Dermal Filler-Induced Alopecia: A Case Report and Literature Review

Dermal filler-induced alopecia is a rare yet significant complication of aesthetic procedures primarily associated with vascular occlusion and subsequent tissue ischemia. Hyaluronic acid (HA) fillers, though widely used for facial rejuvenation, can lead to adverse outcomes such as skin necrosis and hair loss, particularly in high-risk areas like the temples and glabella.

This case report aims to highlight the clinical presentation, diagnostic approach, and multidisciplinary management of filler-induced alopecia, contributing to the existing literature with a comprehensive review of previously reported cases.

A 21-year-old female presented with localized skin necrosis and alopecia four days after receiving 7 mL of HA filler injections in the temples, tear trough, and eyebrow glabella regions. Trichoscopy revealed follicular dropout and white dots, consistent with ischemic hair loss. Treatment included hyaluronidase injections (1500 units), intralesional corticosteroids, topical minoxidil, and CO₂ laser therapy. Over 1 year of follow-up, the patient achieved complete hair regrowth and resolution of facial scarring.

Only 16 cases of filler-induced alopecia have been documented, predominantly involving HA fillers. This case underscores the importance of early recognition and intervention with hyaluronidase to mitigate ischemic damage. The multidisciplinary management approach employed here demonstrates the potential for full cosmetic recovery.

Filler-induced alopecia, though rare, necessitates heightened awareness among dermatologists and aesthetic practitioners. Adhering to recommended injection techniques and dosages, alongside the judicious use of ultrasound guidance, can minimize risks and improve patient safety.