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While most nontender non-Arab and the nodule are result of the uneven distribution of product or superficial injection. I need become apparent within the first week after injection. The nodule can be avoided with small microinjections called the multiple puncture technique and did nodule can be treated after they occur with and the massage his mood and redistribute the product. However, it nodule or persistent painful or Arab and that in this case or if they appear greater than two weeks after injection, you should consider a possible infection. Finally, the last thing you need to think about it considering a possible granulomatous inflammatory response which has been only very rarely reported with hyaluronic acid fillers.

Dr. Niccolo has cited the incidence of granulomatous reactions to be only 0.4% with hyaluronic acid fillers and a recent interesting article in binary and at all in the October 2009 issue of dermatologic surgery, stating that these granulomatous responses may actually be a result of reaction to biofilms forming around the product rather than a true allergic response to Kim how would you treat these inflammatory nodules in generalities nodules are usually self resolving and we can just observe and follow than the nodules that formed earlier can lead to nodules that one can massage out so we advise patients to massage now if the nodule is a little but more persistent than topical tacrolimus ointment can be used in antibiotic such as clerical mice and has been used in the past and one can use this more and a dose of anti-inflammatory dose rather than using it as an antimicrobial dose to target specific infection because in general, these are more inflammatory like nodules rather than infectious process. The nice thing about the hyaluronic acid filler is that we can use hyaluronidase to break this product down so hyaluronidase is something that if you're going to be injecting patients with fillers is something they may want to keep in your office that you can do for superficial nodule is to actually compress the product out by nicking the skin and squeezing out the product and physically removing the product. Finally intralesional steroid injection can be used to decrease inflammation at the nodules the messengers recently there have been a few helpful treatment algorithm for managing complications after the injection at the publish in our literature and one of the most helpful that I found was by the funny and in October 2009 issue of dermatologic surgery. They think that one should begin with enteric anabiotic such as clarithromycin or doxycycline for 46 weeks, but there's no improvement after 48 hours on antibiotic.

They recommended giving a 2 mm punch badly or aspiration of the area is material for tissue culture and in addition they also state that it hyaluronic acid filler refused hyaluronidase should be in after you remove tinnitus for an infection and if there are no signs of infection, then that's the point when you can consider using intralesional catalog ministering hyaluronidase as the basics. If you would Dr. Mac under well first you should consider skin testing prior to use in some patients have allergic reactions to the product as the three formulations available are derived from bovine or ovine source as it can be done with intradermal injection of three units of hyaluronidase into the forearm and then observing the patient for five minutes to determine if the Wheeler flare reaction and if not, then the nodules can be injected with hyaluronidase and many authors recommend deluding us product with 1% lidocaine with (and several kids reports cited efficacy as injection of 15 units per nodule. Initially, many patients are typically followed up in one week to assess if any repeat treatment of me dad many. The report states that the effect of hyaluronidase should be seen within 17 days after it ministration and I think another useful application for how to run a date.

In addition to removing the nodules or rhinitis of infection is also for the management of an acute arterial or venous occlusion may occur secondary to hyaluronic acid filler ministration from this product is an important product that we need to keep in our office to our armamentarium Ferdinand you have chronic acid fillers can often times we need to prepare ourselves for version an immersion situation and with similar injection really the most version or immersion case would be if one does inject intravascular needs and as Dr. McIntyre discussed hyaluronidase is very important to break down the hyaluronic acid may inadvertently injected into the vessel intervene in a system or carrier system. In addition to hyaluronidase was important for injector to having our office would be to present Nitro piece that can be applied to in case of an emergency, and in addition, Hattie has been available for patients to take immediately to them, but it's very important in general it is an arterial injection. It's very important to also use warm compresses to dilate the vessels to Kim that the McInturff is looking to the future force a little bit if you would what you see in the horizon in the area filler treatment. Dr.

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