Delayed Hypersensitivity Reaction to Restylane® SubQ

Abstract

Purpose: To report on 4 patients who developed delayed hypersensitivity reactions to Restylane® SubQ and their management. To our knowledge, no cases of delayed hypersensitivity to Restylane® SubQ have been previously reported.Methods: A retrospective case series of 4 patients who were treated with preperiosteal Restylane® SubQ to their cheeks, for facial volume augmentation. All 4 patients were subsequently referred with delayed hypersensitivity reactions over a 4-month period.Results: The hypersensitivity reactions occurred from 1 week to 4 months’ post-cheek augmentation using Restylane® SubQ. All patients had previously (and some since) been treated with other non-animal stabilized hyaluronic acid (NASHA) products without adverse effect. Hyaluronidase led to fast and effective resolution in all cases, although 2 of the patients required repeat treatment.Conclusion: Hyaluronidase was effective at treating the inflammatory reaction and breaking up the retained Restylane® SubQ in all patients. Although Restylane® SubQ should be avoided in these patients, in our experience this does not preclude them from using other similar NASHA products.