Granulomatous reaction to hyaluronic acid dermal filler: clinical and histological features

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Vittorio Agosti
Giorgia Stefanini


Granuloma, filler, hyaluronic acid, histology, reaction


The use of Dermal filler is greatly increased in the past years, indeed now it is one of the most frequent non-surgical cosmetic procedures performed all over the world. Because of its safety profile,  hyaluronic acid is the most used injection substance. Although the use of hyaluronic acid in aesthetic medicine is safe, as any other medical procedure it has its own risk to develop complications and adverse effects. The aim of this article it’s to focus on one of them, the granulomatous foreign body reaction. In this mini-review are summarized clinical and histological features of granulomatous foreign body reaction in hyaluronic acid filler.

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1. Ballin AC, Brandt FS, Cazzaniga A. Dermal Fillers: an update. Am J Clin Dermatol. 2015; 16(4):271-283.
2. FDA summary of safety and effectiveness data (SSED) of Restylane Contour. Accessed October 5, 2023.
3. The American Board of Plastic Surgery. Plastic Surgery Statistics Report 2019 - Cosmetics Procedures.; 2020.
4. Kablik J, Monheit GD, Yu LP, Chang G, Gershkovich J. Comparative physical properties of hyaluronic acid dermal fillers. Dermatol Surg. 2009; 35 Suppl 1:302-312.
5. Lemperle G, Morhenn V, Charrier U. Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesthetic Plast Surg. 2003; 27(5):354-366.
6. Murray G, Convery C, Walker L, Davies E. Guideline for the Safe Use of Hyaluronidase in Aesthetic Medicine, Including Modified High-dose Protocol. J Clin Aesthet Dermatol. 2021; 14(8):E69-E75.
7. Witmanowski H, Błochowiak K. Another face of dermal fillers. Advances in Dermatology and Allergology/Postępy Dermatol Alergol. 2019; 37(5):651-659.
8. Chiang YZ, Pierone G, Al-Niaimi F. Dermal fillers: pathophysiology, prevention and treatment of complications. J Eur Acad Dermatol Venereol. 2017; 31(3):405-413.
9. Rohrich RJ, Nguyen AT, Kenkel JM. Lexicon for soft tissue implants. Dermatol Surg. 2009; 35 Suppl 2:1605-1611.
10. Urdiales-Gálvez F, Delgado NE, Figueiredo V, et al. Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations. Aesthetic Plast Surg. 2018; 42(2):498-510.
11. Czumbel LM, Farkasdi S, Gede N, et al. Hyaluronic Acid Is an Effective Dermal Filler for Lip Augmentation: A Meta-Analysis. Front Surg. 2021; 8:681028.
12. Munavalli GG, Guthridge R, Knutsen-Larson S, Brodsky A, Matthew E, Landau M. “COVID-19/SARS-CoV-2 virus spike protein-related delayed inflammatory reaction to hyaluronic acid dermal fillers: a challenging clinical conundrum in diagnosis and treatment”. Arch Dermatol Res. 2022; 314(1):1-15.
13. Pagán AJ, Ramakrishnan L. The Formation and Function of Granulomas. Annu Rev Immunol. 2018; 36:639-665.
14. Adams DO. The granulomatous inflammatory response: A review. Am J Pathol. 1976; 84(1):164-191.
15. Snozzi P, Van Loghem JAJ. Complication Management following Rejuvenation Procedures with Hyaluronic Acid Fillers—an Algorithm-based Approach. Plast Reconstr Surg Glob Open. 2018; 6(12):e2061.
16. Fischer J, Metzler G, Schaller M. Cosmetic permanent fillers for soft tissue augmentation: a new contraindication for interferon therapies. Arch Dermatol. 2007; 143(4):507-10.
17. Kassir M, Gupta M, Galadari H, et al. Complications of botulinum toxin and fillers: A narrative review. J Cosmet Dermatol. 2020; 19(3):570-573.