
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:
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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