Lingling Jia,1,2,* Jiachao Xiong,1,2,* Changjiang Zhao,1,2 Hua Jiang,1,2 Yufei Li1,2 

1Department of Plastic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People’s Republic of China; 2Medical College, Tongji University, Shanghai, 200331, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Hua Jiang, Email dosjh@126.com Yufei Li, Email lufylee@hotmail.com

Background: Hyaluronic acid injections, commonly used for anti-aging purposes, carry potential risks, including transient or permanent alopecia, a complication not yet fully characterized. This adverse effect can result from various mechanisms, such as pressure, ischemia, inflammation, and necrosis.
Objective: This study aimed to present a case report of a patient treated with Concentrated Growth Factor combined with microneedling and minoxidil for alopecia following hyaluronic acid injection in the left temporal scalp and to systematically review literature from January 2000 to December 2024 on alopecia secondary to hyaluronic acid injections.
Methods: A 23-year-old woman developed a 5× 6.5 cm alopecic patch on the left temporal scalp just four days after receiving 5 mL of Restylane hyaluronic acid filler in the frontal area. Despite initial treatment with 1500 units of hyaluronidase, alopecia progressed. A multimodal therapy was then initiated, including Concentrated Growth Factor injections, microneedling, and topical 5% minoxidil, delivered over three sessions at 1– 2-week intervals. A systematic literature search (PubMed/Web of Science/Embase, 2000– 2024) identified 13 relevant articles reporting on 19 cases of hyaluronic acid-induced alopecia for analysis.
Results: In the case report, the patient experienced full hair regrowth after treatment with Concentrated Growth Factor, microneedling, and minoxidil. Additionally, thirteen full-text articles involving 19 patients with hyaluronic acid-induced alopecia were analyzed. Data collected included filler type, injection site, complication site, onset of alopecia, associated symptoms, diagnostic tests, proposed mechanisms, treatment approaches, and outcomes. Various treatments were employed across studies, with variable success rates.
Conclusion: Prompt diagnosis and early intervention are crucial in preventing irreversible hair loss after HA injections. Knowledge of scalp anatomy and injectable materials is essential. This case suggests that combining Concentrated Growth Factor, microneedling, and minoxidil may offer a promising therapeutic strategy for HA-induced alopecia.

Keywords: alopecia, cosmetic procedures, fillers, dermal fillers, hyaluronic acid, hair loss