Ofir ArtziJoel L. CohenJeffrey S. DoverAtchima SuwanchindaTatjana PavicicMarina LandauGreg J. GoodmanSahar GhannamFiras Al NiaimiJani A.J. van LoghemKate GoldieSonja SattlerDaniel CassutoTing Song LimRungsima WanitphakdeedechaInes VernerTanja C. FischerVivian BucayEli SprecherDana ShalmonAlexandria UniversityUniversità degli Studi di Roma La SapienzaMae Fah Luang UniversityMonash UniversityUniversity of Texas Health Science Center at San AntonioYale School of MedicineFaculty of Medicine, Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine, Siriraj Hospital, Mahidol UniversityThe Warren Alpert Medical SchoolTel Aviv Sourasky Medical CenterGoethe-Universität Frankfurt am MainTel Aviv University, Sackler Faculty of MedicineClique ClinicUMA InstituteAboutSkin Dermatology and AboutSkin ResearchDermatologyVerner ClinicPrivate PracticeEuropean Medical Aesthetics LtdPrivate Practice for Dermatology and AestheticsSkinCare PhysiciansSkin and Laser Center PotsdamRosenparkklinik2020-06-022020-06-022020-01-01Clinical, Cosmetic and Investigational Dermatology. Vol.13, (2020), 371-378117870152-s2.0-85085349655https://repository.li.mahidol.ac.th/handle/20.500.14594/56332© 2020 Artzi et al. Background and Objectives: There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose. Materials and Methods: A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists. Results: Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3–6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement. Conclusion: A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.Mahidol UniversityMedicineArticleSCOPUS10.2147/CCID.S247171