Late-Onset Inflammatory Response to Hyaluronic Acid Dermal Fillers

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

Disclosures

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

In This Article

Case 4

A 46-year-old female Caucasian patient presented with a diffuse swelling with hard lumps on the forehead and a diffuse swelling of the labiomental corners 5 months after receiving a 1 mL injections of Teosyal® Deep Lines in the glabellar area and corners of the mouth (Figure 1) Table 1. The injection was performed in a different clinic, to subdermal/deep dermis with a retrograde linear thread technique. The filler was lidocaine-free.

Figure 1.

Photographs of patient 4 (46 years old) taken at first presentation to the author after unsuccessful treatment with antihistamines (5 months after injection). A–D, immediate reaction onset; A, B, diffuse swelling with hard lumps on the forehead; C, D, diffuse swelling on the labiomental corners.

This was the patient's first experience with HA injections. No known allergies were reported. During the week before the reaction onset, the patient had been abroad on holiday, where she had been systemically unwell and had suffered a gastrointestinal upset.

Before being referred to the author, the patient had taken oral antihistamines for 2 days without improvement. The author treated the affected areas with an injection of hyaluronidase (Hyalase®, Wockhardt UK Ltd.) 1,500 units in 1 mL, and the patient was given oral steroids (soluble Prednisolone®) for 5 days in reducing doses of 60, 40, 20, 10, and 5 mg. The erythema and swelling resolved, but a small palpable lump remained in the glabellar area, despite the overall improvement (Figure 2). Three weeks following the first hyaluronidase administration, the patient was reviewed, and a further injection of Hyalase 1,500 units dissolved in 4 mL was injected into the residual glabellar lump. The patient subsequently called to report full resolution of her symptoms.

Figure 2.

Full resolution at labiomental corners and improvement in the glabellar area following treatment with steroids and the first dose of hyaluronidase. A-D, Photographs of patient 4 taken at full resolution at labiomental corners and improvement in the glabellar area following treatment with steroids and the first dose of hyaluronidase.

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