Sir, we read with interest the recent letter regarding dermal filler complications presenting to emergency departments.1

Another filler complication, as a consequence of infection/abscess formation subsequent to filler injections and a post-injection inflammatory response, is that of collection and cavity formation under pressure, skin thinning and even necrosis of the skin. These were complications witnessed in a patient of ours last year during the COVID-19 pandemic. This prompted extensive investigation for any underlying immunosuppression; eg diabetes, blood-borne virus, use of steroids, COVID-19 testing, culture of organisms drained and a referral for consideration regarding excision/reconstruction of the affected area which was at least 4 cm in diameter involving the left external cheek. Fortunately, this was not a through and through defect into the oral cavity. This complication has been reported previously and has been subject to a literature review.2

We hope this experience further alerts colleagues within maxillofacial units to the potential complications associated with dermal fillers.