Persistent Nodules on Necklines Following Hyaluronic Acid Filler: A Case Report.

Necklines are a common complaint in patients as they are a sign of aging. Hyaluronic acid (HA) fillers are widely used to address volume loss and linear depressions. HA fillers are safe, effective, and versatile, but their use for necklines is not well-documented in the literature. To report a rare case of persistent, treatment-resistant early-onset nodules in the neck follwoing HA "skin booster" filler injection. Furthermore, to highlight the importance of injector expertise as this complication often arises from technical error. A 40-year-old woman presented with nodules on the neck following HA "skinbooster" filler (Restylane Vital; Galderma; Sweden). The nodules were firm, non-tender, non-inflamed, and located in the superficial layer of the skin, suggesting that a superficial injection of the filler had been performed. She reported undergoing five separate sessions of hyaluronidase, yet no improvement was observed and the nodules persistent for 6 months afterwards. At 1 week, significant reduction in neck nodules after 300 IU/mL of hyaluronidase was injected. The patient reported high satisfaction with the outcome. This case highlights the importance of injector expertise and technique, especially when treating critical areas like the neck. Moreover, further research is needed to determine the optimal protocol for persistent and treatment-resistant complications such as this case.