Dermal fillers: pathophysiology, prevention and treatment of complications

Chiang, Yi Zhen; Pierone, Gerald; Al‐Niaimi, Firas

doi:10.1111/jdv.13977

Cited by 138 publications

(170 citation statements)

References 37 publications

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“…A higher risk of complications is seen when large volumes of LIS or PMMA are injected in a single session or when industrial‐grade or adulterated low‐viscosity silicone is used . Bacterial biofilm around fillers might also play a role in the pathogenesis of such granulomatous reactions . The immune pathomechanism of GFBR to soft tissue fillers is unclear.…”

Section: Discussionmentioning

confidence: 99%

Management of granulomatous foreign body reaction to fillers with methotrexate

Broly

Marie

Picard³

et al. 2019

Acad Dermatol Venereol

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Background Granulomatous foreign body reactions (GFBR) have been reported after injection with almost every soft tissue fillers, more commonly with non‐biodegradable ones. Such granulomatosis is rare but can cause significant discomfort owing to their aesthetic and functional repercussions. Objective To determine whether immunomodulation with low doses of methotrexate is effective in the treatment of GFBR to filler material. Methods Clinical case series of four patients with severe, treatment‐resistant GFBR to non‐biodegradable fillers in the Department of Dermatology of Bordeaux University Hospital, Bordeaux, France, successfully treated with oral or subcutaneous methotrexate, 10–15 mg weekly during 6 months. Adverse events were monitored throughout the treatment once weekly the first month then once monthly the remaining 5 months. Results Four women with a mean age of 73.7 years (66–85 years) and nodularity of the face were included and treated up to 6 months. Histological findings were consistent with GFBR to liquid injectable silicone in 2 cases, polymethylmethacrylate in 1 case and hydroxyethylmethacrylate in the last case. The delay after injection of the filler material was from 17 to 30 years. In one patient, inflammatory lesions followed dental care. After 6 months of treatment with 10–15 mg once weekly, all patients were cleared. Three patients developed a mild hepatic cytolysis (grade 1 or 2). Methotrexate could be maintained in those 3 cases and was discontinuated after 6 months in all cases. Two patients developed recurrence of lesions, 28 and 9 months, respectively, after treatment stops, requiring reintroduction of treatment. The two other patients remained cleared after 6 months of follow‐up. Conclusion Low doses of methotrexate appear to offer a low‐risk therapeutic alternative in resistant and severe GFBR to fillers. A prospective study with long‐term follow‐up is required to confirm these preliminary observations.

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Section: Discussionmentioning

confidence: 99%

Management of granulomatous foreign body reaction to fillers with methotrexate

Broly

Marie

Picard³

et al. 2019

Acad Dermatol Venereol

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“…Early detection and management of vascular occlusion can help preserve the ischemic tissues. Emergency management of vascular compromise includes vigorous massage, topical nitroglycerin paste, warm compression, oral anticoagulants, and hyaluronidase injection . Hyaluronidase injection into the ischemic tissues has been widely accepted to be used to prevent skin necrosis from vascular compromise after HA injection.…”

Section: Introductionmentioning

confidence: 99%

The study of histological changes of the arterial vascular structure after hyaluronidase exposure

Wattanakrai

Jurairattanaporn

Rojhirunsakool

et al. 2018

J of Cosmetic Dermatology

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“…We discussed the pathology results with the patient, who reported having received filler injection of HA in her midface years previously. While many complications of soft tissue augmentation appear immediately or occur shortly afterwards and are easily linked to the procedure, the occurrence of delayed filler migration poses a diagnostic challenge. There are several recent case reports of delayed filler migration presenting as discrete facial masses or periorbital oedema .…”

Section: Discussionmentioning

confidence: 99%