Complications of injected vitamin E as a filler for lip augmentation: case series and therapeutic approach

Abstract

The strive for proficient cosmetic facial appearance is growing in the past decades. Fillers for tissue augmentation are gaining wide popularity. Uncertified products based on oleic solutions are applied by untrained staff, thus growing the risk for certain complications such as infections, allergic and irritant contact dermatitis, and lipogranuloma formation. We present a series of three cases lipogranuloma after liquid vitamin E injection for lip augmentation. In all cases, painful edema at the injected area followed the procedure. The patients were presented with erythema, firm indurations of the lips and the perioral skin, and tenderness. Histological examination of skin biopsies showed round-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with a lipogranuloma. In this paper, we propose a protocol for treatment of this specific complication with systemic corticosteroids and a broad spectrum antibiotics.

Serious complication as a result of lip augmentation with vitamin E

“…Complication can be early to late onset and range from mild to less often severe reactions such as hemorrhage, abscess formation, and cellulitis. Swelling, erythema, ecchymosis, hematoma, bruising, necrosis, infections, pain, paresthesia, and asymmetry are major problems that practitioner encounter . Vitamin E is an oil‐soluble vitamin.…”

“…Lipogranuloma is categorized as chronic reaction; however, it's onset is related to amount of material injected and different immunogenicity . It is characterized by multiple cavities with different size and shape that make Swiss cheese‐like appearance with arabesque architecture in high magnification.…”

“…Antibiotics are used to control acute infection. Corticosteroids can be administered systematically (0.5‐0.7 mg/kg tapered over 6‐8 weeks) or intralesionally . In resistant lesions, allopurinol and colchicine have been tried due to anti‐inflammatory properties.…”

“…In many countries, only practitioners with academic skills in esthetic field are allowed to accomplish this procedure. Financial benefit and high demand persuade undertrained staff to use unregistered material which can lead to severe adverse effects …”

Management of complications of vitamin E injections into the face

“…As for our case, histopathologically, the subcutaneous tissue was normal, but there was a granuloma formation.Similar reactions are observed with mesotherapy solutions containing vitamin E (Pugliese, Yaar, Al-Dawsari, Goldberg, & Garg, 2010).The reactions against these foreign materials are very difficult to treat, and the cure rates are quite low. Extended-spectrum antibiotics, systemic and intralesional steroid, colchicine, allopurinol, topical calcineurin inhibitors, imiquimod, systemic bleomycin, or withdrawal of foreign material with a cannula are treatment options.Surgical treatment is another option for those who are unresponsive to all the treatments (Kamouna et al, 2015). We treated the patient with systemic 0.5 mg/kg/day methylprednisolone, 1,5 mg/day colchicine, and extended-spectrum antibiotic along with intralesional steroid, clindamycin, and 5-fluorouracil.…”