title: Granulomatous reaction to Belotero Balance: A case study.
abstract: OBJECTIVE
  The most commonly used dermal fillers are hyaluronic acids (HAs), and in general, are well tolerated with mild to moderate risk of adverse events. The most frequently reported side effects are injection site erythema and bruising. We present the first case of a patient who developed a severe granulomatous foreign body reaction to the HA filler, Belotero Balance. In our review of the literature, a granulomatous reaction has never before been reported as a side effect of this particular HA filler (1).
  
  
  METHODS
  On exam, the patient had firm erythematous, granulomatous plaques on her bilateral cheeks, with a tender, fluctuant nodule on her right cheek. Complete resolution of this delayed reaction was achieved after several injections of intralesional Kenalog (IL-K) 2.5 mg/cc, and further fine-tuning was achieved through laser resurfacing.
  
  
  CONCLUSIONS
  Granulomatous reactions can occur with any HAs, though such incidents are not commonly reported. These delayed reactions are generally localized immunological reactions, though biofilm infections should be excluded where appropriate. It is only with long-term (5-year) longitudinal studies that accurate numbers of such reactions will be known.
authors.affiliation: a School of Medicine , University of California, Irvine , Irvine , CA , USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gandy
authors.affiliation: b Department of Dermatology , University of California, Irvine , Irvine , CA , USA.
authors.forename: Dina
authors.initials: D
authors.lastname: Bierman
authors.affiliation: b Department of Dermatology , University of California, Irvine , Irvine , CA , USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Zachary
mesh_terms: D000067548:Dermal Fillers / Q000009:adverse effects*; D005148:Facial Dermatoses / Q000139:chemically induced* / Q000628:therapy; D005260:Female; D015745:Granuloma, Foreign-Body / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D000067548:Dermal Fillers; C584568:belotero balance; D006820:Hyaluronic Acid
keywords: Belotero; Granuloma; filler; granulomatous reaction