HA, CaHA and PLLA complication management

This chapter covers clinical presentations of soft tissue filler induced complications. It presents comprehensive algorithms as a guide to approach the most common soft tissue filler complications: skin discoloration, edema, infection, nodules, and vascular compromise (peripheral and central). Reactivation of Herpes simplex is the most common viral infection to occur after filler injection. Preferred locations are the lip skin, vermillion border, nasal mucosa, and mucosa of hard palate. Granulomatous inflammatory reactions usually begin no earlier than 3 to 4 weeks after injection but can occur months or even years later. The pathophysiology behind the development of granulomatous inflammation after filler injections is complex and multifactorial. Granuloma formation after PLLA injection usually presents as several nodules 6-24 months after injection at the areas where PLLA was injected. These late inflammatory nodules are less well defined compared to PLLA nodules and if untreated will remain active for 1-5 years.