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Resistant and Recurrent Late Reaction to Hyaluronic Acid–Based Gel

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

doi: 10.1097/DSS.0000000000000562
Original Article

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.

MATERIALS AND 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.

CONCLUSION 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.

*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

Address correspondence and reprint requests to: Ofir Artzi, MD, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2016 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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