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Delayed-Onset Nodules to Differentially Crosslinked Hyaluronic Acids

Comparative Incidence and Risk Assessment

Sadeghpour, Mona MD*,†; Quatrano, Nicola A. MD*; Bonati, Lauren Meshkov MD*; Arndt, Kenneth A. MD*,‡,§; Dover, Jeffrey S. MD, FRCPC*,‡,‖; Kaminer, Michael S. MD*,‡,‖

doi: 10.1097/DSS.0000000000001814
Original Article

BACKGROUND Robust and long-term data on true incidence of delayed-onset nodules and immune tolerance of hyaluronic acid (HA) fillers are lacking.

OBJECTIVE To characterize the incidence of delayed nodules in Vycross (VYC) HA fillers compared with previously reported FDA and non-FDA data of all HA fillers.

METHODS AND MATERIALS The incidence of delayed nodules in all patients who had received VYC fillers in a 12-month period was assessed through a retrospective chart review. Nodule incidence for currently approved nonanimal-stabilized hyaluronic acid (NASHA) fillers was assessed using the FDA Summary of Safety and Effectiveness Data.

RESULTS Overall, 1,029 patients received 1,250 VYC filler treatments. Five patients developed delayed nodules to VOB, with an incidence of 1.0% per patient and 0.8% per syringe. No nodules were observed in patients who received VLR or VOL. All nodules were treated successfully using a combination of intralesional triamcinolone and hyaluronidase. Compared with other currently approved NASHA fillers, VOB is associated with a higher incidence of nodule formation.

CONCLUSION The introduction of VYC HAs has introduced a new variable that may be changing the immune tolerance of these substances, resulting in a higher incidence of delayed nodules than previously expected.

*SkinCare Physicians, Chestnut Hill, Massachusetts;

Department of Dermatology, University of Colorado, Aurora, CO;

Department of Dermatology, Brown Medical School, Providence, RI;

§Department of Dermatology, Dartmouth-Hitchcock, Lebanon, NH;

Department of Dermatology, Yale University School of Medicine, New Haven, CT

Address correspondence and reprint requests to: Mona Sadeghpour, MD, Department of Dermatology, University of Colorado, 13100 East Colfax Avenue, Unit 70, Aurora, CO 80011, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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