Pulmonary Disorders After Injections of Hyaluronic Acid Fillers

Abstract

Hyaluronic acid is chemically a repeating glycosaminoglycan (disaccharide of D- glucuronic acid and N-acetyl-D-glucosamine), the presence of which has been established in many human organs and tissues. In vivo, this disaccharide is produced by epithelial cells of the synovial membranes of joints. The highest level of hyaluronic acid is found in the skin. Due to their high biological compatibility, hyaluronic acid preparations are used as injectable dermal fillers in cosmetology. Hyaluronic acid is believed to promote accelerated wound healing after facial plastic surgery. In recent years, fillers based on hyaluronic acid have been used for surgical interventions on the genitals. There are separate publications on the adverse outcomes of such operations related to non-compliance with standard operating procedures, protocols of operations, and the participation of unqualified personnel. The purpose of our study is to describe the signs of complications that occurred after injections of hyaluronic acid fillers. In this paper, we have summarized the available publications on such outcomes and our own case of forensic establishment of a fatal pulmonary embolism that occurred after injections with hyaluronic acid preparations of a man's penis. The studied materials are combined into one table. A comparative analysis of these observations indicates that after injections of fillers based on hyaluronic acid, in particular in the genital area, there is a risk of developing pulmonary disorders, up to the onset of a fatal outcome.