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Quttaineh D, Pusztaszeri M, Mlynarek A, Hier MP, Mascarella MA. Latent Granulomatous Foreign Body Reaction to Dermal Fillers: A Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231213256. [PMID: 38140878 DOI: 10.1177/01455613231213256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Affiliation(s)
- Danah Quttaineh
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
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2
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Mechanisms of Foreign Body Giant Cell Formation in Response to Implantable Biomaterials. Polymers (Basel) 2023; 15:polym15051313. [PMID: 36904554 PMCID: PMC10007405 DOI: 10.3390/polym15051313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
Long term function of implantable biomaterials are determined by their integration with the host's body. Immune reactions against these implants could impair the function and integration of the implants. Some biomaterial-based implants lead to macrophage fusion and the formation of multinucleated giant cells, also known as foreign body giant cells (FBGCs). FBGCs may compromise the biomaterial performance and may lead to implant rejection and adverse events in some cases. Despite their critical role in response to implants, there is a limited understanding of cellular and molecular mechanisms involved in forming FBGCs. Here, we focused on better understanding the steps and mechanisms triggering macrophage fusion and FBGCs formation, specifically in response to biomaterials. These steps included macrophage adhesion to the biomaterial surface, fusion competency, mechanosensing and mechanotransduction-mediated migration, and the final fusion. We also described some of the key biomarkers and biomolecules involved in these steps. Understanding these steps on a molecular level would lead to enhance biomaterials design and improve their function in the context of cell transplantation, tissue engineering, and drug delivery.
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Delans K, Kelly K, Feldman SR. Treatment strategies, including antibiotics, to target the immune component of rosacea. Expert Rev Clin Immunol 2022; 18:1239-1251. [PMID: 36137266 DOI: 10.1080/1744666x.2022.2128334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Recent advances in the understanding of the pathophysiology of rosacea have led to increased focus on the disease's immunologic etiology and to the development of immunologically based treatments. With many patients suffering from incomplete control, addressing the immune components of the disease process may provide a more effective treatment option for rosacea patients that may improve quality of life. AREAS COVERED This review will provide a brief overview of the pathophysiology of rosacea, as well as specific immunologic contributions to the disease state. Current standard-of-care treatments will be described, including anti-parasitic, anti-inflammatory agents, and antibiotics. Emphasis will be placed on treatments that target the immune components of the disease process. EXPERT OPINION Rosacea remains a difficult dermatologic disease to treat, partially due to an incomplete understanding of the disease pathophysiology. The immune pathophysiology of rosacea, particularly the key role of inflammation, has been clarified over the past decade. Identification of specific molecules, including cytokines and nuclear transcription factors, may allow for the development of targeted rosacea-specific biologic and topical treatments. However, medication nonadherence is a limiting factor to achieving symptomatic control among rosacea patients. Focusing on the development of oral or injectable forms of therapy may circumvent poor adherence.
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Affiliation(s)
- Kristen Delans
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Katherine Kelly
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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4
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van der Pluijm RW, W Haak B, Kers J, L Siegenbeek van Heukelom T, van Vugt M. Immune reconstitution inflammatory syndrome induced by gluteal silicones in a transgender woman living with HIV. Int J STD AIDS 2022; 33:625-627. [PMID: 35343334 DOI: 10.1177/09564624221086853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of an immune reconstitution inflammatory syndrome induced by gluteal silicones in a transgender woman living with HIV following the start of antiretroviral therapy. This case resembles the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) syndrome that has been described as a complication of insertions of materials such as injected or implanted silicones. The potential of developing an inflammatory response in patient with injected or implanted silicones/foreign substances should be considered in patients who have recently started antiretroviral therapy.
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Affiliation(s)
- Rob W van der Pluijm
- Department of Medicine, Division of Infectious Diseases, 26066Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bastiaan W Haak
- Department of Medicine, Division of Infectious Diseases, 26066Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jesper Kers
- Department of Pathology, 26066Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Michele van Vugt
- Department of Medicine, Division of Infectious Diseases, 26066Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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5
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Wiggins C, Gupta R, DeBord LC, Ketcham M, Dao H. Multidisciplinary diagnosis of silicone granuloma-associated gluteal inflammation: Combined clinical, radiological and histopathological assessment. Australas J Dermatol 2021; 63:118-120. [PMID: 34463954 DOI: 10.1111/ajd.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claire Wiggins
- Department of Medicine and Pediatrics, University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Rohit Gupta
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Logan C DeBord
- Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Megan Ketcham
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Harry Dao
- Department of Dermatology, Loma Linda University, Loma Linda, California, USA
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6
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Safety of Copolyamide Filler Injection for Breast Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3296. [PMID: 33680632 PMCID: PMC7929552 DOI: 10.1097/gox.0000000000003296] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 01/05/2023]
Abstract
Although injections with copolyamide fillers (Aquafilling/Los Deline and Aqualift/Activegel) are currently used widely for breast augmentation, many complications have been reported. A recent position statement by a Korean aesthetic/reconstructive breast surgery society indicated these fillers are the same as polyacrylamide gel (PAAG), which is widely prohibited due to complications. To test this statement, this retrospective cohort study examined the clinical complications after breast augmentation with copolyamide fillers. Nuclear magnetic resonance (NMR) analysis of copolymer and PAAG fillers was also conducted.
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7
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Buccal Silicone Granuloma Caused by the Dental Infection. Case Rep Dent 2020; 2020:8834475. [PMID: 33204544 PMCID: PMC7655241 DOI: 10.1155/2020/8834475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/11/2020] [Accepted: 10/25/2020] [Indexed: 11/21/2022] Open
Abstract
The facial injection of liquid silicone is performed for cosmetic purposes. The use of injectable fillers in facial procedures has become extremely popular over the past decade. Most procedures are performed in the perioral, periocular, and cheek areas of middle-aged women. Even though silicone is biologically inert, its injection can result in the formation of granulomas. Silicone granulomas can result from an inflammatory or autoimmune tissue response. However, the development of silicone granulomas secondary to dental infection has not yet been reported. We report a case of a 73-year-old woman with a right buccal silicone granuloma that developed following a dental infection. Ultimately, this case healed completely after the surgical removal of all lesions. Silicone in the facial region may become infected by a dental infection, and infective silicone develops granulomas and cellulitis. In the context of cosmetic facial silicone injections, it is necessary to improve oral hygiene prior to dental treatment and to maintain a healthy oral environment after surgery. In some cases, surgical treatment using an intraoral approach is effective.
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Di Meo N, Conforti C, Toffoli L, Ukmar M, Degrassi F, Ramella V, Zalaudek I. Silicone granulomas of the face caused by injectables: A therapeutic challenge. Australas J Dermatol 2020; 61:e461-e463. [PMID: 32671832 DOI: 10.1111/ajd.13379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nicola Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Ludovica Toffoli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Maja Ukmar
- Department of Radiology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Ferruccio Degrassi
- Department of Radiology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Vittorio Ramella
- Department of Medical Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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9
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Chen YC, Lee JYY. Extensive disfiguring silicone granuloma of the face successfully treated with corticosteroid and doxycycline. Int J Dermatol 2019; 58:e217-e219. [PMID: 31281961 DOI: 10.1111/ijd.14576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/01/2019] [Accepted: 06/10/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Yu-Chen Chen
- Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Julia Yu-Yun Lee
- Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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Dhingra N, Bonati LM, Wang EB, Chou M, Jagdeo J. Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. J Am Acad Dermatol 2019; 80:1712-1721. [DOI: 10.1016/j.jaad.2018.05.1259] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/28/2022]
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11
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Wang LL, Thomas WW, Friedman O. Granuloma formation secondary to silicone injection for soft-tissue augmentation in facial cosmetics: Mechanisms and literature review. EAR, NOSE & THROAT JOURNAL 2018; 97:E46-E51. [PMID: 29493732 DOI: 10.1177/0145561318097001-211] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The use of injectable fillers is increasingly popular as an alternative to surgery for facial cosmetic applications. In this regard, silicone is a versatile biomaterial filler that has been used for these purposes, but its use warrants further investigation, especially since it is not clinically approved for such uses. We describe the use of silicone as a facial injectable filler through a scholarly review of the literature for cases of silicone granuloma formation published from September 2007 through September 2017, and we present various contexts in which this complication has been observed. We further review the immunologic etiology of granuloma formation and other complications of silicone injections. We write this report to caution physicians on the use of silicone fillers which, for all their advantages, are associated with significant long-term risks that are frequently overlooked.
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Affiliation(s)
- Leo L Wang
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.
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12
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Silicone-Induced Foreign Body Reaction: An Unusual Differential Diagnosis of Posterolateral Hip Pain. Case Rep Med 2018; 2018:1802794. [PMID: 30073026 PMCID: PMC6057356 DOI: 10.1155/2018/1802794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/25/2018] [Indexed: 01/16/2023] Open
Abstract
Background Silicone injection is commonly used for soft tissue augmentation for esthetic purposes. It is not without complications. Case presentation We present a case of a 31-year-old woman presenting with refractory left lateral hip pain. Magnetic resonance imaging of the patient's pelvis revealed innumerable small low signal foci throughout the gluteus maximus and overlying subcutaneous fat bilaterally consistent with injectable material, possibly silicone. Conclusions This case report emphasizes that silicone-induced granulomatosis must be considered in the differential diagnosis of hip pain when evaluating a patient who has had access to plastic surgery or clandestine operators.
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Abstract
BACKGROUND A foreign body reaction (FBR) is a typical tissue response to a biomaterial that has been injected or implanted in human body tissue. There has been a lack of data on the classification of foreign body reaction to silicone injection, which can describe the pattern of body tissue responses to silicone. OBJECTIVE Determine the foreign body reaction to silicone injection. METHOD We modified the classification proposed by Duranti and colleagues, which has categorized a FBR to hyaluronic acid injection into a new classification of an FBR to silicone injection. A cohort study of 31 women suffering from silicone-induced granulomas on their chin was conducted. Granulomatous tissue and submental skin were stained with hematoxylin–eosin and evaluated. RESULTS Our data revealed that there were at least 7 categories of FBRs to silicone injection that could be developed. Categories 1 to 4 showed inflammatory activity, and categories 5 to 8 showed tissue repair by fibrosis. CONCLUSION Using histopathological staining, we are able to sequence the steps of body reactions to silicone injection. Initial inflammatory reaction is then replaced by fibrosis process repairing the damaged tissues. The process depends on the host immune tolerance.
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14
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Chen TA, Mercado CL, Topping KL, Erickson BP, Cockerham KP, Kossler AL. Disseminated silicone granulomatosis in the face and orbit. Am J Ophthalmol Case Rep 2018; 10:32-34. [PMID: 29780909 PMCID: PMC5956674 DOI: 10.1016/j.ajoc.2018.01.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose To report a case of disseminated silicone granulomatosis presenting with ptosis, proptosis and vision loss. Observations A 56-year-old female presented with ptosis, proptosis, and vision loss and was noted to have palpable, erythematous masses involving the orbit, face, trunk, and body. She had a history of bilateral silicone breast implants and cosmetic facial filler injections. Orbital biopsy demonstrated non-caseating granulomas with foreign-body giant cells and vacuoles containing material consistent with silicone. Removal of the patient's breast implants and systemic immunosuppression led to dramatic granuloma regression. Conclusions Silicone can induce a severe, systemic inflammatory response and should be considered in the differential for facial and periorbital granulomas in patients with a history of silicone breast implants. Management of disseminated silicone granulomatosis is challenging and requires multimodal treatment with silicone removal and systemic immunomodulation.
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Affiliation(s)
- Tiffany A Chen
- Stanford University, School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Carmel L Mercado
- Stanford Health Care, Byers Eye Institute at Stanford, 2452 Watson Court, Palo Alto, CA 94303, USA
| | - Katie L Topping
- Stanford Health Care, Byers Eye Institute at Stanford, 2452 Watson Court, Palo Alto, CA 94303, USA
| | - Benjamin P Erickson
- Stanford Health Care, Byers Eye Institute at Stanford, 2452 Watson Court, Palo Alto, CA 94303, USA
| | - Kimberly P Cockerham
- Veterans Administration Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Andrea L Kossler
- Stanford Health Care, Byers Eye Institute at Stanford, 2452 Watson Court, Palo Alto, CA 94303, USA
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Barilaro G, Spaziani Testa C, Cacciani A, Donato G, Dimko M, Mariotti A. ASIA syndrome, calcinosis cutis and chronic kidney disease following silicone injections. A case-based review. Immunol Res 2017; 64:1142-1149. [PMID: 27665458 DOI: 10.1007/s12026-016-8871-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An immunologic adjuvant is a substance that enhances the antigen-specific immune response preferably without triggering one on its own. Silicone, a synthetic polymer used for reconstructive and cosmetic purposes, can cause, once injected, local and/or systemic reactions and trigger manifestations of autoimmunity, occasionally leading to an overt autoimmune disease. Siliconosis, calcinosis cutis with hypercalcemia and chronic kidney disease have all been reported in association with silicone injection. Here, we describe a case of autoimmune/auto-inflammatory syndrome induced by adjuvants, calcinosis cutis and chronic kidney disease after liquid silicone multiple injections in a young man who underwent a sex reassignment surgery, followed by a review of the literature. To our knowledge, this is the first report describing the concomitance of the three clinical conditions in the same patients. The link between silicone and the immune system is not completely understood yet and requires further reports and investigations with long-term data, in order to identify the main individual and genetical risk factors predisposing to the wide spectrum of the adjuvant-induced responses.
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Affiliation(s)
- Giuseppe Barilaro
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy.
| | - Claudia Spaziani Testa
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Antonella Cacciani
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Giuseppe Donato
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Mira Dimko
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
| | - Amalia Mariotti
- Nephrology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00161, Rome, Italy
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Granda ML, Huang LE. Silicone Injection–Related Granulomatous Hypercalcemia. Am J Med Sci 2017; 353:492-494. [DOI: 10.1016/j.amjms.2016.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Lipogranuloma after facial cosmetic procedures. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:e123-e132. [PMID: 28117206 DOI: 10.1016/j.oooo.2016.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/04/2016] [Accepted: 11/13/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Lipogranuloma is a rare inflammatory reactive process in the dermis and subcutis. We present a summary of the 6 cases of lipogranuloma after facial cosmetic procedures. STUDY DESIGN We performed a retrospective review including patient demographic data, clinical symptoms, appearance on computed tomography, treatment, pathology results, and history of facial cosmetic procedures. RESULTS In most cases, the nodules were painless and showed no significant growth. Computed tomography revealed ill-defined swellings in the buccal fat pad with heterogeneous density. Histopathological examinations revealed numerous variable-sized empty microcysts surrounded by abundant lymphocytes and foamy macrophages, the characteristic features of lipogranuloma. On further questioning, all of the patients revealed that they had undergone some form of facial cosmetic procedure in the preceding months to years. Among the 6 cases, facial autologous fat injection may have been the main cause of lipogranuloma. CONCLUSION Lipogranulomas can develop months to years after facial cosmetic procedures distant from the injection sites. A thorough understanding of the patient's medical history and the clinical and histopathologic characteristics of lipogranuloma are necessary to make a definite diagnosis and allow appropriate treatment.
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Novo RC, Salgado CJ, Yim E, Sinha V, Chim HW, Romanelli P. A staging system for gluteal foreign body reaction to injectables. J Plast Reconstr Aesthet Surg 2016; 69:e174-9. [PMID: 27325516 DOI: 10.1016/j.bjps.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Esthetic augmentation of the gluteal region can lead to complications including debilitating pain, infections, wounds, and scars. To our knowledge, a general consensus of staging and treatment guidelines for managing gluteal foreign body reaction to injectables has not yet been established. OBJECTIVE The objective of this study was to develop a reliable staging system that can be used to implement a treatment algorithm for gluteal foreign body reactions. METHODS A retrospective review of 40 patients treated for complications of gluteal injections between September 2010 and May 2014 was performed. Patient symptoms, imaging, and photographs were used to develop a staging system of disease. Institutional review board approval was obtained from the University of Miami Miller School of Medicine. Five independent observers reviewed the patients' documented symptoms and photographs. Using our staging system, the independent observers reviewed the patient cases at two separate time intervals. Intra- and interclass correlation coefficients (ICCs) were computed to assess the reliability for each of the observers. RESULTS Seven patients were classified as Stage I, fifteen as Stage IIa, nine as Stage IIb, and nine as Stage III. The mean patient age was 34 years (21-50). Analysis of the independent reviewer results revealed ICC for each rater to range from 0.96 to 0.98, demonstrating high indexes of intra-rater reliability. CONCLUSIONS Based on our statistical analysis, we found an excellent inter- and intra-observer reliability, indicating that the staging system is reproducible and reliable. A treatment strategy dependent on the stage can be implemented as a guideline to optimize functional and esthetic outcomes.
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Affiliation(s)
- Rebecca C Novo
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher J Salgado
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Elizabeth Yim
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Varsha Sinha
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harvey W Chim
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paolo Romanelli
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Silicone-induced Granuloma After Buttock Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e624. [PMID: 27014553 PMCID: PMC4778895 DOI: 10.1097/gox.0000000000000618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
Liquid silicone is inexpensive, minimally antigenic, and likely noncarcinogenic. Its simplicity of use has made it popular as a soft-tissue filler in some parts of the world for patients seeking rapid soft-tissue augmentation of the face, breast, and buttocks. However, multiple reports describe the complications of silicone injections such as cellulitis, abscess, ulceration, and foreign body migration. We present an unusual complication of granulomatous reaction secondary to silicone injection for buttock augmentation, with a literature review of this entity and treatment options. Our patient was a 54-year-old woman who underwent bilateral buttock augmentation in the Dominican Republic using percutaneous injection of liquid silicone. She presented to our facility 1 year after this procedure with pain and inflammation of both buttocks. She was diagnosed with multiple silicone granulomas. Her symptoms completely resolved with a 3-week course of minocycline. Granulomatous reactions to silicone may occur months to years after the silicone injection. The incidence of such complications may be increased when nonmedical-grade silicone is used, and hence, when these procedures are performed in developing countries. Tetracycline antibiotics, especially minocycline, may be used to achieve sustained remission.
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21
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Rewriting History: Fever of Unknown Origin. Am J Med 2015; 128:956-8. [PMID: 26007673 DOI: 10.1016/j.amjmed.2015.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022]
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22
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Nasseri E. Gluteal Augmentation With Liquid Silicone of Unknown Purity Causes Granulomas in an Adult Female. J Cutan Med Surg 2015. [DOI: 10.1177/1203475415598065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A 39-year-old woman presented with a history of relapsing painful erythema and progressive fibrosis of the lower back. Upon questioning, the patient admitted to receiving liquid silicone (LS) injections for gluteal augmentation abroad and was diagnosed with silicone migration, granulomatous reaction, and fibrosis of the lower back. Objective: To review the history of LS injections for cosmetic soft tissue augmentation (STA) as well as its complications and potential treatments. Methods: The author reviewed articles that involved the use of LS for STA and summarized their findings. Results: The author summarizes the various treatments that have been described for inflammatory reactions following LS injection. Conclusion: The growth of cosmetic medical tourism and its inherent lack of after-care as well as patients’ ability to obtain restricted products at home raise the likelihood of encountering granulomatous or fibrotic reactions to fillers during consultations. Physicians should have a structured approach to these patients.
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Affiliation(s)
- Eiman Nasseri
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
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Crocco E, Pascini M, Suzuki N, Alves R, Proença T, Lellis R. Minocycline for the treatment of cutaneous silicone granulomas: A case report. J COSMET LASER THER 2015; 18:48-9. [PMID: 26073116 DOI: 10.3109/14764172.2015.1052514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Silicone oil injections are often used for soft tissue augmentation and local and general adverse effects occurring from a few months to 15 years after injection have been reported. Here, we present a case of delayed granuloma formation due to liquid injectable silicone with large extent of involvement, which precluded surgical removal. Our patient was successfully treated with minocycline, considering its anti-inflammatory, immunomodulating and antigranulomatous properties. This case presents minocycline monotherapy as a useful treatment option for the management of severe granuloma induced by silicone use when surgical excision is not possible.
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Affiliation(s)
- Elisete Crocco
- a Sector of Cosmetic Dermatology, Clinic of Dermatology, Santa Casa de São Paulo Hospital and School of Medicine , São Paulo-SP , Brazil
| | - Mirella Pascini
- b Specialization program at the Clinic of Dermatology, Santa Casa de São Paulo Hospital and School of Medicine , São Paulo-SP , Brazil
| | - Nathalie Suzuki
- b Specialization program at the Clinic of Dermatology, Santa Casa de São Paulo Hospital and School of Medicine , São Paulo-SP , Brazil
| | - Renata Alves
- c Voluntary program at the Clinic of Dermatology, Santa Casa de São Paulo Hospital and School of Medicine , São Paulo-SP , Brazil
| | - Thais Proença
- c Voluntary program at the Clinic of Dermatology, Santa Casa de São Paulo Hospital and School of Medicine , São Paulo-SP , Brazil
| | - Rute Lellis
- d Pathology Department, Santa Casa de São Paulo Hospital and School of Medicine , São Paulo-SP , Brazil
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Foreign body granulomas after the use of dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment. Arch Plast Surg 2015; 42:232-9. [PMID: 25798398 PMCID: PMC4366708 DOI: 10.5999/aps.2015.42.2.232] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/03/2014] [Accepted: 09/18/2014] [Indexed: 11/08/2022] Open
Abstract
A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.
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Grippaudo FR, Di Girolamo M, Mattei M, Pucci E, Grippaudo C. Diagnosis and management of dermal filler complications in the perioral region. J COSMET LASER THER 2014; 16:246-52. [DOI: 10.3109/14764172.2014.946048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Almost all granulomatous skin disorders can cause red lesions on the face. Such disorders may include many bacterial, fungal, or parasitic infections, noninfectious inflammatory disorders, foreign body reactions, and even neoplasms. Clinically, they usually present with papules, plaques, nodules, and/or abscesses, which may ulcerate. It may be helpful in their differential diagnosis to define certain clinical patterns, such as multiple and discrete papules, necrotic or umbilicated papules or nodules, annular plaques, vegetative plaques or tumors, verrucous plaques or tumors, abscesses and/or sinuses, and lymphocutaneous pattern. Some disorders, such as sarcoidosis, can cause a wide variety of lesions. We accept that cutaneous leishmaniasis is also among such great imitators.
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Visnyei K, Samuel M, Heacock L, Cortes JA. Hypercalcemia in a male-to-female transgender patient after body contouring injections: a case report. J Med Case Rep 2014; 8:71. [PMID: 24572248 PMCID: PMC3976093 DOI: 10.1186/1752-1947-8-71] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Body contouring injections by non-licensed providers are frequently sought out by a subset of the male-to-female transgender community. Although short-term side effects such as pulmonary embolism and injection site infection are well known, long-term consequences of such practices are less well studied. CASE PRESENTATION Here we describe the case of a 40-year-old African American male-to-female transgender patient who presented to our institution with hypercalcemia and acute renal failure secondary to body contouring injections with industrial strength silicone by non-licensed providers, a decade prior to her visit. Work-up revealed an extensive granulomatous inflammatory process in the injection area resulting in electrolyte abnormalities and kidney injury. The patient's lab results and symptoms responded well to long-term corticosteroid treatment and correlated with treatment adherence. CONCLUSION Affected patients can sometimes present with unusual clinical symptoms many years after silicone injections. In a constantly growing transgender community that often utilizes non-licensed providers for silicone injections, the medical community will likely face an increasing number of patients with long-term side effects of such practices. Therefore, it is imperative for physicians to recognize such cases promptly and initiate potentially life-saving treatment.
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Affiliation(s)
- Koppany Visnyei
- Department of Internal Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine, 1st Ave at 17th St, Baird Hall, 20th Floor, New York, NY 1000, USA.
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Owosho AA, Bilodeau EA, Vu J, Summersgill KF. Orofacial dermal fillers: foreign body reactions, histopathologic features, and spectrometric studies. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:617-625. [PMID: 24656730 DOI: 10.1016/j.oooo.2014.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to assess the different histopathologic presentations of dermal filler materials-induced foreign body reactions by spectrometric analyses. STUDY DESIGN Sixteen cases of dermal filler foreign body reactions in the orofacial region were retrieved from the 2006-2013 period. The histologic features were evaluated and categorized into 5 groups (I to V). Unstained deparaffinized sections of representative tissue from one case in each of groups I to IV were sent for spectrometric analysis, along with samples of 2 popular dermal fillers (Juvéderm and Radiesse). RESULTS With the help of spectrometric analysis, we were able to correlate the histopathologic presentations with the specific type of dermal filler used.
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Affiliation(s)
- Adepitan A Owosho
- Resident, Oral and Maxillofacial Pathology, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.
| | - Elizabeth A Bilodeau
- Assistant Professor, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - John Vu
- Assistant Professor, Department of Pathology, Division of Dermatopathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kurt F Summersgill
- Associate Professor, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
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Ledon JA, Savas JA, Yang S, Franca K, Camacho I, Nouri K. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options. Am J Clin Dermatol 2013; 14:401-11. [PMID: 24037757 DOI: 10.1007/s40257-013-0043-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.
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Affiliation(s)
- Jennifer A Ledon
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, 2nd floor, Miami, FL, 33136, USA,
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Herink C, Zwaka P, Schön M, Mempel M, Seitz C. Schwere Komplikationen nach glutealer Silikoninjektion. Hautarzt 2013; 64:599-602. [DOI: 10.1007/s00105-013-2573-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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García Callejo FJ, Calvo González J, Agustí Martínez J, Bécares Martínez C, Monzó Gandía R, Marco Algarra J. Neck lymphadenitis due to silicone granuloma after mammary implants. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 64:217-22. [PMID: 23499209 DOI: 10.1016/j.otorri.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A foreign body reaction due to silicone where it is infiltrated or at the places to which it can migrate is known as siliconoma. The use of silicone in breast augmentation procedures can provoke this reaction at the neck level in cases of leakage from mammary implants. METHODS We reviewed the cases of patients with increased size neck lymph nodes who had previously undergone plastic surgery of the breast with highly cohesive silicone gel implants. RESULTS In a 10-year period, we identified 12 cases with silicone-infiltrated neck lymphadenopathies, histologically confirmed by fine needle aspiration. They represented 3.5% of patients attended for neck lymph node study. We removed those detected by physical examination and CT in 5 cases, due to pathological characteristics of the node or a previous malignant history. In 2 of these nodes recurred, and node size also increased in 2 of the other 7 non-operated cases. After implant removal, silicone leakage was observed in only 7 cases. CONCLUSIONS Cohesive gel silicone used for mammary implants can generate increased neck lymphadenopathies as a secondary effect due to systemic reactions against the silicone when it migrates in cases of implant failure. Surgical options for involved nodes usually do not offer good long-term results.
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Grippaudo F, Tammaro A, Narcisi A, Paolini G, Longo B, Falesiedi F, Santanelli F. Conservative Surgical Approach for Reduction of Macrocheilitis Caused by Massive Injection of Liquid Silicone. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Cosmetic lip augmentation, regardless of the filling agent, is nowadays one of the most requested aesthetic procedures. Liquid silicone injections were used in the past, but after reports of severe late complications their use has been discontinued, ending with a permanent ban in most western countries. In this report we describe clinical presentation, diagnostic pathways and surgical reconstruction of six patients presenting with macrocheilia due to previous liquid silicone augmentation. Patients showed chronic inflammation of the lower third of the face, lip eversion, various degrees of asymmetry and functional impairment of the lips. All patients underwent preoperative soft tissue High Frequency Ultrasound (HFUS) and Magnetic Resonance Imaging (MRI) of the of the face to obtain evidence of the filler material and to ascertain its diffusion within the soft tissues of the perioral region. Conservative surgery was carried out to remove foreign material and to restore symmetric aesthetically pleasing lips. Histology confirmed the siliconoma diagnosis. HFUS and RMI allowed to clearly identify the silicone within the soft tissues. The conservative surgery restored the harmonious relationship between the lips, with an improvement in lip functionality at long term follow-up. Healing was complete and uneventful in all of the patients.
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Affiliation(s)
- F.R. Grippaudo
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A. Tammaro
- Dermatology Unit, NESMOS Department, Hospital S. Andrea, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A. Narcisi
- Dermatology Unit, NESMOS Department, Hospital S. Andrea, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - G. Paolini
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - B. Longo
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - F. Falesiedi
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - F. Santanelli
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Diez Morrondo C, Palmou Fontana N, Lema Gontad JM, Álvarez Rivas N, Freire González M, García Silva J, Hermida Romero T, Galdo F. Paniculitis facticia y síndrome de Löfgren inducidos por silicona: a propósito de un caso clínico. ACTA ACUST UNITED AC 2012; 8:368-71. [DOI: 10.1016/j.reuma.2011.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/20/2011] [Accepted: 12/21/2011] [Indexed: 01/16/2023]
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Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: prevention and management. J Cutan Aesthet Surg 2012; 5:121-32. [PMID: 23060707 PMCID: PMC3461789 DOI: 10.4103/0974-2077.99451] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.
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Affiliation(s)
- Lauren L Levy
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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Cho S, Jung JY, Shin JU, Lee JH. Silicone-Induced Foreign Body Reaction of the Face Successfully Treated Using Nonablative 1,550-nm Erbium-Glass and Ablative 10,600-nm Carbon Dioxide Fractional Lasers. Dermatol Surg 2012; 38:1744-6. [DOI: 10.1111/j.1524-4725.2012.02523.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carlos-Fabuel L, Marzal-Gamarra C, Martí-Álamo S, Mancheño-Franch A. Foreign body granulomatous reactions to cosmetic fillers. J Clin Exp Dent 2012; 4:e244-7. [PMID: 24558563 PMCID: PMC3917632 DOI: 10.4317/jced.50868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The use of different facial cosmetic fillers has increased in recent years. The introduction of apparently inert substances in the epidermis can give rise to foreign body granulomatous reactions. Objetives: A literature review is made of the foreign body granulomatous reactions to cosmetic fillers. MATERIAL AND METHODS A PubMed-Medline search was made using the following keywords: "granulomatous reactions", "foreign body reactions", "esthetic fillers", "cosmetic fillers". The search was limited to articles published in English and Spanish during the last 10 years. A total of 22 articles were reviewed. RESULTS A great variety of substances have been found to give rise to foreign body granulomatous reactions. The most common locations are the upper and lower lip and the nasogenian sulcus. The clinical presentation is variable and can range from single or multiple nodules to diffuse facial swelling of hard-elastic consistency, accompanied by reddening. Most lesions are asymptomatic or cause only mild discomfort. The literature describes different treatments, including systemic corticosteroids, local tacrolimus infiltrations, minocycline, retinoids, allopurinol, 5% imiquimod, and surgical removal. CONCLUSIONS In view of the current demand for esthetic treatments, the use of cosmetic fillers can be expected to increase in future, together with the incidence of complications. Key words:Esthetic fillers, granulomatous reactions, foreign body reactions, cosmetic fillers.
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Affiliation(s)
- Laura Carlos-Fabuel
- DDS. Master in Oral Medicine and Surgery. University of Valencia. Valencia (Spain)
| | | | - Silvia Martí-Álamo
- DDS. Master in Oral Medicine and Surgery. University of Valencia. Valencia (Spain)
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Mahé E, Zimmermann U. [Significant improvement in ulcerative necrobiosis lipoidica with doxycycline]. Ann Dermatol Venereol 2011; 138:686-8. [PMID: 21978507 DOI: 10.1016/j.annder.2011.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/01/2010] [Accepted: 02/21/2011] [Indexed: 11/29/2022]
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40
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Sturm LP, Cooter RD, Mutimer KL, Graham JC, Maddern GJ. A systematic review of dermal fillers for age-related lines and wrinkles. ANZ J Surg 2011; 81:9-17. [PMID: 21299793 DOI: 10.1111/j.1445-2197.2010.05351.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dermal fillers are gaining popularity for rapid aesthetic improvement. Long-term efficacy and safety have not been well documented. The aim of this systematic review was to assess the safety and efficacy of injectable dermal fillers compared with other facial augmentation techniques for the management of age-related lines and wrinkles. METHODS Studies including patients receiving injectable semi-permanent or permanent dermal fillers for age-related lines and wrinkles were included in this review. Efficacy outcomes (including changes in skin thickness and patient satisfaction) and safety outcomes (including mortality, lumps and infections) were examined. RESULTS Three randomized control trials and six case series were included. Permanent and semi-permanent dermal fillers improved subjective ratings of appearance and resulted in higher patient satisfaction than temporary fillers. Long-term efficacy appeared good in the few studies that reported it. Short-term safety appeared favourable. Lumps were reported in all but one study but received little follow-up. Long-term safety data were limited. CONCLUSIONS The treatment of age-related lines and wrinkles with permanent and semi-permanent dermal fillers is more efficacious compared with temporary fillers in those studies that compared them. Case series evidence suggests that these fillers achieve their objective, which is to decrease the visible effects of age-related changes. These fillers appear at least as safe as temporary fillers in the short term in those studies that compared them. Long-term safety could not be determined.
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Affiliation(s)
- Lana P Sturm
- Royal Australasian College of Surgeons, Adelaide, SA, Australia
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Moscona RA, Fodor L. A retrospective study on liquid injectable silicone for lip augmentation: Long-term results and patient satisfaction. J Plast Reconstr Aesthet Surg 2010; 63:1694-8. [DOI: 10.1016/j.bjps.2009.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Revised: 10/03/2009] [Accepted: 10/13/2009] [Indexed: 11/16/2022]
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Plaza T, Lautenschlager S. Penis swelling due to foreign body reaction after injection of silicone. J Dtsch Dermatol Ges 2010; 8:689-91. [PMID: 20337774 DOI: 10.1111/j.1610-0387.2010.07427.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 19-year-old man presented with phimosis and painful swelling of the penis four weeks after augmentation with silicone in Thailand. Histology revealed a foreign body reaction to silicone. Infectious causes were ruled out. Granulomatous foreign body reactions to silicone are common, but there are few case reports on reactions following silicone injection for penis enlargement. Foreign body reactions should be included in the differential diagnosis of penis swelling.
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Affiliation(s)
- Tobias Plaza
- Dermatology Office Dr. Tobias Plaza, Uster, Switzerland.
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Kluger N, Plantier F, Carlotti A, Guillevin L. Facial granuloma after occult silicone injection (siliconoma): a diagnosis not to be missed. Eur J Intern Med 2009; 20:e120-1. [PMID: 19712832 DOI: 10.1016/j.ejim.2008.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 11/03/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
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Sanchis-Bielsa JM, Bagán JV, Poveda R, Salvador I. Foreign body granulomatous reactions to cosmetic fillers: a clinical study of 15 cases. ACTA ACUST UNITED AC 2009; 108:237-41. [DOI: 10.1016/j.tripleo.2009.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 03/04/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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Abstract
One fascinating element of medical dermatology is the diversity of available therapeutic agents, and dermatologists are well versed in applying the mechanism of action of a drug to modify a disease process. Oral antibiotics are the ideal example of pharmacologic agents that are effective against inflammatory processes and have obvious roles in infectious diseases.
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Affiliation(s)
- Neal Bhatia
- University of Wisconsin Medical School, Madison, WI, USA.
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46
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Anastassov G, Schulhof S, Lumerman H. Complications after facial contour augmentation with injectable silicone. Diagnosis and treatment. Report of a severe case. Int J Oral Maxillofac Surg 2008; 37:955-60. [DOI: 10.1016/j.ijom.2008.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 11/08/2007] [Accepted: 04/24/2008] [Indexed: 10/22/2022]
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Abstract
Fever and periorbital swelling are the manifestation of a broad array of diseases. Among them are emergency situations, which need prompt physician input. Swiftly formulating a differential diagnosis approach is crucial. Diseases causing fever and periorbital edema are either local or systemic. Nevertheless, their impact can be systemic if they evade diagnosis. Infectious diseases and non-infectious diseases (inflammatory and allergic diseases, autoimmune diseases, neoplastic diseases, and trauma) can all lead to fever and periorbital edema. A meticulous history and physical examination in association with targeted tests against the presented spectrum of diseases (specific serological tests, radiological tests, cultures taken from the surface of the periorbital area and other relevant areas, and skin biopsy for histological and microbiological examination) will clarify the diagnosis.
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Baijens L, Speyer R, Linssen M, Ceulen R, Manni JJ. Rejection of injectable silicone “Bioplastique” used for vocal fold augmentation. Eur Arch Otorhinolaryngol 2007; 264:565-8. [PMID: 17211623 DOI: 10.1007/s00405-006-0224-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
A rare case of repeated granulomatous inflammation after silicone injection laryngoplasty for vocal fold immobility as well as its treatment by endoscopic approach is reported. The patient presented a right-sided vocal fold immobility after laryngeal trauma and remained dysphonic despite of logopedic voice therapy because of severe glottal insufficiency. An endoscopic transoral intrafold silicone injection was applied to improve the vocal function. Silicone granuloma inflammation was observed 8 days after the vocal fold augmentation. Oral broad-spectrum antibiotics and corticosteroids did not improve the inflammation. A cordotomy was performed to remove the silicone implant. After 3 months, a second endoscopic surgical intervention was necessary to remove a recurrent silicone granuloma. Eight months after the second surgical intervention, the inflammation had disappeared. An autologous fat injection to restore the glottal closure was performed successfully. Type IV contact allergy was excluded with an epicutaneous patch and scratch test with components of the silicone implant. Clinical and treatment observations are reported and the literature on complications of intrafold injected silicone for vocal fold augmentation is reviewed.
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Affiliation(s)
- Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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Conejo-Mir JS, Sanz Guirado S, Angel Muñoz M. Adverse Granulomatous Reaction to Artecoll Treated by Intralesional 5-Fluorouracil and Triamcinolone Injections. Dermatol Surg 2006; 32:1079-81; discussion 1082. [PMID: 16918572 DOI: 10.1111/j.1524-4725.2006.32117.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julián S Conejo-Mir
- Department of Dermatology, Hospital Universitario Virgen del Rocío, Seville, Spain.
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