow-up at 6 months
- Side effects:
- No side effects were reported.
- Study 6:
- Authors: Tenna et al.10
- Total # of patients: 30
- # of female patients: (not reported)
- # of male patients: (not reported)
- Age of patients: 18-50
- Filler type: Autologous fat with platelet-rich plasma (PPR)
- Duration of treatment and follow-up: 2 sessions, follow-up at 1, 3, and 6 months after the procedure
- Side effects:
- Mild pain during the procedure: incidence not reported
- Study 7:
- Authors: Shetty et al.11
- Total # of patients: 24
- # of female patients: (not reported)
- # of male patients: (not reported)
- Age of patients: (not reported)
- Filler type: Autologous fat
- Duration of treatment and follow-up: 1 session, follow-up for 3 months
- Side effects:
- Mild pain during the procedure: incidence not reported
- Erythema (redness): incidence not reported
Study 1: In a study published in 2014 in the Journal of the American Academy of Dermatology, Karnik and colleagues randomly assigned 147 patients with at least 4 moderate to severe rolling acne scars to receive either up to 2 PMMA-collagen injections or saline (salt water) injections. The patients were followed up at 1, 3, and 6 months. Side effects were rare and mild and most disappeared within 5 days. One patient developed acne at the injection site, which disappeared in 16 days.8
Study 2: In a study published in 2014 in Dermatologic Surgery, Nofal and colleagues treated 15 patients with augmentation with platelet-rich plasma (PRP) fillers. The patients received 3 sessions of treatment at 2-week intervals and were followed up 2 weeks after the final treatment. All patients reported experiencing pain during the procedure, but the pain was tolerable and required no treatment.5
Side effects | Number of patients and % of patients5 |
None | 14, 93.3% |
Mild bruises | 1, 6.7% |
Hyperpigmentation (skin darkening) | 0, 0% |
Erythema (redness) and edema (swelling) | 0, 0% |
Pain * Mild * Moderate * Severe | 6, 40% 3, 20% 6, 40% |
Study 3: In a study published in 2013 in Dermatologic Surgery, Munavalli and colleagues treated 99 patients with moderate to severe atrophic acne scars with augmentation on one side of the face. The patients received 4 sessions of injections with autologous fibroblast suspension (the patient’s own cells that make collagen) at 4-week intervals and were followed up 4 months after the last injection. The patients tolerated the treatment very well and experienced only mild to moderate side effects.6
Side effects | Number of patients and % of patients6 |
Erythema (redness) * Mild * Moderate | 7, 7% 5, 5% |
Swelling * Mild * Moderate | 6, 6% 5, 5% |
Study 4: In a study published in 2015 in Dermatologic Surgery, Sapra and colleagues treated 22 patients with atrophic acne scars with augmentation. Patients received 3-4 sessions of injection of Poly-L lactic acid (PLLA) at 4-week intervals and were followed up 6 months after the last treatment. No serious side effects were reported. 36.8% of patients experienced at least one temporary side effect.7
Study 5: In a study published in 2022 in Journal of Cosmetic Dermatology, Nilforoushzadeh and colleagues treated 9 patients with rolling atrophic acne scars with augmentation. Patients received an injection of autologous fat and were followed up 6 months after the treatment. No side effects were reported in this study.9
Study 6: In a study published in 2017 in Aesthetic Plastic Surgery journal, Tenna and colleagues treated 30 patients with atrophic acne scars with augmentation. Patients received 2 injections of autologous fat combined with PRP at 6-month intervals. Patients were followed up at 1, 3, and 6 months after the treatment. Patients experienced mild pain during the procedure, but no serious side effects were reported.10
Study 7: In a study published in 2021 in Journal of Cosmetic Dermatology, Shetty and colleagues treated 24 patients with atrophic acne scars with augmentation or PRP and compared the efficacy and safety of given treatments. Patients received an injection of autologous fat or went to 3 PRP treatments at 1-month intervals. Patients were followed for 3 months after the treatment. Most patients experienced mild pain and redness but no serious side effects were reported in the group treated with autologous fat.11
References
- Levy LL, and Zeichner JA. Management of acne scarring, part II. A comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 13(5), 331-340 (2012).
- Forbat E, Ali FR, and Al-Niaimi F. The role of fillers in the management of acne scars. Clin Exp Dermatol. Apr 10 (2017). [Epub ahead of print]
- Wollina U, and Goldman A. Fillers for the improvement in acne scars. Clin Cosmet Investig Dermatol. 8, 493-9 (2015).
- Almukhadeb E, Binkhonain F, Alkahtani A, Alhunaif S, Altukhaim F, Alekrish K. Dermal Fillers in the Treatment of Acne Scars: A Review. Ann Dermatol. 35(6), 400-7 (2023).
- Nofal E, Helmy A, Nofal A, Alakad R, and Nasr M. Platelet-rich plasma versus CROSS technique with 100% trichloroacetic acid versus combined skin needling and platelet rich plasma in the treatment of atrophic acne scars: a comparative study. Dermatol Surg. 40(8), 864-73 (2014).
- Munavalli GS, Smith S, Maslowski JM, and Weiss RA. Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial. Dermatol Surg. 39(8), 1226-36 (2013).
- Sapra S, Stewart JA, Mraud K, and Schupp R. A Canadian study of the use of poly-L-lactic acid dermal implant for the treatment of hill and valley acne scarring. Dermatol Surg. 41(5), 587-94 (2015).
- Karnik J, et al. A double-blind, randomized, multicenter, controlled trial of suspended polymethylmethacrylate microspheres for the correction of atrophic facial acne scars. J Am Acad Dermatol.71(1), 77-83 (2014).
- Nilforoushzadeh MA, Heidari-Kharaji M, Alavi S, Nouri M, Nikkhah N, Jahangiri F, Mahmoudbeyk M, Peyrovan A, Baiat Tork B, Torkamaniha E, Zare S. Transplantation of autologous fat, stromal vascular fraction (SVF) cell, and platelet-rich plasma (PRP) for cell therapy of atrophic acne scars: Clinical evaluation and biometric assessment. J Cosmet Dermatol. 21(5), 2089-98 (2022).
- Tenna S, Cogliandro A, Barone M, Panasiti V, Tirindelli M, Nobile C, Persichetti P. Comparative Study Using Autologous Fat Grafts Plus Platelet-Rich Plasma With or Without Fractional CO2 Laser Resurfacing in Treatment of Acne Scars: Analysis of Outcomes and Satisfaction With FACE-Q. Aesthetic Plast Surg. 41(3), 661-6 (2017).
- Shetty VH, Bhandary SN, Bhandary R, Suvarna C. A comparative study of efficacy and safety of autologous fat grafting versus Platelet-rich plasma in the treatment of post-acne scars. J Cosmet Dermatol. 20(11), 3454-61 (2021).