摘要

Objectives: The IMCAS Alert facility is structured to assist and support colleagues in the management of troubling cases in their practices. An international array of colleagues readily and voluntarily participate in response tendering advice and discussion with the objective of resolving the case. The process of case submission, discussion and resolution can prove professionally nurturing for all participants and readers. Introduction: This case presentation refers to a submission to the IMCAS Alert forum titled "Late Onset Inflammatory Reaction to Hyaluronic Acid" https://www.imcas.com/en/academy/alert/injectables/2619/late-onset-inflammatory-reaction-to-hyaluronique-acide The overriding concern was an inflammatory swelling bilaterally of the lower face. The swelling was described as being without local heat or redness with 3cm lumps bilaterally. Materials / method: Case presentation submitted by author colleague Responding colleagues post suggestions and a discussion ensues among all participants. Results: In this case submission, responses revolved around several issues and possibilities including: Infective or allergic aetiologies of the presenting inflammation; Delayed filler inflammatory reactions; Hyaluronidase dosage; Filler migration; The value and interpretation of ultrasound in diagnosis and indeed differential diagnosis between filler nodules and filler granulomas ; Rheological filler selection; The amount of fillers injected. Conclusion: A challenging case was submitted with many insightful responses. Conclusive follow-up on the case is still outstanding at this time.