Compounded Tirzepatide and Facial Nodules
COMPOUNDED tirzepatide use may be associated with persistent facial nodules after filler and toxin injections.
A new case report describes persistent dermal nodules developing at sites of hyaluronic acid, calcium hydroxyapatite, and incobotulinumtoxin A injections after initiation of compounded tirzepatide for weight loss. The patient had previously received similar cosmetic injections on multiple occasions without developing nodules, raising concern for a possible temporal association between compounded tirzepatide and delayed inflammatory reactions at injection sites.
Nodules Emerged After Cosmetic Injections
The case involved a 66-year-old woman who presented with 9 months of persistent facial nodules. She had started compounded tirzepatide 2.5 mg weekly 11 months before presentation and underwent calcium hydroxyapatite injections to the cheeks, hyaluronic acid filler to the lips, and incobotulinumtoxin A injections 1 month after beginning treatment.
Several weeks later, a large nodule appeared on the left cheek, with a smaller nodule at the left zygomatic arch. The lesions did not improve after intralesional triamcinolone or hyaluronidase, and the cheek site became depressed. Additional filler injections performed to mask the original nodules led to new persistent nodules at the cheeks, temples, marionette lines, and later the glabella.
Rechallenge Supports A Temporal Association
The nodules remained refractory to two 30 day courses of doxycycline and further hyaluronidase. Compounded tirzepatide was discontinued after clinicians proposed that it may have contributed to nodule formation. Although existing lesions did not resolve immediately, no new nodules appeared after stopping the drug.
Isotretinoin 20 mg daily was then started, and the lesions resolved within 1 month. A rechallenge with compounded tirzepatide 2.5 mg was attempted while the patient remained on isotretinoin, with no new nodules after additional hyaluronic acid injections. However, after the tirzepatide dose was increased to 5 mg and then 7.5 mg, two small nodules developed on the upper lip at hyaluronic acid injection sites.
Clinical Awareness Needed In Aesthetic Practice
The report adds to emerging cutaneous manifestations described with GLP-1 receptor agonists, while noting that tirzepatide also activates glucose dependent insulinotropic polypeptide receptors. The authors could not confirm causation, and key limitations included unknown ingredients in the compounded tirzepatide formulation and the absence of biopsy because the nodules were facial.
Still, the pattern of onset, cessation after discontinuation, and recurrence after rechallenge suggests a clinically relevant signal. Dermatologists and aesthetic practitioners may need to ask about GLP-1 receptor agonists and compounded tirzepatide use when evaluating persistent filler nodules.
Reference
Moore L et al. Facial nodules following filler injections after initiating compounded tirzepatide use. JAAD Case Rep. 2026;72:1-3.
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