The incidence of late reactions to HA-based fillers varies between products. The authors are reporting an exceptionally high rate of cutaneous reactions for this newly introduced filler. In the authors' experience, broad-spectrum antibiotics in conjunction with repeated high-dose hyaluronidase injections into the inflammatory nodules were effective treatments.

Background and Objectives: There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose. Materials and Methods: A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists. Results: Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement. Conclusion: A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.

Nonsurgical rhinoplasty with injectable fillers has become an increasingly popular option in recent years. Their rise in popularity has been driven by a number of factors, including their minimally invasive nature and the cost lower than surgical option. Physicians should keep in mind that there are many possible complications, especially in the hands of a novice injector. Fortunately, most complications are minor and transient in nature, although the patient may consider them aesthetically displeasing and unacceptable. Major complications are rare; however, an inadequate treatment can produce transient to permanent damage for the patient. A review of the medical literature from 2002 was performed to gather information on main complications after nasal injections using the databases of the National Library of Medicine, Ovid MEDLINE, and Cochrane Library. Understanding the basic anatomical knowledge of the midface, especially the vascular system, is fundamental to prevent the appearance of complications. However, recognize immediately the symptoms and know the correct treatment in case of complications is the only way to minimize permanent bad outcome.

An increasing number of minimally invasive cosmetic procedures, such as filler or botulinum toxin injections, are performed annually. These procedures are associated with a high risk of post‐procedure bruising or ecchymosis. Ecchymoses arise following hemorrhage and extravasation of red blood cells into the subcutaneous tissue, leading to local skin discoloration. Although ecchymoses generally resolve within 14 days, their appearance is cosmetically bothersome, and they may be painful and cause major distress to patients. Recent clinical evidence suggests that light/laser technology with pulsed dye laser (PDL) or intense pulsed light (IPL) can dramatically alleviate and minimize bruising when delivered within 24–72 hr of the injection. This article, will review reports of treatment of ecchymosis by lasers and IPL.

BACKGROUND Microneedling fractional radiofrequency (FRF) and chemical peels are widely used for skin rejuvenation. OBJECTIVE The authors aimed at evaluating the efficacy and safety of FRF and trichloroacetic acid 20% (TCA20%) peel in different combinations for determining the optimal treatment protocol. METHODS In this prospective clinical comparison of 4 protocols (FRF alone, TCA20% alone, TCA20% before FRF [TCA→FRF], and TCA20% following FRF [FRF→TCA]), the patients underwent 3.8 ± 1.2 successive treatments of one protocol at 4- to 6-week intervals. The patients and 2 dermatologists evaluated improvement of pigmentation and dyschromia, erythema and blood vessels, laxity and wrinkling, and skin imperfections using a global aesthetic improvement scale (GAIS) and a 1 to 5 scoring system. The patients rated their satisfaction and reported adverse effects and reduced activity. Skin impedance and histological changes following the different protocols were also evaluated on 3 additional volunteers. RESULTS Sixty-seven patients (age range 22–80 years) were studied. TCA→FRF caused skin impedance to decrease, yielding a more superficial and less-efficient penetration of FRF energy. FRF→TCA produced more significant improvement in overall facial skin appearance (GAIS) and most evaluated skin parameters. Adverse effects and satisfaction rates were similar for all approaches. CONCLUSION FRF→TCA had the best synergistic effect on skin rejuvenation compared with FRF or TCA20% alone and TCA→FRF.