Although uncommon, researchers recommend physicians are aware of the risk for delayed nodules in patients after 3-D facial injections with Juvéderm Voluma, and have a management protocol in place, according to recent study results.
Patients have reported delayed-onset inﬂammatory nodules following treatment with 3-D soft tissue augmentation, according to background information provided in the study. For this reason, researchers led by Katie Beleznay, MD, FRCPC, FAAD, of the department of dermatology and skin science at the University of British Columbia, conducted a retrospective chart review of patients who underwent 3-D facial injection with Juvéderm Voluma (hyaluronic acid gel, Allergan), a 20 mg/mL smooth cohesive filler, from Feb. 1, 2009 to Sept. 30, 2014.
During the 68-month period, 4,702 treatments performed with 11,460 mL gel injections.
Overall, 23 patients (0.5%) experienced delayed-onset nodules, with a median time from injection to reaction of 4 months and a median time to resolution of 6 weeks, according to study results. The researchers identified an immunologic trigger (flu-like illness, dental procedure or trauma) prior to the onset of nodules in 39% of patients. Effective treatments included prednisone, intralesional corticosteroids and hyaluronidase.
“It is the belief that when hyaluronic acid gel is injected into a predisposed individual, these risk factors can trigger immune-mediated delayed nodules,” the researchers wrote. “Hyaluronic acid gel and the delayed nodules that have been seen may serve as a model to highlight the immunologic properties of hyaluronic acid in addition to the well described structural role. Additional research is necessary to evaluate this mechanism further.”
Disclosure: Beleznay reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.