Background Injectable dermal fillers are widely used in aesthetic medicine; however, immunologically mediated hypersensitivity reactions may negatively influence clinical and aesthetic outcomes. Understanding their incidence, clinical presentation, and consequences is essential for improving patient safety and treatment effectiveness. Objective To evaluate the incidence, clinical characteristics, and impact of hypersensitivity reactions on aesthetic outcomes after dermal filler injections. Methods A prospective observational study included 92 patients aged 25–64 years who underwent cosmetic filler injections at an aesthetic clinic in Poland between November and December 2024. The fillers used included hyaluronic acid, calcium hydroxyapatite, and polycaprolactone-based preparations. Patients were monitored for 30 days with follow-up visits on days 3, 7, 14, and 30. Hypersensitivity reactions were classified according to the Gell–Coombs classification (types I and IV). Clinical manifestations, severity, and laboratory parameters (IgE, C-reactive protein, and procalcitonin) were evaluated in selected cases. Aesthetic outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) and a Visual Analogue Scale (VAS) of patient satisfaction. Results Hypersensitivity reactions occurred in 21 patients (22.8%). Delayed type IV reactions predominated (13.0%) and manifested with infiltrates, erythema, and pain occurring 5–14 days after injection, whereas immediate type I reactions were recorded in 9.8% of patients within the first 72 h. The highest reaction rates were observed with calcium hydroxyapatite and polycaprolactone fillers. Severe reactions required systemic therapy and were associated with elevated IgE levels in most cases. Patient satisfaction was significantly lower in the reaction group (VAS 5.9 ± 1.8 vs. 8.4 ± 1.1; p < 0.01). All reported aesthetic complications, including fibrosis and hyperpigmentation, occurred exclusively in patients with hypersensitivity reactions. Conclusion Hypersensitivity reactions to dermal fillers occur relatively frequently and significantly affect aesthetic outcomes and patient satisfaction. Individual risk assessment, careful filler selection, and extended post-procedure monitoring are necessary to minimise complications. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.

Hypersensitivity Reactions to Injectable Fillers and Their Impact on Cosmetic Procedure Results

期刊论文
发表日期：

2026年6月15日

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Maria Zofia Lisiecka,
Joanna Luczak

摘要

Background

Injectable dermal fillers are widely used in aesthetic medicine; however, immunologically mediated hypersensitivity reactions may negatively influence clinical and aesthetic outcomes. Understanding their incidence, clinical presentation, and consequences is essential for improving patient safety and treatment effectiveness.

Objective

To evaluate the incidence, clinical characteristics, and impact of hypersensitivity reactions on aesthetic outcomes after dermal filler injections.

Methods

A prospective observational study included 92 patients aged 25–64 years who underwent cosmetic filler injections at an aesthetic clinic in Poland between November and December 2024. The fillers used included hyaluronic acid, calcium hydroxyapatite, and polycaprolactone-based preparations. Patients were monitored for 30 days with follow-up visits on days 3, 7, 14, and 30. Hypersensitivity reactions were classified according to the Gell–Coombs classification (types I and IV). Clinical manifestations, severity, and laboratory parameters (IgE, C-reactive protein, and procalcitonin) were evaluated in selected cases. Aesthetic outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) and a Visual Analogue Scale (VAS) of patient satisfaction.

Results

Hypersensitivity reactions occurred in 21 patients (22.8%). Delayed type IV reactions predominated (13.0%) and manifested with infiltrates, erythema, and pain occurring 5–14 days after injection, whereas immediate type I reactions were recorded in 9.8% of patients within the first 72 h. The highest reaction rates were observed with calcium hydroxyapatite and polycaprolactone fillers. Severe reactions required systemic therapy and were associated with elevated IgE levels in most cases. Patient satisfaction was significantly lower in the reaction group (VAS 5.9 ± 1.8 vs. 8.4 ± 1.1; p < 0.01). All reported aesthetic complications, including fibrosis and hyperpigmentation, occurred exclusively in patients with hypersensitivity reactions.

Conclusion

Hypersensitivity reactions to dermal fillers occur relatively frequently and significantly affect aesthetic outcomes and patient satisfaction. Individual risk assessment, careful filler selection, and extended post-procedure monitoring are necessary to minimise complications.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.