title: Resistant and Recurrent Late Reaction to Hyaluronic Acid-Based Gel.
abstract: BACKGROUND
  Late reactions to hyaluronic acid (HA)-based fillers have a recorded rate of 0.02%. The recent experience with a newly introduced filler in the tear trough area and the lips showed higher rate of reactions with a tendency to persistency and recurrences.
  
  
  OBJECTIVE
  To delineate the features of reactions to this newly introduced filler.
  
  
  METHODS
  Medical records of 400 patients (360 women and 40 men; average age = 49.6 years) were examined in this retrospective study. Juvéderm Volbella (HA-Vb) filler was injected only into the tear trough area or lips. Other HA-based products were used in other areas of the face.
  
  
  RESULTS
  Seventeen patients (4.25%) developed prolonged (up to 11 months) and recurrent (average: 3.17 episodes) late (average onset: 8.41 weeks after the injection) inflammatory cutaneous reactions.
  
  
  CONCLUSIONS
  The incidence of late reactions to HA-based fillers varies between products. The authors are reporting an exceptionally high rate of cutaneous reactions for this newly introduced filler. In the authors' experience, broad-spectrum antibiotics in conjunction with repeated high-dose hyaluronidase injections into the inflammatory nodules were effective treatments.
authors.affiliation: *Tel Aviv Sourasky Medical Center, Department of Dermatology, The Sackler School of Medicine, Tel Aviv, Israel; †Dr. Verner Clinic of Dermatology & Aesthetics, Kiriat Ono, Israel; ‡Wolfson Medical Center, The Sackler School of Medicine, Tel Aviv, Israel.
authors.forename: Ofir
authors.initials: O
authors.lastname: Artzi
authors.forename: Christoforos
authors.initials: C
authors.lastname: Loizides
authors.forename: Ines
authors.initials: I
authors.lastname: Verner
authors.forename: Marina
authors.initials: M
authors.lastname: Landau
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000009:adverse effects*; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology*; D005123:Eye; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use; D017496:Hypopigmentation / Q000139:chemically induced; D008046:Lip; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015595:Skin Aging / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D000067548:Dermal Fillers; D005782:Gels; D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase