Granulomatous reactions after injections of multiple aesthetic micro‐implants in temporal combinations: a complication of filler addiction

Abstract

Excessive demand of multiple cosmetic injections may increase the frequency of skin granulomatous reactions and can be included in the spectrum of similar addictive dysmorphophobic behaviours. Histopathology is the best mean to achieve the diagnosis.

Delayed sclerosing granulomatous reaction to dermal filler injection of poly‐hydroxyethyl‐methacrylate suspended in hyaluronic acid: Histochemical and confocal laser scanning microscopical analysis

“…HA is a constituent of several normal tissues and, as such, does not lead to adverse reactions; therefore, when FBGs develop, one should argue that additional components were bound to HA . HEMA has been used as a stabilizer of HA‐based fillers but it is known to induce transient macrophagic reaction, fibroblast proliferation with scarce collagen deposition, and multinucleated giant cells . The morphological features of the present case are consistent with previous injection of HA + HEMA, and the prolonged time interval from injection to clinical manifestations indicates the adverse reaction was slowly progressive.…”

Consensus statement on prevention and management of adverse effects following rejuvenation procedures with hyaluronic acid‐based fillers

“…Interestingly, with the accepted high safety and efficacy levels of filler procedures, a new clinical situation has emerged in which some patients, in the quest for physical perfection, become addicted to multiple sequential cosmetic injections, thereby increasing the risk of AEs, particularly skin granulomatous reactions. In such cases, histopathology is the best way to achieve accurate diagnosis …”

“…In such cases, histopathology is the best way to achieve accurate diagnosis. 51 Hypersensitivity Until recently, it was believed there were no cases of HA hypersensitivity. However, local and systemic, acute and chronic hypersensitivity cases have been observed after HA injection.…”

Minocycline successfully treats exaggerated granulomatous hypersensitivity reaction toMwimmunotherapy

“…Minocycline was used to treat our patient because of its immunomodulatory and anti‐mycobacterial action, unlike steroids that are immunosuppressive and carries a risk of exacerbation of cutaneous warts (Leite et al, ). Variable success has been previously reported with doxycycline and minocycline in the treatment to granulomatous reaction to microneedling and fillers (Rongioletti et al, ; Soltani‐Arabshahi et al, ). In contrast, all of our patients uniformly responded to minocycline.…”

“…Granulomatous inflammation has been reported with various injectables including vaccines (Alsuwaidi, Albawardi, Khan, & Souid, ; Bellet & Prose, ), fillers (Rongioletti et al, ), and microneedle therapy (Soltani‐Arabshahi, Wong, Duffy, & Powell, ). The reasons for granulomatous response in our patients are speculative.…”