Delayed Hypersensitivity Reaction to Restylane^®SubQ

Abstract

Hyaluronidase was effective at treating the inflammatory reaction and breaking up the retained Restylane(®) SubQ in all patients. Although Restylane(®) SubQ should be avoided in these patients, in our experience this does not preclude them from using other similar NASHA products.

Resistant and Recurrent Late Reaction to Hyaluronic Acid–Based Gel

“…1,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Before 1999, the reported rate of delayed reactions to HA fillers was 0.07%. The introduction of highly purified products decreased the incidence of such side effects to 0.02%, 1 which is now the accepted safety threshold for HA-based products.…”

Consensus statement on prevention and management of adverse effects following rejuvenation procedures with hyaluronic acid‐based fillers

“…Hyaluronidase is an enzyme that is able to rapidly counteract the effects of HA treatment within a few hours by breaking down HA molecules at the cross‐link points; however, significantly, it does not seem to have any effect on the body's own HA . Gentle massage increases the effect of the enzyme by ensuring sufficient dispersal.…”

“…Hyaluronic acid fillers are considered very safe, with most AEs being mild and temporary. 30 However, even if a patient has previously been treated with facial fillers without complications, it is vital to inform them that there is a rare but possible risk of an immunological reaction or a vascular accident after HA treatment. All patients should sign an informed consent document pretreatment and should be informed about all possible HA-specific complications.…”

“…Hyaluronidase is an enzyme that is able to rapidly counteract the effects of HA treatment within a few hours by breaking down HA molecules at the cross-link points; however, significantly, it does not seem to have any effect on the body's own HA. 30,32 Gentle massage increases the effect of the enzyme by ensuring sufficient dispersal. Hyaluronidase products are either of ovine, Special caution should be undertaken before injecting a patient with a known hypersensitivity to hymenoptera venom as these patients have a higher incidence of allergic reactions to hyaluronidase.…”

Relationship Between Delayed Reactions to Dermal Fillers and Biofilms

“…Concern with Type I reactions to bovine collagen dermal fillers resulted in patients undergoing intradermal collagen injections to ensure the patient was not sensitive. 1,[6][7][8] Antigenic stimulation tracing back to the contaminants from the bacterial fermentation method of producing HA is one source ascribed to delayed reactions. 5 Delayed reactions can take place weeks to months to years removed from the time of the initial injection, and there are a number of reports that describe events from 2 to 12 months after the injection of HA.…”