How long will this delayed reaction to Volite last? (Photo)

Question

I received volite in the lines of my neck 6 months ago. 4 weeks ago I started to notice lumps on my neck. Not sore nor itchy but very noticeable I had hyaluronidase no real change. Now on 2 antibiotics clarithromycin 500mg and ciproflaxin 500mg have been on for not even 3 days. No one really knows what to do! Or what they are actually called and how to treat it? Will they just go away?

John J. Martin, Jr., MD · Answer

Nodules that form several months after an HA injection are usually auto-immune related and not infectious.  They will sometimes occur after you have a cold or other flu like illness.  A course of steroids will usually help to decrease the nodules.  Hyaluronidase injections may help if they persist and may need more than one injection to eliminate this product.  The antibiotics will only help if this is infection.  Excising one of the nodules for pathology and culture would be a good way to help figure out what you have.

Mark Kearns, MBChB, BSc, FRACGP · Answer

Hey there thanks for the question! Delayed nodule formation can occur after fillers but unfortunately yours is quite noticeable. The antibiotics would only work if there is an infection in them and taking them for a few more days may rule that out. If there is no change your injector may recommend repeat doses of hylase and a course of anti inflammatories.
Hope that helps, good luck.

Sachit Shah, MD · Answer

Unfortunately these can occur post injection with any filler. The Volite injection is meant to be very superficial. I speak to your injector about getting repeated injections of hylauronidase and/or cortisone and it is good that you are taking antibiotics. 
I would ask your injector to report this to Allergan the makers of Volite. 
Best Wishes

Martin Ray, MD · Answer

Hi Barbara,
Late onset of nodules are most likely related to your body's immune system reacting against the cross linked hyaluoronic acid (HA). These reactions often follow an infection or immune response unrelated to the dermal filler. Prednisone injection or a one week course will normally help to settle things down. Episodes may reoccur and normally respond again to a repeat course of prednisone. This is unlikely infection; however, consideration has been given that these late nodules are related to biofilm introduced at the time of injection. The biofilm becomes active as the product breaks down. Based on the biofilm theory, many physicians will recommend antibiotics. Use of Hyaluronidase to dissolve the nodules can be challenging with Volite because the injected product is small in size and injection sites are numerous. The Vycross technology used in Volite, Volbella, Volift and Voluma can be more challenging to dissolve than other products because of the cross linking of the HA.
Doing nothing is an option, as most nodules will in time resolve spontaneously. Some physicians will consider biopsy and culture of one of the nodules in order to better understand what is going on. My experience with this is that the reports normally describe a granuloma and no cultured bacteria. In your case, where the problem is quite noticeable, I recommend treatment with prednisone. This reaction should be reported to Allergan and to Health Canada by your physician. Good luck and please do not worry - there will not be any permanent or long term problem associated with this reaction.
Regards, Dr Ray

How long will this delayed reaction to Volite last? (Photo)

Answers (4)

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