Severe Acute Local Reactions to a Hyaluronic Acid-derived Dermal Filler

Abstract

Injectable fillers are normally well tolerated by patients with little or no adverse effects. The most common side effects include swelling, redness, bruising, and pain at the injection site. This report describes three cases in which patients injected with a hyaluronic acid-derived injectable filler that is premixed with lidocaine developed adverse reactions including persistent swelling, pain, and nodule formation. Two of the three patients' abscesses were cultured for aerobic and anaerobic bacteria and mycobacterium. All three cultures were negative. Abscess persistence in all cases necessitated physical removal and/or enzymatic degradation with hyaluronidase. The effects subsided only after the product had been removed. Two of these patients were subsequently treated with other hyaluronic acid-derived dermal fillers without adverse events.

Figures 1

Graphic timeline of Case Report 1 showing medications, treatments, and procedures provided relative to the initial Elevess treatment.

Figure 2

Patient from Case Report 1 treated with Elevess. Photo taken 32 days after initial Elevess treatment.

Figure 3

Patient before Elevess treatment (left), after Elevess treatment to nasolabial and infraorbital areas (middle), and after treatment with hyaluronidase (right).

Figure 4

Adverse reaction to Elevess at treatment site including severe edema and recurring nodules.