title: Adverse late reactions after cosmetic implantation of hydroxyethylmethacrylate particles suspended in hyaluronic acid: clinics and complication management.
abstract: BACKGROUND
  The late-stage clinical course, histopathologic analysis, and surgical salvage procedures after eventful cosmetic injection of hydroxyethylmethacrylate particles suspended in hyaluronic acid (DermaLive, marketed through Dermatech, Paris, France and Novamedical GmbH, Langenfeld, Germany) have been studied. The study was designed to present modified treatment guidelines, report results, and draw conclusions regarding the future management of patients with late-stage DermaLive complications.
  
  
  METHODS
  The study consulted and reviewed 21 patients with late-stage complications after facial implantation of DermaLive. Histology samples from excisional biopsies followed by radical surgical excision procedures were obtained and analyzed for nine patients.
  
  
  RESULTS
  The treated zones included nasolabial folds, forehead and glabella, lips, and the perioral and zygoma regions. The late-onset period between injection and first symptoms averaged 17.5 months. Lesions were mostly symptomatic, with discomfort, pain, swelling, and edema. Clinical aspects included bulging, palpable nodules, erythema, and scar formation. A positive correlation between patient age and the delay period was found. All surgically treated patients recovered well. The initial conservative measures achieved only partial success, whereas all nine surgically treated patients (43 %) demonstrated complete relief of their clinical symptoms.
  
  
  CONCLUSIONS
  Soft tissue augmentation with DermaLive led to a series of severe delayed adverse reactions. Sclerosing DermaLive granulomas demonstrated low success rates with conservative measures, whereas early radical surgical excision achieved good results.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic- and Hand Surgery, Burn Center, University Hospital RWTH Aachen, Pauwelssstrasse 30, 52074, Aachen, Germany. erhan_demir@t-online.de
authors.forename: Erhan
authors.initials: E
authors.lastname: Demir
authors.forename: A
authors.initials: A
authors.lastname: Perez-Bouza
authors.forename: Norbert
authors.initials: N
authors.lastname: Pallua
mesh_terms: D000179:Acrylates / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003357:Cosmetic Techniques / Q000009:adverse effects; D005145:Face; D005260:Female; D015745:Granuloma, Foreign-Body / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D020100:Hydrogels / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015595:Skin Aging / Q000187:drug effects; D013997:Time Factors
chemical_list: D000179:Acrylates; C482306:Dermalive; D020100:Hydrogels; D006820:Hyaluronic Acid