Abstract

Introduction: Delayed inflammatory reactions (DIR) following filler injections are a relatively rare complication, but with the steady increase in the number of procedures performed, there has been a corresponding increase in the number of such observations. Compared to other types of fillers, DIRs to hyaluronic acid (HA) fillers are diagnosed most often, which is logically associated with their absolute predominance in modern clinical practice. This type of complication is characterised not only by the complexity of treatment, but also by the tendency for the inflammatory process to become chronic and to recur frequently, which in some cases leads to fibrotic changes in tissues, their deformation, microcirculation disorders, and the appearance of congestive erythema. All this often leads to the formation of pronounced aesthetic defects and serves as an obstacle to further cosmetic procedures, resulting in severe psycho-emotional states in such patients, which significantly affects their quality of life.
Objective: To study the structure of complications after the introduction of hyaluronic fillers.
Materials and methods: The study involved 1,294 patients who sought help for adverse reactions associated with the administration of fillers. Of these, 67.4% were diagnosed with a delayed inflammatory reaction. Of these, 204 patients with DIR to hyaluronic fillers were selected.
Results: During the initial interview, patients diagnosed with an allergic reaction to various types of fillers reported about the filler administered in 63.6% of cases (n=556), but the degree of reliability varied. It is worth noting that of the 556 patients, 62.4% (n=347) confirmed that they had received injections with hyaluronic acid fillers, but further examinations (ultrasound of the skin and soft tissues, biopsy) 31.1% (n=108) of them were found to have other types of fillers, which came as a surprise to them. Among the adverse events that prompted patients to seek medical attention, the most common were: sudden onset of an inflammatory reaction at the injection site, periodic inflammatory reactions at the filler site, induration at the injection site, changes in skin texture, as well as paraesthesia/pain, persistent infraorbital/malar oedema, Tyndall effect, telangiectasia, filler migration, asymmetry, hyperpigmentation, abscess, vascular occlusion, xanthelasma-like lesions. At the same time, despite the predominance of the main negative manifestations, most patients experienced a polysymptomatic picture of complications. The manifestation of DIR after the administration of a HA filler occurred within a wide time interval from 2 weeks to several years, but most often within 25 to 52 weeks. Given the social significance of the problem, we analysed the severity of DIR depending on the legal status of the filler, which allowed us to reliably identify significant differences between certified and uncertified fillers: severe DIR was observed in patients with uncertified fillers in 63.6% of cases. In contrast, when a certified filler was used, severe DIR was observed in only 21.8% of cases.
Conclusions: The study revealed the characteristics of the clinical picture of this type of complication and emphasised the importance of doctors choosing the highest quality, certified fillers for injections. It also highlighted the need for manufacturers to strictly adhere to the production and purification technologies for HA fillers, which can significantly reduce the likelihood of DIR.