Table 3.

Guidance for Managing Late-onset Nodules after Hyaluronic Acid Filler Administration

Hyaluronidase may not provide resolution as the sole treatment

Less likely to resolve nodule if treatment is delayed

Should not be the first course of action for all late-onset nodules

Should only be used with concomitant antibiotics in cases of suspected active infection

May require repeat injections for full resolution of late-onset nodules

H2 antagonists/antihistamines and topical steroids may improve the symptoms of late-onset nodules, but they do not effectively treat the cause

Oral antibiotics, intralesional antibiotics, oral steroids, and nonsteroidal anti-inflammatory drugs are effective against late-onset nodules

5-FU and intralesional steroids should be used when other treatment modalities have been exhausted

Surgical excision should be considered only as a last resort

Combination therapy is the most effective way of treating late-onset nodules

5-FU, 5-fluorouracil.