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.