Etiology of Delayed Inflammatory Reaction Induced by Hyaluronic Acid Filler

Won Lee; Sabrina Shah-Desai; Nark-Kyoung Rho; Jeongmok Cho

doi:10.1055/a-2184-6554

Archives of Plastic Surgery, Table of Contents

CC BY 4.0 · Arch Plast Surg 2024; 51(01): 020-026
DOI: 10.1055/a-2184-6554

Cosmetic

Review Article

Etiology of Delayed Inflammatory Reaction Induced by Hyaluronic Acid Filler

Won Lee

¹Yonsei E1 Plastic Surgery Clinic, Scientific Faculty of the Minimal Invasive Plastic Surgery Association, Dongan-ro, Dongan-gu, Anyang, Republic of Korea

,

Sabrina Shah-Desai

²Perfect Eyes Ltd, London, United Kingdom

,

Nark-Kyoung Rho

³Department of Dermatology, Sungkyunkwan University School of Medicine, Gyeonggi-do, Republic of Korea. Leaders Aesthetic Laser & Cosmetic Surgery Center, Seoul, Republic of Korea

,

Jeongmok Cho

⁴Etonne Plastic Surgery Clinic, Scientific Faculty of the Milimal Invasive Plastic Surgery Association, Seoul, Republic of Korea

› Author Affiliations

Abstract

The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient's immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient's immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.

Keywords

hyaluronic acid filler - delayed inflammatory reaction - filler complication - delayed hypersensitivity

Full Text

References

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