Journal of Asia Pacific Aesthetic Sciences

Abstract: The use of hyaluronic acid (HA) fillers has become increasingly popular for facial contouring and rejuvenation. Although generally considered safe, HA fillers can occasionally lead to chronic inflammatory reactions, particularly in individuals with underlying skin conditions. These complications may manifest as persistent erythema, telangiectasia, and granulomatous inflammation, often resulting from filler migration and related microvascular changes. This study aims to evaluate the efficacy of ultrasound-guided hyaluronidase treatment for chronic inflammatory reactions to HA fillers. This case series presents seven female patients, aged 29–58 years, with chronic complications following HA filler treatments. All patients underwent clinical evaluation using cross-polarized imaging with the OBSERV® 520x to assess surface erythema and vascular patterns, as well as high-frequency ultrasound to detect subsurface abnormalities, including filler migration and vascular congestion, before treatment. Ultrasound-guided hyaluronidase injections were administered over two to four sessions. Patients were evaluated at 1 month and 6 months to assess the resolution of complications. Baseline evaluation revealed persistent complications in all patients, including erythema, nodular inflammation, and telangiectasia. Post-treatment findings showed significant improvements, including a reduction in erythema, resolution of nodular inflammation, and normalization of vascular flow patterns. Mild, transient swelling at the injection sites was the only reported adverse effect. This study highlights the utility of ultrasound imaging for diagnosing and managing chronic HA filler complications. The integration of ultrasound imaging may enable more precise diagnosis and treatment, reducing diagnostic uncertainty and improving patient outcomes.