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Objectives: The objective of this study was to evaluate the efficacy of using the immunosuppressant methotrexate to treat COVID-19 vaccine-related delayed onset nodules in twenty-three patients with moderate facial disfigurement unresponsive to established treatment protocols, including intralesional steroids and hyaluronidase.

Introduction: DURING THE COVID-19 PANDEMIC, dermal fillers made world headlines as it was reported that patients who had cosmetic fillers experienced side effects after receiving vaccines that utilised both viral vector and mRNA technology.

Materials / method: Methotrexate is a chemotherapy agent and immune system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancies. It is particularly used to reduce the activity of the immune system when it mistakenly attacks parts of the body, such as skin and joints, causing illness. Methotrexate is used to treat rheumatoid arthritis, psoriatic arthritis, vasculitis, systemic sclerosis, and severe psoriasis.

Results: All patients successfully responded to 10 mg of methotrexate for three months and all their nodules dissipated. One patient had to stop the treatment in week ten due to moderately severe anergia.

Conclusion: The treatment protocol above was submitted and accepted by peer review at both the AIDA Dermatology Conference in Abu Dhabi (May 2022) and the IMCAS World Conference in Paris (June 2022). It has changed the lives of many patients by reducing the distress caused by this condition.

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Objectives: To describe the anatomy of malar & infraorbital edema
To educate on how to prevent this common side effect when injecting the cheeks and undereye.
To review a protocol for treatment of this condition

Introduction: Now that infraorbital hollow filler is more popular, malar and undereye swelling is becoming more common. While this condition is one of the more difficult ones to treat, we present several cases that were remedied with filler below the malar septum and micro-dose hyaluronidase above.

Materials / method: We will present several cases of malar and infraorbital edema and show step by step how the issue was corrected and how the patients have been maintained for many years.

Results: Before and After photos and videos will show the patients results

Conclusion: There are many more side effects when treating under the eye, however after treating hundreds of side effect referrals, there has yet to be one patient that has not been able to be corrected back to baseline with this new protocol presented.

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