Granuloma as a complication of polycaprolactone-based dermal filler injection: ultrasound and histopathology studies

Abstract

In aesthetic medicine, there has been an ongoing search for an ideal dermal filler to offer zero complication rate. Polycaprolactone-based dermal filler (PCL) has been available since 2009. The purpose of the paper was to present a case of granuloma as a complication of PCL injection, which has not been reported so far by other researchers. A 68-year-old female was injected with PCL. One year later, nodules accompanied by bluish skin discoloration developed within the injection site. Ultrasound and histopathology studies were performed. The examinations confirmed the presence of foreign body granuloma after PCL, which makes it the first reported case worldwide. The published data analyses showed general lack of studies and case reports to address this issue. The PCL, like an injection of any soft tissue filler, may lead to serious complications, such as granuloma formation. This makes further research legitimate and necessary.

Polycaprolactone‐based dermal filler complications: A retrospective study of 1111 treatments

“…In contrast, histopathology of a nodule reveals an overabundance of product; this is distinct from a granuloma, which shows an overabundance of host tissue reaction to a small amount of product, indicating an immune origin that depends on the host's immune status or incidents that cause changes in immune status. Granuloma has been reported with all currently available commercial products, including collagen, HA, PLLA, silicone, calcium hydroxyapatite (CaHA), polymethylmethacrylate, polyacrylamide gel 20 and PCL‐based filler 21 . Most nodules disappear spontaneously within a year.…”

“…On histology examination, numerous colonies of Streptococcus parasanguinis were identified; infection might be suspected as the cause of the reported complication. The patient subsequently withdrew consent for treatment and was lost to follow‐up 21 . In one analysis of cases induced by dermal fillers, one case of xanthelasma‐like reaction using PCL‐based filler was cited, showing that this is an extremely rare reaction 22 .…”

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“…84 Another case described as a granuloma, the first one, was reported in a subject who observed tiny nodules at the injection sites 1 year after facial treatment, and waited for follow-up visit 2 years posttreatment; the patient refused to consent to treatment and was lost to follow-up; bacterial contamination was detected on biopsy. 85 A retrospective case analysis considered discoloration, xanthelasma-like reaction after dermal fillers injection, hyaluronic acid, calcium hydroxyapatite and one case with PCL in lower eyelid. 86. It is a very rare reaction with dermal fillers and eyelid treatment is not an indication for PCL; it should not be injected in the periorbital region.…”

Another face of dermal fillers

“…Permanent fillers require a longer follow-up. Injected filler materials and related complications should be examined by such techniques as ultrasonography, magnetic resonance imaging (MRI), and computed tomography [31][32][33][34]. High-frequency ultrasound imaging is helpful in distinguishing between granulomas and nodules-dermal filler deposits, which can form after dermal filler injections.…”

“…However, none of techniques is 100% effective in avoiding ischaemic complications. Another very important issue is the establishment of treatment indications with dermal fillers and the choice of appropriate material for soft tissue augmentation [ 14 , 30 – 32 ]. Treatment with permanent and semi-permanent fillers is contraindicated in areas previously injected with other dermal fillers, in patients with a tendency to develop hypertrophic scars, in those with a history of autoimmune or inflammatory disease or receiving immunotherapy, and in patients with multiple allergies or those allergic to sodium hyaluronate.…”