Complications of regenerative therapeutics in facial plastic surgery: a case series and review of the literature

Aesthetic facial plastic surgery is at the forefront of technical innovation, and novel regenerative medicine modalities are significant contributors to the evolution of the field. Some methods of regenerative medicine have been well studied, and the risks and benefits of these techniques are adequately established. However, the novelty of some therapeutic modalities, while exciting, may lead to rapid implementation into practice with which regulation cannot keep pace. Furthermore, research dedicated to understanding the risks and complications of novel treatments is often underrepresented in the literature. While outcomes tend to be positive, understanding the risk profiles of different regenerative medicine modalities is critical to patient safety. A PubMed literature search yielded 19 studies discussing complications of regenerative therapeutics in facial plastic surgery and aesthetics. Discussed therapies included platelet-rich plasma (PRP), fat and nanofat grafting, and exosomes with complications ranging from stroke and blindness to mild local reactions like bruising and edema. We additionally collected 6 cases of complications from our institution which we highlight as additional examples of adverse effects of different therapies in our practice. Between cases evaluated from the literature and those of our own institution, complications of PRP include lymphadenopathy, blindness, and immune reaction. Complication of fat and nanofat grafting include blindness, cerebrovascular event, bruising, and edema. Complications of exosome therapy include cutaneous nodule formation, granuloma formation, skin necrosis, and scarring. In the current literature review and internal chart review, we found that complications from these procedures range in severity, from transient cutaneous events to lethal cerebrovascular accidents, demonstrating the importance of understanding therapeutic mechanisms and potential side effects and their management when offering novel interventions to patients.