Diagnosis and management of dermal filler complications in the perioral region

Abstract

Complications of oral region fillers are similar in clinical presentation but differ in etiology, therefore necessitating different clinical approaches. Imaging techniques add useful information for treatment planning.

High‐frequency ultrasound‐based differentiation between nodular dermal filler deposits and foreign body granulomas

“…Unfortunately, they did not address this diversity in their work. The study by Grippaudo et al confirmed the utility of MRI in differentiating between granulomas and fibrosis . On the other hand, Di Girolamo et al showed a statistically significant difference between various granulomas in contrast enhancement during MRI.…”

“…The attempts to image dermal filler deposits using the magnetic resonance imaging (MRI) and computed tomography (CT) showed the utility of both methods for specifying the location of the previously administered dermal filler . Ginat and Schatz presented CT and MR images of various dermal fillers and their chronic complications, such as abscesses, overcorrection, migration, chronic inflammation, scarring and foreign body granulomas .…”

“…Ultrasound imaging of soft tissue fillers conducted in recent years, focused on confirmation of their presence within the tissues, as the underlying cause of clinically observed complication and imaging various substances used as dermal fillers . Many authors agree that the HA deposits present in ultrasonography as well defined, hypoechoic subcutaneous lesions without any signs of internal echoes. Furthermore, as observed by Grippaudo et al, the ultrasound images of HA and collagen deposits did not differ significantly.…”

“…One of the first papers to address ultrasound imaging of dermal fillers published in 2004 by Giovagnorio et al, discusses ultrasound imaging of granulomas in patients after silicone‐based lip enhancement, which they described as hypoechoic, poorly defined, and with irregular margins. Grippaudo et al imaged FBGs in patients after injections of hydroxyethyl methacrylate (AH) and silicone, which presented as poorly differentiated masses with blurred borders and of heterogeneous structure. Foreign body granulomas forming in response to AH injections tended to be extensive and confluent.…”

Complications caused by injection of dermal filler in Danish patients

“…The optimal therapy for complications to dermal fillers depends on the nature, the onset of the complication, and the type of injected substance. A variety of therapeutic regimes have been suggested in the literature, including antibiotics, hyaluronidase, local or systemic corticosteroids, antimalarial drugs (mainly hydroxychloroquine), antihistamine, surgical excision, and laser treatment [11]. The first stage in the therapy is to identify the dermal filler given.…”