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 5

A 46-year-old female Caucasian patient presented with an asymmetrical bilateral swelling on the outer lid-cheek margins 14 months after receiving a 1 mL injection of Teosyal® Puresense Global Action in the outer cheeks and lateral tear troughs, as well as 1 mL of the same filler in the labiomental triangles (Figure 3) Table 1. The injections were performed in the author's clinic with subdermal retrograde linear technique with needle and cannula. A supraperiosteal bolus was deposited around the cheeks and the lid-cheek junction with a needle. A deep dermal bolus was deposited in the labiomental triangles with a cannula. The filler contained lidocaine, and no additional anesthetics were applied. The reaction was seen only in the lateral tear trough/lid cheek margin area; the labiomental triangles were unaffected.

Figure 3.

Photographs of patient 5 (46 years old) taken at first presentation to the author after unsuccessful treatment with antihistamines (14 months after injection). A–C, immediate reaction onset. The larger swelling on the left lid-cheek margin, where the reaction is more pronounced due to a slightly larger injected volume, and the smaller swelling on the right.

The patient's previous medical history included 6 injections with Juvéderm® 18, Succeev® One (Sanofi Aventis, Paris, France) and Teosyal® Puresense Global Action administered over the previous 7 years (total volume = 4.8 mL). The patient reported a long-term history of hay fever and atopy, without mentioning any prior systemic illness.

At the reaction onset, the patient did not relate the symptoms to the filler, and thus first contacted her general practitioner. Upon prescription, the patient administered oral antihistamines for a week without improvement. Then the patient presented to the author and was treated with oral steroids (soluble Prednisolone®) for 5 days in reducing doses of 60, 40, 20, 10, and 5 mg leading to full resolution of the symptoms (Figure 4).

Figure 4.

Full resolution following steroid intake. A, B, Photographs of patient 5 at full resolution following steroid intake.