Adverse cutaneous reactions to soft tissue fillers – a review of the histological features

Abstract

The enhanced use of exogenous substances for cosmetic and reconstructive procedures is paralleled by an increase in reports of cutaneous adverse reactions to several of these agents. Recognition of the histological features of these reactions is of importance to both dermatologists and dermatopathologists but is not always easy for several reasons. First, cost-related issues are resulting in an increasing number of these procedures being performed overseas. Thus, patients are often unsure about the exact product used. Compounding this is the fact that practitioners who perform these procedures are not forthright in divulging this information, given that improper substances may be admixed in the filler injected. Furthermore, cutaneous reactions may occur at sites distant from injected sites, secondary to migration of the filler substance and a lapse of months to years may occur prior to the development of a cutaneous reaction. Thus, a causal relationship between the procedure and the reaction is often not made. We present an overview of the histological features of adverse reactions to currently available soft tissue fillers, both in the United States and overseas, in an attempt to enhance awareness of the diversity of these reactions.

Foreign Body Granulomas

“…4C), which was the injected HA gel. 40,41 Scant amounts of HA may also be seen within multinucleated giant cells. The HA stains positively for alcian blue at a pH of 2.7 and is negative when examined under polarized light.…”

“…4G). 41 On ultrasound, CH appears as hyperechoic deposits with variable degrees of posterior acoustic shadowing. 31…”

Estudio clínico de eficacia, duración y efectos adversos del implante de ácido hialurónico en área buco-maxilo-facial

“…These occurrences were overcome in time using bioengineering to synthesize the HA (3-s5,12,15,17,84) . Other currently used filler materials still cause diverse, significant adverse reactions (1,5,17,(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)(98)(99)(100) , therefore, it is not advisable to combine HA with other materials, or brand names that are not subject to stringent quality controls (1,4-5,84,87,93) .…”

Migrating Granulomatous Chronic Reaction from Hyaluronic Acid Skin Filler (Restylane): Review and Histopathological Study with Histochemical Stainings

“…Although it contains trace amounts of bacterial proteins and is generally well tolerated, there have been rare reports of occasional allergic hypersensitivity reactions [3,4,5] and of long-term cutaneous adverse reactions displaying two different histological patterns, i.e. granulomatous and non-granulomatous [1,6,7,8]. These reactions may be due to the reformulation of Restylane in 1999 into a more purified HA raw material containing less bacterial protein.…”