Delayed complication of botulinum toxin and hyaluronic acid filler injections: A case report

Abstract Background Botulinum toxin and hyaluronic acid (HA) filler injections are popular minimally invasive cosmetic procedures owing to their convenience, efficiency, and durability; however, adverse reactions often occur. Materials and methods We describe the delayed hypersensitivity reaction that occurred after sequential injections of botulinum toxin and HA filler. Results The histopathologic and dermatoscopic findings suggested a delayed hypersensitivity reaction with the formation of a dermal foreign body granuloma. The rash resolved 2 months following treatment with antihistamines and topical steroids cream. Conclusion We assume that local trauma during the blepharoplasty stimulated an immune response, which was the basis for this complication.