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Objectives: Presentation of a Delayed HA volumetric filler Inflammatory Reaction (DIR) in a 59 y.o. female Patient affected by quiescent autoimmune thyroiditis well compensated with low dose synthetic thyroid hormone therapy.

Introduction: We present a Delayed HA volumetric filler Inflammatory Reaction (DIR) in a 59 y.o. female Patient affected by quiescent autoimmune thyroiditis well compensated with low dose synthetic thyroid hormone therapy. DIR could be possibly interpreted as linked to the super-antigens theory and/or bio-film theory. One-ml HA filler volume per session and deep bolus injection technique were performed. Progressively enlarging, painful inflammatory swelling was observed in September 2020 on left zygomatic malar region.

Materials / method: In October Patient was initially treated with oral antibiotic (amoxicillin + clavulanic acid) and anti-inflammatory medications obtaining a significant reduction of symptoms and clinical inflammatory signs, but pinpoint oozing skin ulcerations were observed. Hydrogen peroxide 3% solution was used to irrigate subcutaneous cavities and another course of oral antibiotic was prescribed obtaining a partial reduction of clinical signs. In November 2021 plastic surgeon became positive to Covid-19 and Patient was referred to Plastic Surgery department of the local University Hospital in January.

Results: A series of non-invasive and invasive diagnostic procedures were performed. A 7mm x 6.5mm subcutaneous fluid mass was confirmed by sonography, Bacteriological swab came in negative twice, 15mm local biopsy confirmed the presence of giant cells and eosinophils commonly observed in foreign body reactions. Incision and drainage procedures were performed followed by partial reduction of clinical signs.

Conclusion: Once discharged by Plastic Surgery Department, Patient was referred to National University Center for Filler Complications and treated with intralesional hyaluronidase (3 infiltrations) and prolonged (2 months) oral antibiotic with complete remission of symptoms and clinical signs.

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Objectives: A complication in the last thing that any aesthetic physician would want to face, but we all know that aesthetic procedures are associated with potential complications and that it is critical for doctors to not only master relevant techniques but also learn to manage complications effectively.

Introduction: I present thirty cases of complications from the period 1999-2022. Combines the early days of treating HIV with Sculptra and later BioAlcamid, the onset of Bird Flu and Mad Cow Disease changing American attitudes to collagen, the problems with Sculptra in the Covid booster era, how to treat Granulomas, Biofilms, and Vascular occlusions. The early days of hyaluronidase. The problems with silicone implants. Interesting historical lecture

Materials / method: Oral antibiotics and steroids
Methotrexate
Intralesional steroids
Hyaluronidase
Stem cells and PRP
Surgery

Results: In conclusion, complications are inevitable in aesthetic practice; however, the challenge lies in handling them carefully and successfully to enable us to carry on our work with the same enthusiasm we started with.

Conclusion: The author has twenty years of a database of patients whom he has treated

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