Delayed complication of botulinum toxin and hyaluronic acid filler injections: A case report.

[BACKGROUND] Botulinum toxin and hyaluronic acid (HA) filler injections are popular minimally invasive cosmetic procedures owing to their convenience, efficiency, and durability; however, adverse reactions often occur.

[MATERIALS AND METHODS] We describe the delayed hypersensitivity reaction that occurred after sequential injections of botulinum toxin and HA filler.

[RESULTS] The histopathologic and dermatoscopic findings suggested a delayed hypersensitivity reaction with the formation of a dermal foreign body granuloma. The rash resolved 2 months following treatment with antihistamines and topical steroids cream.

[CONCLUSION] We assume that local trauma during the blepharoplasty stimulated an immune response, which was the basis for this complication.