Xanthelasma-Like Reaction Following Poly-L-Lactic Acid Intradermal Injection Managed With Fractional Non-Ablative Lasers and Stem Cell-Derived Conditioned Media: A Case Report

Abstract

Background: Xanthelasma-like periocular plaques are rare adverse reactions following injectable collagen stimulators and may be challenging to manage in cosmetically sensitive areas. Aims To describe a rare xanthelasma-like reaction after polymer-based collagen stimulator (poly-L-lactic acid or poly-D,L-lactic acid) intradermal injection and its management using fractional non-ablative lasers and stem cell-derived conditioned media. Patients/Methods: A 49-year-old woman with Fitzpatrick skin type IV developed bilateral infraorbital yellowish plaques (similar to 1 x 2 cm) approximately two weeks after a collagen stimulator injection and presented four months later with persistent lesions, after showing minimal response to a prior 577-nm yellow laser treatment performed at another clinic. Our first treatment approach consisted of a fractional 1550-nm erbium glass laser combined with intralesional 0.9% sodium chloride and a short course of oral corticosteroids. A subsequent session incorporated combined fractional 1550-nm erbium glass and 1450-nm diode lasers, followed by intradermal stem cell-derived conditioned media. Results: Partial improvement was observed after the initial treatment. Further improvement was achieved following combination laser therapy with adjunctive stem cell-derived conditioned media, with marked lesion flattening and reduced erythema within two months and sustained improvement at four-month follow-up. Conclusions: This case highlights a rare xanthelasma-like reaction following polymer-based collagen stimulator injection and demonstrates that a staged, non-ablative fractional laser approach with adjunctive stem cell-derived conditioned media may be an effective and minimally invasive management option.