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To date the market provides a wide variety of hyaluronic acid types. On sonography, pure low density hyaluronic acid usually lasts between 3 to 6 months; however, the new high density types of hyaluronic acid seem to last beyond 2 years.  It seems that these high density hyaluronic acids are much more synthetic than biodegradable. Are you following patients with high density hyaluronic acid on sonography? Have you seen complications with high density hyaluronic acid in the long term follow-up?

More info on the sonographic appearance of cosmetic fillers in: J Ultrasound Med. 2015 Jul;34(7):1163-72.

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No, just this moment i dont'see any particolar complication


I have seen two complications of late foreign-body reactions after 30 months of the hyaluronic filler injection. In both cases the filler used was Volbella, and in both cases the reaction occurred in the infrapalpebral sulcus, bilaterally. Both cases ended up going to plastic surgery, because conservative treatment did not work (including hialuronidase, antibiotics and a bunch of corticosteroids). The histopathology report after the surgery included the presence of the hyaluronic acid plus granulomatous reaction. In attachment, the sonographic features of one of those cases, showing a hypoechoic fusiform mass, restricted to the subcutaneous tissue, not well defined, and showing diffuse vascularization with Doppler. 

In a third case, I could also see the presence of the hyaluronic acid, but in a pseudo-cystic conformation, without inflammatory signs, also in the infrapalpebral sulcus, after almost 2 years of injection. 


I have seen several granulomas post-injection with high density hyaluronic acid even after  2,5 years of injection , and also fluid -filled cavities and fistulous tracts post-injection with mixed formulations of hyaluronic acid and lidocaine. However, these complications seem to be much more common after the second injection of fillers and even more frequent in patients with previous injections of non-approved agents such as silicone oil.  Sometimes we find 2 or 3 types of fillers in the face of the same person.

As described above I also have seen many cases of fillers (including hyaluronic acid) forming granulomas, fistulas, inflammatory processes and fluid-filled cavities, early and late. Another aspect is that in many cases neither the referring physician nor the patient knows what kind of material was placed.

What I can confirm, in terms of my personal experience, is that by now I did not notice any difference between old and new hyaluronic acid types.

Hello Fernanda! How good to see you here in  the group!

We had a case of capsulation of highly reticulated HA with extensive  migration . The trademark was Voluma.As Fernanda, Marcio  and Ximena say there are three kind of reactions:

  • Purely  related to the filler  (migration, compresion, fistulization ) ,
  • Purely inmunologically related with filler ( we biopsied some of the second type  and the histology was neutrophilic infiltrate without a trace of foreign body).
  •  Third mixed group like the patients of Fernanda that have both components


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