Persistent symptoms after filler- 4 months

Question

I had dermal HA filler (RHA4 product) placed in my cheeks 4 months ago. Since then, I have had the following issues: -burning/tingling sensation throughout my face -itchiness at injection site -persistent fatigue -loose/doughy skin on my face. Before, my cheeks/mid face was sunken, but the skin was at least tight and could not be pulled. I am considering dissolving but do not want to make things worse. Is this an immune/autoimme reaction? Should I dissolve?

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about the issues you're experiencing. Here are some general considerations and steps to take:

Potential Causes
1. **Immune/Autoimmune Reaction**: Although rare, it's possible to have an immune or autoimmune reaction to dermal fillers. Symptoms like burning, tingling, and itchiness could be indicative of an inflammatory response.
2. **Delayed Hypersensitivity Reaction**: This can occur weeks to months after filler injection and can cause symptoms like swelling, redness, and discomfort.
3. **Infection**: Though less likely after 4 months, it's important to rule out any low-grade infection.
4. **Filler Migration or Misplacement**: This could cause a change in the texture of your skin and discomfort.

Steps to Take
1. **Consult with Your Injector**: Your first step should be to consult with the medical professional who administered the filler. They will have the most context regarding your procedure and can provide specific advice.
2. **Seek a Second Opinion**: If you are not getting satisfactory answers or solutions, consider consulting a dermatologist or another qualified healthcare professional who specializes in cosmetic procedures.
3. **Diagnostic Tests**: Your healthcare provider may recommend blood tests, imaging studies, or a biopsy to rule out infection or an autoimmune reaction.
4. **Patch Testing**: To rule out an allergic reaction, a patch test might be useful.

Considering Dissolution
1. **Hyaluronidase**: This enzyme can dissolve hyaluronic acid fillers like RHA4. However, it's important to have this done by an experienced professional to minimize the risk of complications.
2. **Risk of Dissolution**: Dissolving the filler might relieve some symptoms but can also lead to further changes in skin texture and volume. Discuss these risks thoroughly with your healthcare provider.

Management of Symptoms
1. **Topical Treatments**: Anti-inflammatory creams or antihistamines might help with itchiness and burning.
2. **Oral Medications**: If an autoimmune or inflammatory reaction is suspected, your doctor might prescribe corticosteroids or other immunosuppressive medications.
3. **Skincare Routine**: Gentle skincare products that target inflammation and skin sensitivity might provide some relief.

Monitoring and Follow-Up
1. **Regular Check-Ups**: Keep regular appointments with your healthcare provider to monitor your symptoms and response to any treatments.
2. **Document Symptoms**: Maintain a diary of your symptoms, noting any changes, which can be helpful in managing your condition and communicating with your healthcare providers.

While it is possible that your symptoms could be due to an immune or autoimmune reaction to the filler, it is crucial to get a thorough evaluation by a healthcare professional. Dissolving the filler might be an option, but it should be carefully considered and discussed with a qualified specialist.

Please make an appointment with your healthcare provider as soon as possible to discuss these symptoms and potential next steps.

Camille Cash, MD · Answer

I encourage you to visit with your injector for an examination.  The symptoms that you mention are not common and should be evaluated.  HA fillers can be dissolved using hyaluronidase, though it may take more than one treatment session.

Persistent symptoms after filler- 4 months

Answers (2)

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