COVID-19 vaccine in patients with dermal hyaluronic acid fillers in the tear trough: A retrospective study.

CONFLICT OF INTEREST

None.

ETHICAL APPROVAL

The study adhered to the principles of the declaration of Helsinki. No institutional ethical approval was applied as it was a retrospective study.

To the Editor,

COVID‐19 has affected the entire world since its onset in 2020. Recently, concerns have raised regarding potential hypersensitivity reactions of previously placed HA dermal fillers with COVID‐19 vaccines. The Moderna mRNA‐1273 vaccine trial reported an incidence rate of facial swelling of 0.02% after receiving the vaccine. We conducted a retrospective study that aimed to assess the incidence of adverse events related to COVID‐19 vaccines.

All included patients had received two doses of Pfizer/BioNTech COVID‐19 vaccine (US) (interval of 21–28 days) and had been previously injected with dermal fillers in the tear trough area, from January 2020 to January 2021. This study adhered to the principles of the Declaration of Helsinki.

Forty‐one participants were included in the study. Table 1 summarizes the demographic data. All the included patients were injected supraperiosteally using Stylage M (Vivacy, Paris) to correct the tear trough hollowness with microcannula. None of the injected patients developed swelling, erythema, or nodules after two doses of Pfizer/BioNTech COVID‐19 vaccine. One healthy 38‐year‐old patient reported pain (2.4%) in the zygomatic arch and tear trough areas that began 12 h after the second vaccine dose and lasted for 48 h. She also developed flu‐like illness symptoms including fatigue, myalgia, and headache. This patient had undergone a previous injection of 0.6 ml HA filler to her both tear trough areas (0.3 ml in each side), 263 days prior her second dose of vaccine. There was no swelling or erythema in the injected area. The pain in the tear trough region as well as the flu‐like illness resolved spontaneously within 48 h, without any intervention.

TABLE 1

Summary table of data (N = 41)

	Mean ± SD	Range
Age (years)	45.70 ± 7.85	33–64
Interval between filler injection and first dose of vaccine (days)	154.53 ± 97.81	10–388
Interval between filler injection and second dose of vaccine (days)	175.80 ± 97.84	32–409
Interval between questionnaire and second dose of vaccine (days)	180.09 ± 36.51

There have been two published case reports regarding DIR and COVID‐19 vaccine in a previous injected HA patients. , Michon published a case of DIR 2 days following Pfizer/BioNTech vaccine. The patient was previously injected in the tear trough area with Juvederm Volite (Allergan Inc.). In our case series, only one patient suffered from pain in a previous uneventful injected tear trough area. There was no swelling, nodules, or erythema. Therefore, according to the DIR definition, this pain did not qualify. The precise mechanism of pain is not clearly understood; therefore, there is a need for more data to be collected regarding any association between dermal fillers and COVID‐19 vaccine.

Recently, Gotkin et al published a global survey that was conducted to capture the incidence of adverse events post COVID‐19 vaccines in patients who had undergone previous soft tissue fillers injections. Of the 78 patients who received at least one dose of the COVID‐19 vaccine, four participants reported pain that lasted longer than 2 days. Our study differs from this survey in that all of the participants were injected using the same technique, using the same filler type and in the same region of the face. Furthermore, all of our patients received two doses of the Pfizer/BioNTech vaccine, and the interval between the soft tissue filler injection and COVID‐19 vaccine in the patient who developed pain was longer. Despite the differences between the two studies, we concur that there does not appear to be an increased risk of developing adverse reactions following COVID‐19 vaccine in patients who have had dermal filler injection in tear trough area.

Previous literature published a frequency of 11.6% and 0.9% of transient edema or inflammation and severe edema, respectively, following tear trough filler injections independent from vaccination. Therefore, according to the data from this retrospective study and due to the increasing morbidity and mortality of the COVID‐19 pandemic, vaccination should not be discouraged in a patient with previous dermal filler injected tear trough. Furthermore, as more people receive the third dose of the vaccine worldwide, more data will be available regarding the connection, if any, between dermal filler and COVID‐19 vaccine.