Radiesse-induced herpes zoster

Radiesse is a filler material for deep nasolabial folds that was recently approved by the United States Food and Drug Administration. It is composed of calcium hydroxylapatite crystals measuring 25 mum to 45 mum. Few complications have been reported to date. We present a case of a woman who developed herpetic appearing skin lesions after the injection of Radiesse in the glabella. She noted tenderness and tingling along with redness and bumps. The vesicles were isolated to the right ophthalmic branch of the trigeminal nerve distribution and the skin was erythematous with associated pustules. After disease progression while on systemic antibiotics, she improved markedly when started on antivirals. Three days later the tingling resolved, the erythema was markedly improved, and the vesicles started to resolve. She had returned to baseline after a month. Physicians should be suspicious for herpetic infection or reactivation with facial injections of Radiesse or other fillers and should initiate immediate treatment with oral antivirals upon identifying the above signs and symptoms.