Case report and literature review of late inflammatory reactions to hyaluronic acid filler in a 28-year-old female
Main Article Content
Keywords
Hyaluronic acid, dermal filler, filler complication, adverse events, delayed onset reactions, delayed onset nodule
Abstract
Aesthetic procedures with hyaluronic acid (HA) dermal fillers have been rated the second most popular nonsurgical procedure. Although considered as low risked procedures, they can cause significant adverse events. Delayed inflammatory reactions have been a serious problem, characterized by swelling and areas of induration presenting at least 2 weeks after the filler injection. Late-onset nodules had an incidence of less than 1.0 % and may arise from a number of factors, including hypersensitivity, foreign body reaction, injection placement, infection, sterile abscess, or biofilm development. The patient was a 28-year-old female who underwent cheek HA filler and develop delayed onset inflammatory reaction 1.5 months later, presenting purplish nodule on her right cheek. The nodule measured 1 x 1 x 0.5 cm. Ultrasonography and biopsy were not performed due to the patient’s desire to have minimally invasive resolutions to their symptoms as quickly as possible. Strategies recommended for managing delayed onset inflammatory reactions require combination therapy. In this patient, symptoms resolved in 3 weeks after being treated with intralesional hyaluronidase and triamcinolone. To the author knowledge, this is the first case being reported in Indonesia.
References
1. Funt DK. Treatment of Delayed-onset Inflammatory Reactions to Hyaluronic Acid Filler: An Algorithmic Approach Special Topic. Plast Reconstr Surg Glob Open 2022;10:e4362.
2. Alawami AZ, Tannous Z. Late Onset Hypersensitivity Reaction to Hyaluronic Acid Dermal Fillers Manifesting as Cutaneous and Visceral Angioedema. J Cosmet Dermatol. 2020;00:1–3.
3. Chung KL, Convery C, Ejikeme I, Ghanem AM. A Systematic Review of the Literature of Delayed Inflammatory Reactions After Hyaluronic Acid Filler Injection to Estimate the Incidence of Delayed Type Hypersensitivity Reaction. Aesthetic Surgery Journal 2020;40(5):NP286–NP300.
4. Owczarczyk-Saczonek A, Zdanowska N, Wygonowska E, Placek W. The Immunogenicity of Hyaluronic Fillers and Its Consequences. Clinical, Cosmetic and Investigational Dermatology 2021;14:921-934.
5. Lee W, Shah-Desai S, Rho N-K, Cho J. Etiology of Delayed Inflammatory Reaction Induced by Hyaluronic Acid Filler. Archives of Plastic Surgery 2023.
6. Bhojani-Lynch T. Late-Onset Inflammatory Response to Hyaluronic Acid Dermal Fillers. Plast Reconstr Surg Glob Open 2017;5:e1532.
7. Cohen JL, Hicks J, Nogueira A, Lane V, Andriopoulos B. Postmarket Safety Surveillance of Delayed Complications for Recent FDA-Approved Hyaluronic Acid Dermal Fillers. Dermatol Surg. 2022;Feb;48(2):220-224.
8. Convery C, Davies E, Murray G, Walker L. Delayed-onset Nodules (DONs) and Considering Their Treatment Following Use of Hyaluronic Acid (HA) Fillers. J Clin Aesthet Dermatol. 2021;14(7):E59–E67.
9. Rowland-Warmann MJ. Hypersensitivity Reaction to Hyaluronic Acid Dermal Filler Following Novel Coronavirus Infection –a Case Report. J Cosmet Dermatol. 2021;20:1557–1562.
10. Artzi O, Loizides C, Verner I, Landau M. Resistant and Recurrent Late Reaction to Hyaluronic Acid–Based Gel. Dermatol Surg 2016;42:31–37.
11. Mikkilineni R, Wipf A, Farah R, Sadick N. New Classification Schemata of Hypersensitivity Adverse Effects after Hyaluronic Acid Injections: Pathophysiology, Treatment Algorithm, and Prevention. Dermatol Surg 2020;46:1404–1409.
12. Koh IS, Lee W, in: Filler-Induced Hypersensitivity Inflammation and Granuloma. Springer Nature, Singapore;2019,pp.41-51.
13. Tomescu R, Nasturica I, Grigorescu A, Dodan G, Leventer M. Delayed Complications during Aesthetic Procedures after Injection of Hyaluronic Acid Dermal Filler and Their Management. DermatoVenerol. (Buc.), 2020;65(3):19-30.
14. Philipp-Dormston WG, Goodman GJ, Bouelle KD, et al. Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers. Plast Reconstr Surg Glob Open 2020;8:e2730.
15. Rivers JK. Incidence and Treatment of Delayed-onset Nodules after VYC Filler Injections to 2139 Patients at a Single Canadian Clinic. J Cosmet Dermatol. 2022;21:2379–2386.
16. Ibrahim O, Overman J, Arndt KA, Dover JS. Filler Nodules: Inflammatory or Infectious? a Review of Biofilms and Their Implications on Clinical Practice. Dermatol Surg. 2018;44(1):53-60.
17. Grass J, Majenka P, Sedlaczek OL, Toberer F, Lonsdorf AS. Granulomatous Reaction to Cosmetic Soft Tissue Filler with Late-onset Inflammatory Response. Acta Derm Venereol 2020;100.
18. Artzi O, Cohen JL, Dover JS, et al. Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: a Literature Review and Proposed Treatment Algorithm. Clinical, Cosmetic and Investigational Dermatology 2020;13:371-378.
19. Goodman GJ, McDonald CB, Lim A, et al. Making Sense of Late Tissue Nodules Associated with Hyaluronic Acid Injections. Aesthet Surg J. 2023;43(6):NP438-NP448.