Edema tardio intermitente e persistente (ETIP) associado ao uso de ácido hialurônico

Abstract

The use of hyaluronic acid (HA)-based fillers has grown significantly in minimally invasive aesthetic procedures due to their efficacy, biocompatibility, and relative safety. However, the increase in these procedures has also contributed to a higher occurrence of late complications, including Late Intermittent Persistent Edema (LIPED), characterized by recurrent episodes of edema in previously filled areas. This study aimed to analyze LIPED associated with HA use, addressing its pathophysiology, clinical manifestations, triggering factors, and management strategies described in the scientific literature. To this end, a narrative study was conducted, based on the analysis of articles published in the last ten years (2015–2025), obtained through searches in the PubMed/MEDLINE, SciELO, Scopus, and LILACS databases, using descriptors related to hyaluronic acid, late edema, inflammatory complications, and facial fillers. The studies analyzed demonstrated that late-onset ETIP has a multifactorial etiology, involving immunological and inflammatory mechanisms triggered by infections, vaccines, local trauma, and the physicochemical characteristics of the filler itself. Among the main clinical manifestations are recurrent edema, localized inflammation, and episodes of late angioedema. The therapeutic management described in the literature includes corticosteroids, hyaluronidase, antibiotics, and adjuvant therapies, presenting variable results according to the severity of the condition. It is concluded that ETIP represents an important late complication related to the use of hyaluronic acid, requiring technical and scientific knowledge from professionals for early diagnosis, adequate management, and prevention of complications, in addition to the need for new studies that contribute to the standardization of therapeutic approaches.

Keywords: Hyaluronic Acid; Late-onset Edema; ETIP; Facial Fillers; Aesthetic Complications.