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. 2020 Apr 29;8(4):e2730.
doi: 10.1097/GOX.0000000000002730. eCollection 2020 Apr.

Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers

Wolfgang G Philipp-Dormston  1   2 , Greg J Goodman  3 , Koenraad De Boulle  4 , Arthur Swift  5 , Claudio Delorenzi  6 , Derek Jones  7 , Izolda Heydenrych  8   9 , Ada Trindade De Almeida  10 , Rami K Batniji  11
Affiliations

Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers

Wolfgang G Philipp-Dormston et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Delayed-onset adverse reactions to hyaluronic acid (HA) fillers are uncommon but have received increased attention, particularly with regard to late-onset nodules. Globally, there is a need for comprehensive prevention and management strategies.

Methods: Experts with clinical practices in diverse regions of the world and extensive experience in managing complications related to HA fillers convened to propose and evaluate approaches to prevent delayed-onset adverse reactions after HA filler administration and manage late-onset nodules.

Results: The expert panel agreed to define delayed-onset adverse reactions as those presenting more than 4 weeks posttreatment, with swelling, induration, and nodulation being the most common clinical signs. The panel recommended 5 general key approaches for the prevention of delayed-onset reactions (patient selection, anatomic location of injection/product selection, aseptic technique, injection procedure/filler, and posttreatment care). Strategies recommended for managing late-onset nodules included oral antibiotics, oral steroids, nonsteroidal anti-inflammatory drugs if needed, hyaluronidase for noninflammatory nodules (recognizing the limitations and regional availability of this treatment), intralesional antibiotics, intralesional immunosuppressive drugs such as steroids and fluorouracil, and surgical excision as a last resort. The panel noted that late-onset nodules may vary in both clinical presentation and etiology, making them challenging to address or prevent, and stressed individualized treatment based on clinical presentation. Regional differences in aseptic protocols, antibiotic selection, and steroid formulations were described.

Conclusion: Insights from global experts on approaches to prevent and manage delayed-onset adverse reactions following HA filler administration, including late-onset nodules, support clinicians worldwide in optimizing patient outcomes and safety.

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Conflict of interest statement

Disclosure: Writing and editorial assistance with manuscript preparation was provided to the authors by Regina Kelly, MA, of Peloton Advantage, LLC, an OPEN Health company, Parsippany, N.J., and was sponsored by Allergan plc, Dublin, Ireland. No honoraria or other forms of payment were made for authorship. Dr Batniji is a consultant, speaker, and advisory board member for Allergan plc. Dr Goodman is an advisory board member, clinical investigator, and consultant for Allergan plc; and is a speaker, advisory board member, and consultant for Galderma. Dr Jones is an investigator, consultant, and advisory board member for Allergan plc; and an investigator for Galderma. Dr Philipp-Dormston is an investigator, consultant, speaker, and advisory board member for Allergan plc and Galderma. Dr Heydenrych is an advisory board member and consultant for Allergan plc. Dr Delorenzi is an advisory board member and consultant for Allergan plc; and is a medical director for Allergan Canada and Merz Canada (complications management). Dr Trindade De Almeida is a speaker, advisory board member, and investigator for Allergan plc and Merz. Dr De Boulle is an advisory board member and consultant for Allergan plc and Laboratoires Genevrier. A. Swift is an advisory board member, speaker, and investigator for Allergan plc, Merz, and Galderma.

Figures

Fig. 1.
Fig. 1.
Global Hyaluronic Acid Filler Complications Working Group process.
Fig. 2.
Fig. 2.
Management of late-onset nodules after hyaluronic acid filler administration. *Hyaluronidase dose may vary based on the area treated; lower doses may be required for areas such as the tear trough, whereas higher doses may be necessary for the midface. BID, twice daily.
Fig. 3.
Fig. 3.
Broad-spectrum antibiotic treatment for late-onset nodules after hyaluronic acid filler administration. *Hyaluronidase dose may vary based on the area treated; lower doses may be required for areas such as the tear trough, whereas higher doses may be necessary for the midface. BID, twice daily.
Fig. 4.
Fig. 4.
Oral steroid treatment algorithm for late-onset nodules after hyaluronic acid filler administration. *Hyaluronidase dose may vary based on the area treated; lower doses may be required for areas such as the tear trough, whereas higher doses may be necessary for the midface.
Fig. 5.
Fig. 5.
Summary of global treatment strategies for late-onset nodules after hyaluronic acid filler administration. *Hyaluronidase dose may vary based on the area treated; lower doses may be required for areas such as the tear trough, whereas higher doses may be necessary for the midface.
See this image and copyright information in PMC

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