Augmentation

Scar Treatment

Compared to many other scar revision treatments, augmentation carriers 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
2% to 100%

Possible/Rare Side Effects

SHORT TERM Redness (erythema)
at injection site*
up to 12%
SHORT TERM Swelling at injection
site*†
1% to 11%
SHORT TERM Bruising at injection
site*
2% to 6.7%
SHORT TERM Acne after injection4.5%
SHORT TERM or LONG TERM Color (pigmentation) change at injection site4.5%
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 discolorationincidence not known
SHORT TERM Infectionincidence 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:   

Four 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 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 effectsNumber of patients and % of patients5
None14, 93.3%
Mild bruises1, 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 effectsNumber 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

References
  1. 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).
  2. 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]
  3. Wollina U, and Goldman A. Fillers for the improvement in acne scars. Clin Cosmet Investig Dermatol. 8, 493-9 (2015).
  4. Uptodate.com. Injectable soft tissue fillers: overview of clinical use. Available from: https://eresources.library.mssm.edu:3285/contents/injectable-soft-tissue-fillers-overview-of-clinical-use?source=search_result&search=fillers&selectedTitle=1~25#H3205537. Last retrieved on 18 July, 2017.
  5. 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).
  6. 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).
  7. 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).
  8. 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).