Late-Onset Inflammatory Response to Hyaluronic Acid Dermal Fillers

Tahera Bhojani-Lynch, MRCOphth, CertLRS, MBCAM, DipCS


Plast Reconstr Surg Glob Open. 2017;5(12):e1532 

In This Article

Case 3

A 54-year-old female Caucasian patient presented with a diffuse, reddish, painful swelling without lumps 4 months after receiving injections of 2.4 mL of Teosyal® Puresense Ultra Deep (Teoxane S.A., Geneva, Switzerland) in the cheeks, chin, and marionette lines and 1 mL of Belotero® Intense (Anteis S.A, Geneva, Switzerland; a wholly owned subsidiary of Merz Pharmaceuticals GmbH) in the lips on the same day Table 1. The injections were performed in the author's clinic. Teosyal® Puresense Ultra Deep was injected with the supplied needle and a 27G cannula supraperiosteally and in the deep dermis. Belotero® Intense was injected with the supplied needle by subdermal and submuscular retrograde linear thread technique. The products contained lidocaine, and no additional anesthetics were applied.

The patient's medical history included a 1 mL injection of Teosyal® Puresense Deep Lines to the nasolabial folds in the preceding year. No known allergies or history of autoimmune diseases were reported. A few days before the reaction onset, the patient had experienced a gastrointestinal upset.

The patient is a health care professional, so she was able to describe her reactions correctly over a phone consultation with the author. The patient was unaware of the injected filler brands, but unprompted, reported swelling in all treated areas, except for the lips. The photographs of her reactions were unfortunately lost over time. The patient administered oral antihistamines for 7 days and reported a gradual improvement. She refused intake of steroids and reported full resolution of her symptoms over a 2-week period.

Two months later, the patient experienced a second gastrointestinal upset, and subsequently the same facial areas flared up with red, tender swelling, but again the lips remained unaffected. The patient reported that the second episode was not as severe as the first one, and she self-administered antihistamines for 7 days with slow recovery of her symptoms.