University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Non-Surgical Medical Facial Aesthetics


Dr. Nancy Reid



Purpose: The purpose of this article is to review any delayed hypersensitivity reaction after injection of hyaluronic acid filler to the face as an adverse effect.

Method: A search was conducted on PubMed and Google Scholar using keywords of dermal fillers, facial injections, facial rejuvenation, complications, allergy, hypersensitivity, delayed, facial fillers, cosmetic dermatology, hyaluronic acid, facial anatomy, filler procedure, nonvascular, and treatments. After excluding the non-relevant articles the search was narrowed down to 10 total articles which were relevant to the PICO.

Results: The similarities noted in each of these articles are that they all focused on adverse effects, treatments, systematic approaches, and injection techniques of hyaluronic fillers that are FDA-approved. Each article further focused on the importance of medical history, anatomy, and safe and clean practices. All articles also agreed that all cases reached 100% resolution without any other complications.

Conclusion: Though using hyaluronic acid gel fillers is relatively safe with a low complication profile of delayed reactions, the cases are rising. Infectious or immune-mediated cause in origin can trigger a delayed hypersensitivity outbreak, for example, an influenza-like illness. A thorough medical history by the clinician is necessary to have the foresight for preparedness. Considering that hypersensitivity reactions with HA fillers are an actual possibility, taking a thorough medical history during the consultation is a critical step, as is disclosing to the patient the risk of such adverse effects. “Post-market study of 585 MAUDE reports 195 (33.3%) delayed adverse effects of interest.” Of those, “71.8% were nodules (42.1% inflammatory and 29.7% noninflammatory), 21.5% hypersensitivity, and 6.7% granulomas.” As the use of non-surgical interventions in facial aesthetics continues to grow, so will the reported adverse effects. All the reviewed studies had the same consensus regarding the resolution and treatment of the adverse effect of delayed hypersensitivity. Further studies are needed to understand the exact cause of such reactions.


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