key: cord-0897197-a87oyp25
authors: Buzzaccarini, Giovanni; Borin, Marco; Diffidenti, Bianca; Varì, Simona; Di Gioia, Milvia; Albini, Maria; Noventa, Marco; Laganà, Antonio Simone
title: Addressing the safety of hyaluronic acid dermal filler injections during the SARS CoV-2 pandemic worldwide vaccination.
date: 2021-09-20
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2021.08.037
sha: 6ab50ec3e58f49e49ed47e1a2814c3c91d24782d
doc_id: 897197
cord_uid: a87oyp25

nan

Dear Editor, We recently read the American Society of Plastic Surgeons (ASPS) guidance concerning FDA reported adverse events in patients with dermal fillers receiving the SARS-CoV-2 mRNA vaccine. Since the importance regarding the safety of aesthetic procedures and the current worldwide pandemic, we decided to address the safety of hyaluronic acid (HA) dermal filler procedures during the SARS CoV-2 vaccination campaign.

Data from literature investigates possible (HA) dermal filler adverse events related to the SARS CoV-2 vaccine. For instance, Gotkin et al. recently addressed the question and designed a survey in order to detect correlations between soft tissue filler injections and any of the SARS CoV-2 vaccines globally available. The data collected did not support any increased risk of developing soft tissue filler adverse reactions associated with the SARS CoV-2 vaccines compared to other previously described triggers (Gotkin) . By contrast, in their study, Munavalli et al. presented the first reported cases of delayed inflammatory reactions (DIR) to hyaluronic acid (HA) dermal filler injections after SARS CoV-2 vaccine inoculation. Among these, two cases were related to mRNA-1273 (Moderna) vaccine and one case to BNT162b2 (Pfizer) inoculation (Munavalli) . The patients presented localized symptoms such as primarily edema, erythema, tenderness, swelling. Moreover, formation of painful indurated plaques and nodules occurred in one case requiring treatment with hyaluronidase. The authors believe that the DIR of dermal filler was triggered by the exposure to the SARS CoV-2 spike protein, which could explain the local reaction to HA filler. All the reported reactions were temporary and resolved within a few days.

Given this background, the ASPS recommendation states that patients should not be discouraged from receiving the SARS CoV-2 vaccine. However, patients should be adequately informed before undergoing the aesthetic procedures and a complete medical anamnesis should be obtained before the aesthetic procedure.

However, we notice that Rice et al. performed a review of the literature addressing the same question. They suggest that providers may consider a 4 to 8 week window (before or after) between the SARS CoV-2 vaccine and HA filler injections for the general population. Moreover, this window should be potentially longer for patients with autoimmune risk factors or immunologic disorders, and those with previous dermal filler reactions.

It is of paramount importance to encourage all our patients to abide by the vaccine schedule. Due to a lack of safety data with regards to the causal link between the SARS CoV-2 vaccination and the delayed inflammatory reaction on the filler injection site, it seems crucial for the scientific community to achieve a consensus on: -whether it is appropriate to delay an elective HA dermal filler procedure in patients undergoing the SARS CoV-2 vaccination. -the number of the interval weeks required before and after the I and II dose of vaccination. -whether the same precautionary rule applies to every vaccination.

In addition, we have to consider the need for a second dose of Moderna and Pfizer vaccine up to three months after the first vaccine dose. Moreover, the recent new vaccine from Astrazeneca, which requires an interval of up to three-months between the first and the second dose, could extend the precautionary interval even more. This scenario could appear even more complicated if we take into consideration that the SARS CoV-2 vaccine might require a boosted dosage within six months. Do we need to suspend treating our patients with fillers for the time being?

We believe that a consistent protocol for the collection of the patient's medical history, focused on any present conditions and previous immunological disorders or reactions, is the key factor to eventually postpone a filer implant. For all the reasons expressed so far, we recommend that this issue to be taken into consideration from all the aesthetic medicine societies in order to reach a global consensus.

Funding None

Not required

Global Recommendations on COVID-19 Vaccines and Soft Tissue Filler Reactions: A Survey-Based Investigation in Cooperation With the International Society for Dermatologic and Aesthetic Surgery (ISDS)

COVID-19/SARS-CoV-2 virus spike protein-related delayed inflammatory reaction to hyaluronic acid dermal fillers: a challenging clinical conundrum in diagnosis and treatment

The art of prevention: COVID-19 vaccine preparedness for the dermatologist