Background: The usage of dermal fillers has increased significantly in recent years. Soft tissue augmentation with fillers helps to diminish the facial lines and to restore volume and fullness in the face at a relatively low cost. With the increasing number of treatments, the number of complications is likely to increase as well. 

Methods: A total of 37 patients with complications were collected retrospectively during a period of 13 years using original data files. Information on the type, date, number and location of the injections, type and date of complications, treatment, bacteria, and pathology were registered. 

Results: The most commonly injected material in this series was Polyacrylamide (35.1 %) and Hyaluronic Acid (18.9 %). Most of the patients had filler injected in the lips (54.1 %), periorally (40.5 %), and in the cheek area (29.7 %). The median period between filler injection and complications was 2 years (range 1 day–8 years). The most common reported complications were edema (81 %), noduli (67.7 %), infections (54.1 %), discoloration (51.4 %), and granuloma formation (48.6 %). Surgical removal of the filler material was attempted in four patients. 

Conclusions: With the increased use of dermal fillers and the derived complications, there is a need to determine the optimal treatment for those patients, as a wrong treatment strategy can lead to scarring. This study suggests general recommendations for the referral and treatment of patients with more severe complications associated with dermal filler injection. Level of Evidence: Level IV, therapeutic study.