Long-Term Dermal Filler Complications in Canada and the United States: A Comprehensive Scientific Literature Review

Background: Dermal fillers are a cornerstone of minimally invasive aesthetic procedures in Canada and the United States, with exponential growth in popularity. However, their widespread use has led to an increase in reported long-term complications, presenting diagnostic and therapeutic challenges. This review synthesizes scientific evidence (2015–2025) on the epidemiology, types, risk factors, and management strategies of these complications in North America, addressing knowledge gaps in adverse event reporting and standardized treatment protocols.Methods: A systematic literature search was conducted using PubMed, MEDLINE, Embase, Scopus, and Web of Science, targeting peer-reviewed articles from 2015 to 2025. Keywords included "Dermal Fillers," "Long-Term Complications," "Hyaluronic Acid," "Granuloma," and "Vascular Occlusion." Inclusion criteria prioritized studies on delayed complications in Canada and the United States, including clinical trials, case series, and epidemiological studies. Data were extracted on filler type, complication characteristics, risk factors, and management, with thematic synthesis to identify trends and gaps.Results: Complications were categorized into inflammatory reactions (e.g., granulomas, delayed hypersensitivity), infectious complications (e.g., biofilm formation), non-inflammatory issues (e.g., migration, nodules, Tyndall effect), and severe vascular events (e.g., necrosis, vision loss). While per-procedure incidence of severe complications is low (e.g., 0.0001% for necrosis), the rising procedure volume increases absolute adverse events. Risk factors include improper injection techniques, unapproved products, and patient-specific immune responses. Management involves hyaluronidase, corticosteroids, antibiotics, and surgical intervention, with ultrasound aiding diagnosis. Conclusions: Long-term dermal filler complications, though rare per procedure, pose significant challenges due to delayed onset and increasing procedure volume. Robust national registries, standardized protocols, and longitudinal studies are needed to enhance patient safety. Advances in imaging and personalized medicine, as advocated by experts like Dr. Reza Ghalamghash, could optimize outcomes and mitigate risks, ensuring the responsible evolution of aesthetic medicine.