Introduction: In the last decade, the use of hyaluronic acid fillers for facial enhancement has increased in Latin America. Hyaluronic acid fillers are considered relatively safe with a low incidence of adverse events. Because adverse events are not seen frequently in clinical practice or have been potentially underreported, there is a need for more guidance on the diagnosis and treatment of Hyaluronic acid-related adverse events. Objective: To provide an enhanced understanding of hyaluronic acid-related adverse events and to propose recommendations for their diagnosis and treatment. Methods: A 25-member multi-disciplinary expert panel meeting of Latin-American physicians was convened in Sao Paulo, Brazil to discuss what is known about hyaluronic acid-related adverse events and to provide insights based on clinical experience. Recommendations and algorithms were developed through a consensus process. Results: The panel categorized hyaluronic acid-related adverse events based on 3 time frames of onset (immediate, early and Late) and proposed a new term for adverse events that display persistent, intermittent, delayed Swelling (PIDS). Algorithms were created for diagnosis and treatment for each time frame. Conclusions: The new consensus algorithms for time-related diagnosis and treatment of hyaluronic acid-related adverse events will provide guidance for best practices in the clinical use of hyaluronic acid fillers.

Keywords: COSMETIC TECHNIQUES; DERMAL FILLERS; HYALURONIC ACID; INFLAMMATION; SUBCUTANEOUS INJECTIONS

Introduction: The use of hyaluronic acid fillers (HA) for esthetic corrections has exponentially grown in recent years. Skin ultrasound (US) is an effective method to identify the filler and its complications. A particular type of adverse effect, characterized by late, persistent edema of an intermittent nature, has been lately observed. Objective: To describe a delayed complication due to easy HA fillers, named by the authors as Persistent, Intermitent Delayed Swelling (PIDS). Methods: From October 2016 to July 2017, US examinations performed at Cavallieri Clinic were selected and referred for evaluation of post-filler complications. Questionnaires were sent to requesting physicians for clinical data collection. Results: Of 108 exams, 33 cases of local subcutaneous edema associated with the presence of HA fillers were identified. Episodes of edema were referred to as recurrent, in the previously affected area, or at another injection site. Conclusion: The authors propose a specific nomenclature: PIDS to refer to this late adverse reaction to HA fillers, which includes delayed and intermittent local swelling, triggered by specific conditions, that persists for as long the HA remains in the subcutaneous tissue.

Keywords: DERMAL FILLERS; HYALURONIC ACID; ADVERSE EFFECTS; SKIN ULTRASOUND

The COVID-19 pandemic represents an unprecedented healthy global threat, leading dermatologist surgeons/aestheticians to interrupt or alter clinical practice and adjust to the necessary precautionary methods. This article aims to prepare dermatologists for the upcoming difficulties and precautions for conducting procedures in the midst of coronavirus pandemics, focusing on recommendations and best practices for reopening aesthetic practice while mitigating risks to practitioners, patients, staff, and the general public.

Keywords: COVID-19; Dermatology; Pandemic; Physicians’ office, SARS-CoV-2.