CCID_A_363583 1213..1223

Abstract Complications such as delayed inflammatory reactions (DIRs) and unnatural outcomes can sometimes arise from hyaluronic acid (HA) dermal filler treatments and can be challenging to address. Given the popularity of HA dermal fillers for aesthetic procedures, there is a need for preventive strategies to minimize these complications. Two hundred practitioners from 10 regions in Asia Pacific who administer HA fillers completed a survey on prevention of DIRs and unnatural outcomes. Thirteen global experts convened to evaluate the current practices and propose practical approaches for safe and appropriate use of HA dermal fillers. From the survey, the top three measures used to reduce the risk of DIRs included choosing an appropriate HA filler, aseptic technique, and patient selection. Key strategies employed to achieve natural-looking outcomes were treatment customization, understanding the rheological properties and behavior of different HA fillers, and being conservative in treatment approach. The panel developed a concise reference guide aimed at minimizing the risk of DIRs while achieving natural aesthetic outcomes. Five practical considerations were recommended: patient assessment and individualization of treatment plan, choice of an appropriate HA filler, adequate knowledge of facial anatomy, strict adherence to aseptic methods, and proper injection technique. The panel highlighted the need for education efforts to increase awareness of differential immunogenicity between HA fillers and to improve understanding on the importance of preserving aesthetic individuality for optimal results. These practical insights from the global experts support practitioners in optimizing safety and quality of aesthetic treatment with HA fillers.

[1]  M. Kerscher,et al.  Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range: Best Practice in Specific Facial Indications , 2021, Clinical, cosmetic and investigational dermatology.

[2]  Tingsong Lim,et al.  Target‐Specific Sandwich Technique: Facial rejuvenation leveraging CPM technology , 2021, Journal of cosmetic dermatology.

[3]  W. Placek,et al.  The Immunogenicity of Hyaluronic Fillers and Its Consequences , 2021, Clinical, cosmetic and investigational dermatology.

[4]  Brett Sloan July 2021: Lisinopril for delayed inflammatory responses to hyaluronic acid fillers after COVID-19 vaccinations , 2021, Journal of the American Academy of Dermatology.

[5]  R. Geronemus,et al.  Oral angiotensin-converting enzyme inhibitors for treatment of delayed inflammatory reaction to dermal hyaluronic acid fillers following COVID-19 vaccination-a model for inhibition of angiotensin II–induced cutaneous inflammation , 2021, JAAD Case Reports.

[6]  J. Dover,et al.  Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm , 2020, Clinical, cosmetic and investigational dermatology.

[7]  E. Sprecher,et al.  Management Patterns of Delayed Inflammatory Reactions to Hyaluronic Acid Dermal Fillers: An Online Survey in Israel , 2020, Clinical, cosmetic and investigational dermatology.

[8]  A. Swift,et al.  Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers , 2020, Plastic and reconstructive surgery. Global open.

[9]  A. Swift,et al.  Effective Rejuvenation with Hyaluronic Acid Fillers: Current Advanced Concepts. , 2019, Plastic and reconstructive surgery.

[10]  K. Arndt,et al.  Delayed-Onset Nodules to Differentially Crosslinked Hyaluronic Acids: Comparative Incidence and Risk Assessment. , 2019, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[11]  A. Swift,et al.  A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures and algorithms for management , 2018, Clinical, cosmetic and investigational dermatology.

[12]  L. Schelke,et al.  Ultrasound to improve the safety of hyaluronic acid filler treatments , 2018, Journal of cosmetic dermatology.

[13]  Nicholas C. Oleck,et al.  Adverse Events Associated With Aesthetic Dermal Fillers: A 10-Year Retrospective Study of FDA Data , 2018 .

[14]  A. Moreno,et al.  Treatment of Soft Tissue Filler Complications: Expert Consensus Recommendations , 2018, Aesthetic Plastic Surgery.

[15]  Jeung-Hoon Lee,et al.  Hyaluronic Acid Decreases Lipid Synthesis in Sebaceous Glands. , 2017, The Journal of investigative dermatology.

[16]  X. Wortsman,et al.  Delayed Adverse Subcutaneous Reaction to a New Family of Hyaluronic Acid Dermal Fillers With Clinical, Ultrasound, and Histologic Correlation. , 2017, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[17]  K. Vickery,et al.  The Role of Bacterial Biofilm in Adverse Soft-Tissue Filler Reactions: A Combined Laboratory and Clinical Study , 2017, Plastic and reconstructive surgery.

[18]  P. Quinodoz,et al.  Ultrasound and Histologic Examination after Subcutaneous Injection of Two Volumizing Hyaluronic Acid Fillers: A Preliminary Study , 2017, Plastic and reconstructive surgery. Global open.

[19]  P. Micheels,et al.  Two Crosslinking Technologies for Superficial Reticular Dermis Injection: A Comparative Ultrasound and Histologic Study. , 2017, The Journal of clinical and aesthetic dermatology.

[20]  C. Çağıcı Resistant and Recurrent Late Reaction to Hyaluronic Acid-Based Gel. , 2017, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[21]  A. Nikolis,et al.  Hyaluronic acid fillers with cohesive polydensified matrix for soft-tissue augmentation and rejuvenation: a literature review , 2016, Clinical, cosmetic and investigational dermatology.

[22]  M. Kerscher,et al.  Consensus Recommendations for Optimal Augmentation of the Asian Face with Hyaluronic Acid and Calcium Hydroxylapatite Fillers , 2015, Plastic and reconstructive surgery.

[23]  J. Carruthers,et al.  Delayed-Onset Nodules Secondary to a Smooth Cohesive 20 mg/mL Hyaluronic Acid Filler: Cause and Management , 2015, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[24]  I. Heydenrych,et al.  Patient factors influencing dermal filler complications: prevention, assessment, and treatment , 2015, Clinical, cosmetic and investigational dermatology.

[25]  R. Goldberg,et al.  Hyaluronic acid gel distribution pattern in periocular area with high-resolution ultrasound imaging. , 2014, Aesthetic surgery journal.

[26]  T. Pavicic,et al.  Dermal fillers in aesthetics: an overview of adverse events and treatment approaches , 2013, Clinical, cosmetic and investigational dermatology.

[27]  D. Salomon,et al.  In vivo Bio-Integration of Three Hyaluronic Acid Fillers in Human Skin: A Histological Study , 2013, Dermatology.

[28]  T. Flynn,et al.  Superficial Dermal Injection of Hyaluronic Acid Soft Tissue Fillers: Comparative Ultrasound Study , 2012, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[29]  T. Flynn,et al.  Comparative Histology of Intradermal Implantation of Mono and Biphasic Hyaluronic Acid Fillers , 2011, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[30]  G. Schmitz,et al.  Fifty-kDa Hyaluronic Acid Upregulates Some Epidermal Genes without Changing TNF-α Expression in Reconstituted Epidermis , 2011, Skin Pharmacology and Physiology.

[31]  R. Glogau,et al.  Effect of Injection Techniques on the Rate of Local Adverse Events in Patients Implanted with Nonanimal Hyaluronic Acid Gel Dermal Fillers , 2008, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[32]  P. Noble,et al.  Hyaluronan in tissue injury and repair. , 2007, Annual review of cell and developmental biology.

[33]  Michael H Gold,et al.  Use of hyaluronic acid fillers for the treatment of the aging face , 2007, Clinical interventions in aging.