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


Late-onset inflammatory response occurs at least 2 months after HA injection, and presents as diffuse, firm, red, nonfluctuant inflammation of all areas containing the dermal filler. Patients are otherwise systemically well. Very late presentation, over a year after the last injection, can occur in some cases, depending on the location of the injected product and the speed of degradation in that area. Such reactions may occur with any HA dermal filler, but their incidence may vary depending on the manufacturing technology.

Prompt identification and correct treatment allow successful resolution of inflammatory symptoms within a few days. In the absence of lumps, the reactions may settle over time without intervention, but will need oral steroids in most cases for rapid and sustained improvement, and to reduce the risk of recurrence. Treatment of persistent lumps additionally requires injection of hyaluronidase for optimal resolution. Patients should be correctly informed of all possible rare adverse reactions before treatment to avoid fear, disappointment, or litigation and to ensure that they seek prompt and correct medical intervention when necessary.