Late Complications of Biopolymers in Aesthetic Medicine: Clinical Presentation, Diagnosis, and Management

Permanent biopolymers used as dermal fillers may cause delayed complications due to chronic foreign body inflammation, progressive fibrosis, and, in severe cases, systemic manifestations such as granulomatous hypercalcemia and renal impairment. Late complications may occur years after injection and range from localized nodules, induration, and deformity to material migration and systemic involvement, often mimicking infectious, neoplastic, or autoimmune conditions. Diagnosis relies on clinicoradiographic correlation, with magnetic resonance imaging playing a central role in defining disease extent and ultrasound serving as a useful adjunct for initial evaluation. Management should be individualized according to disease severity. Medical therapy has a limited role because of the persistence of the material, whereas surgery remains the cornerstone of treatment in moderate to severe disease despite challenges in complete resection. Early recognition, multidisciplinary evaluation, and severity-based management are essential to optimize clinical and aesthetic outcomes.