Secondary alopecia induced by aesthetic procedures: An unrecognized potential complication

Cosmetic filler-induced hair loss: case series and literature review

AIM

To present three cases of filler-induced alopecia (FIA) and summarize the current knowledge of its clinical features, mechanisms and treatments.

METHODS

In the first two cases, two females developed well-defined triangular patches of hair loss after hyaluronic acid (HA) injections, and received corticosteriod injections with topical 5% minoxidil. The third case described another female who experienced alopecia areata-like hair loss after autologous fat grafting, and received combined therapies including corticosteriod, 5% minoxidil and microneedling.

RESULTS

All patients got gradual hair regrowth with treatments.

CONCLUSIONS

Early recognition and intervention are crucial to prevent permanent hair follicle damage. A thorough understanding of frontotemporal anatomy is essential for clinical practitioners to minimize risks during cosmetic procedures involving filler injections.

Fillers impacting follicles: the emerging complication of filler-induced alopecia

Filler-induced alopecia is a transient alopecia characterized by localized hair loss and often attributed to vascular compromise following dermal filler injections in facial regions. Although an uncommon phenomenon, the rising incidence of filler-induced alopecia underscores the importance of understanding and managing this condition. We performed an extensive PubMed review of articles reporting filler-induced alopecia and summarizing the implicated filler types, injection areas, hair loss patterns, symptom onset, course progression, treatments, and prognosis. Hyaluronic acid injections were the most implicated in filler-induced alopecia cases, with calcium hydroxylapatite and autologous fat less frequently associated. No cases involved other dermal filler types. Although recovery times varied depending on the treatment, hyaluronidase (HAase) injections rapidly restored near-normal hair density within 3-4 months. Minoxidil and platelet-rich plasma play a more minor role in restoring hair growth but may be used as adjuncts with HAase to facilitate hair growth. Finally, alternative interventions like intralesional triamcinolone, warm compresses, and nitroglycerin warrant exploration, given limited robust clinical data. Our study promotes awareness of filler-induced alopecia's rising incidence and offers practical insights and evidence-based recommendations for effective management. By equipping dermatologists with this knowledge, our aim is to improve patient outcomes and reduce adverse events in filler-based procedures.