Share this article on:

Late-Onset Inflammatory Response to Hyaluronic Acid Dermal Fillers

Bhojani-Lynch, Tahera MRCOphth, CertLRS, MBCAM, DipCS

Plastic and Reconstructive Surgery – Global Open: December 2017 - Volume 5 - Issue 12 - p e1532
doi: 10.1097/GOX.0000000000001532
Original Article
United Kingdom

Objective: Even though injectable hyaluronic acid (HA)–based fillers are considered safe, rare complications, such as late-onset inflammatory reactions have been reported. Possible causes and effective treatments have not been formally described, so this work aims to discuss these and offer a formal protocol for treatment.

Methods: This article presents 5 clinical cases of late-onset inflammatory response occurring at least 3 months after uneventful injection of HA dermal filler.

Results: Inflammation appeared spontaneously, usually 4–5 months after the last injection, but in 1 patient, almost 14 months later. One patient was injected at the same time with fillers manufactured by 2 different technologies. In this case, all areas treated with the same filler showed diffuse swelling of inflammatory nature, whereas the lips, treated with the second filler brand, remained unaffected. Four patients reported a flu-like illness or gastrointestinal upset a few days before the onset of dermal filler inflammation.

Conclusion: Late-onset inflammatory reactions to HA fillers may be self-limiting but are easily and rapidly treatable with oral steroids, and with hyaluronidase in the case of lumps. It is likely these reactions are due to a Type IV delayed hypersensitivity response. Delayed inflammation associated with HA fillers is nonbrand specific. However, the case where 2 different brands were injected during the same session, but only 1 brand triggered a hypersensitivity reaction, suggests that the technology used in the manufacturing process, and the subsequent differing products of degradation, may have an influence on potential allergic reactions to HA fillers.

From the Laser and Light Cosmetic Medical Skin Clinic, Loughborough, United Kingdom.

Received for publication May 8, 2017; accepted August 23, 2017.

Disclosure: Dr. Bhojani-Lynch is currently a consultant for Merz Pharmaceuticals GmbH and Teoxane UK Limited. She has previously performed consulting services for Q-med AB and Allergan Inc. The Article Processing Charge was paid for by Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.

Supported by Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.

Tahera Bhojani-Lynch, MRCOphth, CertLRS, MBCAM, DipCS, The Laser and Light Cosmetic Medical Clinic, 1 Church Gate Mews, Loughborough, Leics LE11 1TZ, United Kingdom, E-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.