Clinical conference: management of rare events following dermal fillers--focal necrosis and angry red bumps.

Typical complications related to hyaluronic facial fillers used in the treatment of wrinkles are well described and readily manageable without sequelae. These events include transient local inflammatory reactions in which edema, erythema, tenderness or pain predominate and which typically resolve spontaneously within a few days but whose resolution may be facilitated by the use of topical steroids or low doses of oral anti-inflammatory agents or oral steroids. As these reactions can occasionally be severe, some physicians pretreat patients known to have such reactions with low doses of oral prednisone continued through a few days after intradermal injection. Historically, collagen-based products are known to induce more severe and long-lasting local allergic reactions. In contrast, with the hyaluronic acid products, including Hylaform and Restylane, local bruising is more common as collagen products stimulate platelet activation. Infections may result from any injection procedure involving placement of an implant. Dermal fillers are also thought to be a trigger for recurrent herpetic lesions and, similarly, may be followed by acneiform eruptions, headache, viral exanthems, or other common conditions. Overly superficial injection may result in product visibility, either as bluish or yellowish lines depending on the product, that can also be managed by local massage or physical removal with a needle.