Incidence and treatment of delayed‐onset nodules after VYC filler injections to 2139 patients at a single Canadian clinic

BACKGROUND: Data suggest that hyaluronic acid (HA) fillers using VYC technology have a higher incidence of delayed-onset nodule development at facial injection sites than earlier HA products. OBJECTIVE: To assess the incidence of delayed-onset nodules with VYC products based on a single experienced injector. METHODS AND MATERIALS: Patients with delayed-onset nodules after injections with VYC-20L, VYC-17.5L, and VYC-15L were identified by retrospective chart review. RESULTS: Since 2010, 2139 patients received injections from the same physician with combinations of VYC-20L (57.6% of patients; 2.4 syringes/patient), VYC-17.5L (23.9%; 1.5), or VYC-15L (18.5%; 1.5). Seven female patients (mean age, 62 years) developed delayed-onset nodules for an overall incidence of 0.33%. A potential inflammatory trigger (reported by 6 patients) occurred 1-168 days prior to nodule development. Nodule biopsy in 1 patient confirmed a foreign-body granuloma. The most effective treatment incorporated prednisone with or without hyaluronidase, and in 2 patients, nodules resolved spontaneously. The incidence of delayed-onset nodules was not associated with injection technique or amount of product used. CONCLUSION: VYC-associated incidence of delayed-onset nodules (0.33%) was lower than earlier estimates from previous studies. In the current analysis, VYC-15L had a rate of delayed reactions comparable with non-VYC products.