Are Delayed Dermal Filler Granulomas More Common Since COVID-19?

Abstract

PurposeGranuloma and delayed inflammatory reaction to hyaluronic acid (HA) facial esthetic fillers occurs rarely. More recently, these reactions have been reported with increasing frequency and have been associated with COVID-19 infection. The purpose of the study is to determine if delayed filler granulomas are more common after the start of the COVID-19 pandemic.MethdosA retrospective cohort study including of all patients treated with dermal filler at 4 offices of a single cosmetic surgery practice between August 1st, 2018 and October 31st, 2021 was performed. The primary outcome variable was granuloma formation. The primary predictor variable was time period, either pre-COVID (8/1/18-2/29/20) or post-COVID (3/1/20-10/31/21). Other study variables recorded were age, amounts of dermal fillers used, and types of dermal filler used. Data was analyzed using chi-squared, t-tests and logistic regression.ResultsOver the study period, 3,255 patients receiving 8,067 syringes of filler over 6,800 sessions were reviewed. The average patient age was 46.8 ± 13.7 years and 2,583 sessions were performed in the pre-COVID time period and 4,217 sessions in the post-COVID time period. There were 11 granulomas in 9 subjects receiving filler in the post-COVID time period and 0 granulomas in the pre-COVID time period (0.3% vs 0.0%, respectively, p = 0.009). Juvederm Vollure was used in 64% of patients who developed granulomas, but only accounted for 26% of filler administrations in the post-COVID time period and 28% in the cohort overall (p=0.02).ConclusionGranuloma formation is a rare complication of HA filler injection that appears to be occurring with more frequency following the COVID-19 pandemic. Practitioners who administer dermal fillers should be aware of this complication and its apparent increased incidence