Abstract
Sir, the report of arterial embolism caused by one of the hyaluronic acid (Restylane) fillers1 is an important reminder that dermal fillers are not without a variety of safety concerns.2, 3 I have observed a vascular problem in the upper lip that resulted from a delayed Restylane reaction causing venous occlusion with a resulting varix and persistent tissue swelling that has lasted 6 years. The varix was confirmed by skin biopsy, there being no residual detectable hyaluronic acid using appropriate histopathological stains. In addition, the authors may be interested in our recently published paper on hyaluronic acid dermal filler reactions and skin testing.2 We have in this paper documented delayed reactions to Hylaform and Restylane in approximately 0·4% of 709 patients. They were seen between 1996 and 1999. It is to be noted that the reaction rate to Restylane has decreased since 1999 when the formulation was changed (Lowe NJ, manuscript in preparation).
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