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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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Michel JC, Perenack JD, Chapple AG, Christensen BJ. Are Delayed Dermal Filler Granulomas More Common Since COVID-19? J Oral Maxillofac Surg 2023; 81:42-48. [PMID: 36270386 PMCID: PMC9507785 DOI: 10.1016/j.joms.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Granuloma and delayed inflammatory reaction to hyaluronic acid facial esthetic fillers occurs rarely. More recently, these reactions have been reported with increasing frequency and have been associated with COVID-19 infection. The purpose of the study is to determine if delayed filler granulomas are more common after the start of the COVID-19 pandemic. MATERIALS AND METHODS A retrospective cohort study including of all patients treated with dermal filler at 4 offices of a single cosmetic surgery practice between August 1, 2018 and October 31, 2021 was performed. The primary outcome variable was granuloma formation. The primary predictor variable was time period, either pre-COVID (8/1/18 to 2/29/20) or post-COVID (3/1/20 to 10/31/21). Other study variables recorded were age, amounts of dermal fillers used, and types of dermal filler used. Data were analyzed using chi-squared test, t-tests, and logistic regression. RESULTS Over the study period, 3,255 patients receiving 8,067 syringes of filler over 6,800 sessions were reviewed. The average patient age was 46.8 ± 13.7 years and 2,583 sessions were performed in the pre-COVID time period and 4,217 sessions in the post-COVID time period. There were 11 granulomas in 9 subjects receiving filler in the post-COVID time period and 0 granulomas in the pre-COVID time period (0.3% vs 0.0%, respectively, P = .009). Juvederm Vollure was used in 64% of patients who developed granulomas but only accounted for 26% of filler administrations in the post-COVID time period and 28% in the cohort overall (P = .02). CONCLUSIONS Granuloma formation is a rare complication of hyaluronic acid filler injection that appears to be occurring with more frequency following the COVID-19 pandemic. Practitioners who administer dermal fillers should be aware of this complication and its apparent increased incidence.
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Affiliation(s)
- Jonathan C. Michel
- Facial Cosmetic Surgery Fellow, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA,Address correspondence and reprint requests to Dr Michel: Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, School of Dentistry, 1100 Florida Avenue #220, New Orleans, LA 70119
| | - Jon D. Perenack
- Fellowship Director and Associate Clinical Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana; and Medical and Surgical Director, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA
| | - Andrew G. Chapple
- Assistant Professor, Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA
| | - Brian J. Christensen
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA
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Trinh LN, McGuigan KC, Gupta A. Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review. Facial Plast Surg 2021; 38:250-259. [PMID: 34666405 DOI: 10.1055/s-0041-1736390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Tear trough deformity is a popular target for the treatment with filler injections. The side effects are generally mild and transient. However, delayed complications may occur. We aim to perform a thorough systematic review of the published literature related to delayed complications after tear trough filler injections. A search of published literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in June 2021 and included PubMed, ScienceDirect, and Embase databases. The Medical Subject Headings (MeSH) terms used included the following terms: delayed complications, nodules, granulomas, swelling, discoloration, dermal filler, hyaluronic acid (HA), polyacrylamide, calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), eyelid, periorbital, periocular, and tear trough. Twenty-eight articles consisting of 52 individual cases were included in the final analysis. 98% (51/52) of patients were female and had an average age of 48.3 years. HA was the most reported product (71.2%, 37/52), followed by PLLA (4/52, 7.7%), and CaHA (4/52, 7.7%). The most common delayed complication with any dermal filler was swelling (42.3%, 22/52) followed by lumps or nodules (25.0%, 13/52). Xanthelasma-like reaction (17.3%, 9/52), migration (7.7%, 4/52), discoloration (3%, 3/52) also occurred. The average time of onset of any complication was 16.8 months with xanthelasma-like reaction appearing soonest (mean: 10 months) and discoloration appearing latest (mean: 52 months). Most swelling cases were caused by HA. Semi-permanent fillers such as PMMA and synthetic fillers such as PLLA were more likely to be associated with lumps and nodules than other complications. It is important that clinicians who perform tear trough augmentation with dermal fillers have a thorough understanding of the risks of the procedure to diagnose and manage them promptly as well as provide patients with accurate information regarding the potential adverse effects.
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Affiliation(s)
- Lily Nguyen Trinh
- School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, Boston, Massachusetts
| | - Kelly C McGuigan
- School of Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Amar Gupta
- Department of Otolarynology, Private Practice-Head and Neck Surgery, Los Angeles, California
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Early lipogranuloma formation after foreign material injection to the face. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.710826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Huang G, Chen J. Preparation and applications of hyaluronic acid and its derivatives. Int J Biol Macromol 2019; 125:478-484. [DOI: 10.1016/j.ijbiomac.2018.12.074] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 12/17/2022]
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Haneke E. Adverse effects of fillers. Dermatol Ther 2018; 32:e12676. [PMID: 30187592 DOI: 10.1111/dth.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 06/27/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Filler injections belong to the most frequently performed noninvasive beautifying procedures. When done correctly they are generally well tolerated. However, a number of factors, such as poor filler quality, and particularly host as well as user dependent filler reactions may lead to unwanted effects. These may be early, late, or delayed events with characteristics for each of them. Temporary fillers almost invariably cause temporary side effects whereas those of permanent fillers may last forever. Some fillers are notorious for their poor safety profile; for example, silicone is banned in the European Union and the United States but nevertheless used by many practitioners and beauticians. Many fillers can be identified in histopathologic sections allowing specific measures to be instituted.
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Affiliation(s)
- Eckart Haneke
- Dermatology Practice Dermaticum, Freiburg, Germany.,Department of Dermatology, Inselspital, Universitätsspital Bern, Bern, Switzerland.,Centro Dermatol Epidermis, Instituto CUF, Porto, Portugal.,Department of Dermatology, University Hospital, Ghent, Belgium
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Irwin T, Snow AR, Orton TS, Elliott C. Endoscopic, Ultrasonographic, and Histologic Descriptions of Dextranomer/Hyaluronic Acid in a Case of Fecal Incontinence. Case Rep Pathol 2018; 2018:5873094. [PMID: 30147980 PMCID: PMC6083641 DOI: 10.1155/2018/5873094] [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: 02/27/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To present a case of fecal incontinence treated with dextranomer/hyaluronic acid (Solesta®) injections, which later caused clinical confusion and avoidable interventions. The endoscopic, ultrasonographic, and histologic appearances of dextranomer/hyaluronic acid will also be reported. CASE PRESENTATION A middle-aged Hispanic male who failed conservative management of his fecal incontinence was injected with dextranomer/hyaluronic acid in an attempt to alleviate symptoms. An unrelated screening colonoscopy was performed soon after, revealing a submucosal rectal lesion. Flexible sigmoidoscopy and endoscopic rectal ultrasound with FNA were scheduled for patient for further evaluation. An unknown foreign material was noted under microscopy and, upon attaining additional history, the gastroenterologist uncovered the patient's recent injections of dextranomer/hyaluronic acid. CONCLUSION Dextranomer/hyaluronic acid for the treatment of fecal incontinence has become more common in recent years. Though the imaging and histologic appearance of this gel-like material is seen in other areas of medicine, equivalent descriptions are limited in the anorectal region. To curb misdiagnoses and prevent unnecessary interventions, it is important to expound on the endoscopic, imaging, and histopathologic features of this tissue-bulking agent in the setting of fecal incontinence and to encourage communication, proper documentation, and easy accessibility to patient health information by all medical staff.
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Affiliation(s)
- Trent Irwin
- University of Nevada, Reno School of Medicine, 1664 North Virginia Street, Reno, NV 89557-0357, USA
| | - Alexandria R. Snow
- University of Nevada, Reno School of Medicine, 1664 North Virginia Street, Reno, NV 89557-0357, USA
| | - Taylor S. Orton
- University of Nevada, Reno School of Medicine, 1664 North Virginia Street, Reno, NV 89557-0357, USA
| | - Christie Elliott
- University of Nevada, Reno School of Medicine, 1664 North Virginia Street, Reno, NV 89557-0357, USA
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Abstract
Fillers belong to the most frequently used beautifying products. They are generally well tolerated, but any one of them may occasionally produce adverse side effects. Adverse effects usually last as long as the filler is in the skin, which means that short-lived fillers have short-term side effects and permanent fillers may induce life-long adverse effects. The main goal is to prevent them, however, this is not always possible. Utmost care has to be given to the prevention of infections and the injection technique has to be perfect. Treatment of adverse effects is often with hyaluronidase or steroid injections and in some cases together with 5-fluorouracil plus allopurinol orally. Histological examination of biopsy specimens often helps to identify the responsible filler allowing a specific treatment to be adapted.
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Affiliation(s)
- Eckart Haneke
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland, Europe; Department of Dermatology, Clinic Dermaticum, Freiburg, Germany, Europe; Centro de Dermatología Epidermis, Inst CUF, Porto, Portugal, Europe; Department of Dermatology, Ghent University Hospital, Gent, Belgium, Europe
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Rejuvenating Effects of Facial Hydrofilling using Restylane Vital. Arch Plast Surg 2015; 42:282-7. [PMID: 26015882 PMCID: PMC4439586 DOI: 10.5999/aps.2015.42.3.282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Morphological changes that accompany aging, such as wrinkles and skin laxity, are particularly prominent on facial skin. Recently, facial rejuvenation using the hydrofilling effect of hyaluronic acid (HA) filler has been employed for improvement of skin texture. In this study, we studied rejuvenating effects of stabilized HA (Restylane Vital) through direct intradermal injections. METHODS A total of 30 female patients underwent a series of procedures on face, including three sessions at intervals of four weeks. A total of 2 mL of Restylane Vital was injected along the whole face using an automatic injector. Improvement of skin surface roughness, elasticity, brightness, moisture, and fine wrinkles was evaluated. Patient satisfaction was evaluated, and pictures of patients were taken at each visit and 6 months after last treatment session. Scoring for each patient was performed by three doctors according in five subjects. Moisture, oil and elasticity were measured before the procedure and before the last treatment in 10 patients. RESULTS The majority of patients (77%) were satisfied with the therapeutic outcomes. Approximately 66% of patients responded that the effects of this procedure persisted for longer than four months, and the majority of patients (77%) wanted to undergo this procedure again and would recommend this procedure to acquaintances. Regarding doctors' evaluation, scores for improvement of skin surface roughness, elasticity, and brightness were significantly higher than those for improvement of moisture and fine wrinkle. CONCLUSIONS Intradermal injection of HA can have a rejuvenating effect on dry and tired facial skin, especially in improvement of skin surface roughness.
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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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Chan KMC, Li RH, Chapman JW, Trac EM, Kobler JB, Zeitels SM, Langer R, Karajanagi SS. Functionalizable hydrogel microparticles of tunable size and stiffness for soft-tissue filler applications. Acta Biomater 2014; 10:2563-73. [PMID: 24561708 DOI: 10.1016/j.actbio.2014.02.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/17/2014] [Accepted: 02/12/2014] [Indexed: 01/26/2023]
Abstract
Particle size, stiffness and surface functionality are important in determining the injection site, safety and efficacy of injectable soft-tissue fillers. Methods to produce soft injectable biomaterials with controlled particle characteristics are therefore desirable. Here we report a method based on suspension photopolymerization and semi-interpenetrating network (semi-IPN) to synthesize soft, functionalizable, spherical hydrogel microparticles (MP) of independently tunable size and stiffness. MP were prepared using acrylated forms of polyethylene glycol (PEG), gelatin and hyaluronic acid. Semi-IPN MP of PEG-diacrylate and PEG were used to study the effect of process parameters on particle characteristics. The process parameters were systematically varied to produce MP with size ranging from 115 to 515μm and stiffness ranging from 190 to 1600Pa. In vitro studies showed that the MP thus prepared were cytocompatible. The ratio and identity of the polymers used to make the semi-IPN MP were varied to control their stiffness and to introduce amine groups for potential functionalization. Slow-release polymeric particles loaded with Rhodamine or dexamethasone were incorporated in the MP as a proof-of-principle of drug incorporation and release from the MP. This work has implications in preparing injectable biomaterials of natural or synthetic polymers for applications as soft-tissue fillers.
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