Resistant and Recurrent Late Reaction to Hyaluronic Acid–Based Gel

Artzi, Ofir; Loizides, Christoforos; Verner, Ines; Landau, Marina

doi:10.1097/dss.0000000000000562

Cited by 89 publications

(102 citation statements)

References 27 publications

(28 reference statements)

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“…The main deficiency was that some of the studies did not report those kinds of AEs although they are expected with filler injections . Only one study describes (in 4.25% of patients) prolonged (up to 11 months) and recurrent (average: 3.17 episodes) late (average onset: 8.41 weeks after injection) inflammatory cutaneous reactions, but the incidence might vary between different products. The authors also believe that the prevalence of such reactions is higher and influenced by several parameters including the number and volume of HA‐based gel injections, the nature of the product injected as well as possible individual factors …”

Section: Resultsmentioning

confidence: 99%

Effectiveness and safety of hyaluronic acid fillers used to enhance overall lip fullness: A systematic review of clinical studies

Stojanovič

Majdič

2019

J of Cosmetic Dermatology

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Background:The majority of aesthetic treatments today are nonsurgical or minimally invasive aesthetic procedures. Soft-tissue augmentation with hyaluronic acid (HA) is one of them. Lip fullness and definition are key aesthetic factors associated with attractiveness, which is the reason that lip augmentation with HA fillers has become so popular.Objective: To provide a systematic review of published medical literature on the effectiveness and safety of different HA fillers used to enhance overall lip fullness. Methods and materials:The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-two studies were included in the qualitative synthesis, 9 of them with level of evidence (LOE) 1b (randomized controlled trials), 1 with LOE 2b (individual cohort study), and 12 with LOE 4 (case series, poor-quality cohort, and case-control studies). A total number of subjects included in all studies were 3965. Results:Hyaluronic acid fillers turned out to be an effective and safe treatment. The assessment methods (especially for efficacy) varied greatly from one study to another. Observed responses to the treatment in studies using different lip fullness scales varied between 71% and 93.2%. The most common adverse events were local reactions at the injection sites (swelling, contusion, bruising, pain, redness, and itching). Conclusion:Based on the results of the studies included in this systematic review, HA fillers are effective and safe to use. The majority of included subjects were satisfied with the result and their looks. K E Y W O R D S efficacy, filler, hyaluronic acid, lips, safety

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Section: Resultsmentioning

confidence: 99%

Effectiveness and safety of hyaluronic acid fillers used to enhance overall lip fullness: A systematic review of clinical studies

Stojanovič

Majdič

2019

J of Cosmetic Dermatology

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“…Although severe adverse events may occur with any HA filler, the rates seem to vary among different products. 22 The fillers cited in this report are characterized as nonimmunogenic, biocompatible, and nontoxic implants, composed of sodium hyaluronate from nonanimal origin cross-linked with 1,4-butanediol diglycidyl ether. 33 – 37 The technology of the cross-linking varies among different manufacturers.…”

Section: Discussionmentioning

confidence: 99%

“…5 , 18 , 19 , 23 , 37 , 40 However, as the manufacturing procedures remain confidential, one can only speculate on the technology-related factors associated with filler complications. 22 …”

Section: Discussionmentioning

confidence: 99%

Late-Onset Inflammatory Response to Hyaluronic Acid Dermal Fillers

Bhojani-Lynch

2017

Plastic and Reconstructive Surgery - Global Open

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Objective:Even though injectable hyaluronic acid (HA)–based fillers are considered safe, rare complications, such as late-onset inflammatory reactions have been reported. Possible causes and effective treatments have not been formally described, so this work aims to discuss these and offer a formal protocol for treatment.Methods:This article presents 5 clinical cases of late-onset inflammatory response occurring at least 3 months after uneventful injection of HA dermal filler.Results:Inflammation appeared spontaneously, usually 4–5 months after the last injection, but in 1 patient, almost 14 months later. One patient was injected at the same time with fillers manufactured by 2 different technologies. In this case, all areas treated with the same filler showed diffuse swelling of inflammatory nature, whereas the lips, treated with the second filler brand, remained unaffected. Four patients reported a flu-like illness or gastrointestinal upset a few days before the onset of dermal filler inflammation.Conclusion:Late-onset inflammatory reactions to HA fillers may be self-limiting but are easily and rapidly treatable with oral steroids, and with hyaluronidase in the case of lumps. It is likely these reactions are due to a Type IV delayed hypersensitivity response. Delayed inflammation associated with HA fillers is nonbrand specific. However, the case where 2 different brands were injected during the same session, but only 1 brand triggered a hypersensitivity reaction, suggests that the technology used in the manufacturing process, and the subsequent differing products of degradation, may have an influence on potential allergic reactions to HA fillers.

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“…As most patients treated are healthy people looking for a cosmetic improvement, the treatments performed should be as safe as possible. Although these fillers are known for a reliable safety profile, adverse events do occur . Complications can be caused by the product itself (too strong cross‐linking of the product), the product‐host interaction (allergic reactions, inflammatory responses), or the injection technique performed (accumulation or dislocation of the product due to muscle movement, intravascular injection, or vascular compression of filler material) .…”

Section: Introductionmentioning

confidence: 99%