Exuberant delayed granulomatous reaction to hyaluronic acid filler material

Dermal fillers are increasing in popularity, especially among young females. Hyaluronic acid is a commonly used injectable material with a relatively safe profile and rare adverse events. In this case, a 34-year-old female patient presented to the oral and maxillofacial clinic in Hafar Al-Batin, Saudi Arabia, with right-sided facial swelling for 1 year. Patient history revealed injection of dermal cosmetic material for 10 years. Magnetic resonance imaging revealed a subcutaneous collection with an irregular wall and adjacent fat stranding. The swelling was removed under general anesthesia, and the tissue was sent for histological diagnosis. The pathological findings included a collection of multinucleated giant cells surrounding cystic spaces filled with frothy, deep blue secretion consistent with foreign body granuloma to hyaluronic acid.