Management of Delayed Complications of Hyaluronic Acid Fillers: Case Series From the Middle East.

[BACKGROUND] Hyaluronic acid (HA) dermal fillers are primarily utilized for restoring volume loss and for the correction of wrinkles and folds. While HA injections are generally considered safe, undesirable and serious complications have been on the rise due to the increased frequency of these procedures. Late-onset complications involve filler migration, foreign body granuloma reactions, delayed hypersensitivity reactions, and infections, among others.

[AIMS/OBJECTIVES] Raising awareness about late complications associated with HA filler injections and highlighting proper management strategies.

[METHODS] We hereby present three patients who experienced distinct forms of delayed reactions to HA fillers, provide a systematic approach to their evaluation, and outline effective treatment strategies to ensure optimal patient outcomes. Written informed consent was obtained from the patients for publication of the details of their medical cases and any accompanying images.

[RESULTS] Delayed complications to HA fillers include erythema, edema, inflammation, nodules, and infections. These late-onset reactions present weeks to months post-injection and may be influenced by immune responses, filler properties, and procedural factors. Ultrasound imaging is a valuable tool in diagnosing and managing these complications, guiding treatments such as hyaluronidase and corticosteroid injections. Preventive measures, including aseptic techniques, patient screening, and proper injector training, help in reducing risks and optimizing patient outcomes.

[CONCLUSION] HA filler injections remain among the most popular cosmetic procedures, generally offering safe outcomes when performed by skilled professionals. Complications may still occur and require prompt recognition and management. This article highlights the importance of imaging in diagnosing non-ischemic complications and provides practical recommendations for managing delayed HA filler reactions. Ensuring patient safety relies on proper training, adherence to aseptic techniques, and careful patient and product selection.