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Understanding Delayed Onset Reaction Nodules After Dermal Fillers

Writer's picture: KateKate


In the world of Aesthetic Medicine, dermal fillers have become a popular solution for those

seeking to enhance their facial aesthetics. While these treatments are generally safe and

effective, they can occasionally lead to complications. One such complication is the

formation of delayed onset reaction nodules. Let's delve into what these nodules are, why

they occur, and how they can be managed.


What Are Delayed Onset Reaction Nodules?


Delayed onset reaction nodules are firm lumps that develop under the skin weeks, months,

or even years after a dermal filler injection. Unlike immediate reactions, which occur within

days of the procedure, these nodules appear after a significant period. They are typically

palpable and can be tender or painless, often causing concern due to their unexpected

appearance and persistence.


Causes of Delayed Onset Reaction Nodules


The exact causes of delayed onset reaction nodules are not fully understood, but several

factors are believed to contribute to their development:


1. Immune Response: The body can sometimes perceive the filler material as a

foreign substance, triggering an immune response. This can lead to inflammation and

nodule formation as the body attempts to isolate the foreign material.


2. Biofilm Formation: A biofilm is a thin, slimy film of bacteria that can develop on

surfaces, including those of injected fillers. Biofilms can cause chronic inflammation

and are often resistant to antibiotics, contributing to the formation of nodules.


3. Filler Composition: Different fillers have different properties and biocompatibility.

For instance, fillers made from synthetic materials like polymethyl methacrylate

(PMMA) or certain long-lasting hyaluronic acid fillers are more likely to cause delayed

nodules compared to others.


4. Injection Technique: The technique used by the practitioner can also influence the

likelihood of nodule formation. Improper placement, depth of injection, or failure to

adhere to aseptic techniques can increase the risk.


Symptoms and Diagnosis


Delayed onset reaction nodules present as firm, often immovable lumps under the skin at

the site of filler injection. They can be accompanied by redness, tenderness, or warmth,

indicating inflammation. Diagnosis typically involves a thorough clinical examination and

patient history. In some cases, imaging studies may be needed to rule out other conditions,

such as infections.


Management and Treatment


The treatment of delayed onset reaction nodules depends on the severity of the symptoms

and the type of filler used. Common approaches include:


1. Observation: In mild cases, where the nodules are not causing significant discomfort

or aesthetic concern, a watch-and-wait approach may be adopted, as some nodules

can resolve on their own over time.


2. Medications: Anti-inflammatory medications, such as steroids, can be injected

directly into the nodule to reduce inflammation. Antibiotics may be prescribed if a

biofilm or infection is suspected.


3. Hyaluronidase: For nodules formed from hyaluronic acid fillers, hyaluronidase can

be injected to dissolve the filler material. This enzyme breaks down hyaluronic acid,

effectively reducing the nodule.


4. Surgical Removal: In rare cases, especially with nodules formed from non-

degradable fillers, surgical removal may be necessary.


Prevention


Preventing delayed onset reaction nodules involves several strategies:


  1. Choosing the Right Filler: Opting for fillers with a good safety profile and proven

biocompatibility can reduce risks – our chosen choice is Teoxane.


2. Experienced Practitioner: Ensuring that the filler is administered by a skilled and

experienced practitioner who follows proper injection techniques and aseptic

protocols.


3. Patient Screening: Thorough patient screening for allergies and previous reactions

to fillers can help identify those at higher risk.


Conclusion


Delayed onset reaction nodules, while uncommon, are a notable complication of dermal

fillers. Understanding their causes, recognising the symptoms, and knowing the treatment

options are crucial for both patients and practitioners. By taking preventive measures and

responding promptly to any complications, the safety and efficacy of dermal filler treatments

can be maintained, ensuring patient satisfaction and well-being.

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