Management of Hyaluronic Acid Filler–Induced Refractory Sterile Abscess With Modified Munhoz-Cavallieri Lavage Protocol: A Case Series

Abstract

Background: The number of cosmetic procedures using hyaluronic acid (HA) has grown significantly in recent years and, consequently, the number of HA injection-induced complications has also increased. The recognition of sterile abscess as a complication of HA fillers is relatively recent and can evolve to disfigurement. Ultrasonography (USG) examination can be an important tool to diagnose, monitor, and guide therapeutic interventions in filler complication scenarios. Despite the number of complications after filling with HA increasing in scientific publications, especially in the last 5 years, dermatologists are still learning to manage these events and there is no standardized treatment consensus. Aims: The cases herewith report the successful treatment of HA injection-induced refractory facial sterile abscess, including the safety of high doses of hyaluronidase. Patients/Methods: Four adult women with refractory facial sterile abscesses due to HA filler were treated with high doses of hyaluronidase (range: 22 500–258 000 IU) by modified Munhoz-Cavallieri lavage protocol after unsuccessful treatment, including antimicrobials, corticosteroids, and simple drainage. Results: All patients required two or more lavages for resolution, with a minimum interval of 48 h and presented complete resolution of the refractory sterile abscesses with no relapse. Conclusion: The cases herewith emphasize the importance of recognizing and correctly managing sterile abscesses to determine a favorable outcome during clinical practice, avoiding prolonged and ineffective treatment, as well as the relevance of USG to the diagnosis, guidance of intervention, and treatment monitoring of filler complications.