New-Fill Injections May Induce Late-Onset Foreign Body Granulomatous Reaction

Dijkema, Sjoerd J.; Lei, Berend van der; Kibbelaar, Robby E.

doi:10.1097/01.prs.0000157022.61766.5d

Cited by 54 publications

(38 citation statements)

References 6 publications

(5 reference statements)

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“…3,72,81,[87][88][89][90][91][92][93][94][95] These develop within 6 to 24 months after implantation (Fig. 8, above) and generally respond to high doses of intralesional triamcinolone.…”

Section: Polylactic Acid Microspheresmentioning

confidence: 99%

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Lemperle

Gauthier-Hazan

Wolters

et al. 2009

Plastic and Reconstructive Surgery

217

243

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Summary Genuine granuloma formation following implantation of injectable dermal fillers is a rare complication, with incidences ranging from one in 100 patients (1 percent) to one in 5000 (0.02 percent). Foreign body granulomas occur several months to years after injection at all implantation sites at the same time. Without treatment, they may grow to the size of beans, remain virtually unchanged for some years, and then resolve spontaneously. Three clinical and histologic types of foreign body granulomas can be distinguished: 1. Cystic granulomas (synonyms: inflammatory, palisading, collagenolytic): these are caused mainly by injected biological gels such as collagens and hyaluronic acids. Their clinical signs are fluctuation (sterile abscess), extreme redness, and induration. Cystic granulomas are small and superficial, occur within the first year, and disappear spontaneously within another year. They are surrounded by a significant number of giant cells. 2. Edematous granulomas (synonym: lipogranuloma): these are caused by artificial fluids such as silicone and polyacrylamides. They appear suddenly years after injection with extensive swelling and are surrounded and infiltrated by mononuclear and inflammatory cells. 3. Sclerosing granulomas (synonyms: sarcoidal and xanthelasmic): these are caused by particulate injectables composed of polymethylmethacrylate, polylactic acid, hydroxyethylmethacrylate, calcium-hydroxylapatite, or dextran microspheres. Sclerosing granulomas occur generally 6 months to 3 years after implantation and are visible, often bluish confined nodules. Histologically, the implant is infiltrated by many macrophages and giant cells, fibroblasts, and collagen fibers but few inflammatory cells. Permanent implants are not characterized by a higher rate of foreign body granuloma per se than temporary implants; however, their clinical appearance is more pronounced and their persistence longer if not treated adequately. (Plast.

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“…3,72,81,[87][88][89][90][91][92][93][94][95] These develop within 6 to 24 months after implantation (Fig. 8, above) and generally respond to high doses of intralesional triamcinolone.…”

Section: Polylactic Acid Microspheresmentioning

confidence: 99%

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Lemperle

Gauthier-Hazan

Wolters

et al. 2009

Plastic and Reconstructive Surgery

217

243

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“…PLLA (New-Fill®, Sculptra®) is a gel polymer made of poly- L -lactic acid and water (97.5%) [7]. Although in the early reports on PLLA injections for cosmetic purposes no significant signs of bio-incompatibility were found [8,9,10,11], more recent evidence refutes these statements, and the complete safety of PLLA gels can therefore no longer be corroborated [12,13,14,15,16,17,18]. We communicate herein our experience with a cohort of 10 non-HIV patients who were referred to our Immunology Unit presenting delayed adverse reactions related to PLLA implant fillers.…”

Section: Introductionmentioning

confidence: 88%

Late-Onset Immune-Mediated Adverse Effects after Poly-<i>L</i>-Lactic Acid Injection in Non-HIV Patients: Clinical Findings and Long-Term Follow-Up

2009

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Background: It has been thought that poly-L-lactic acid (PLLA) injections do not have inflammatory side effects. Recent evidence shows that local/regional/systemic delayed adverse effects may appear with its use. Objective: To evaluate the clinical complaints, treatment response and long-term follow-up of non-HIV patients with delayed immune-mediated adverse effects related to PLLA injections. Methods: Prospective, case series study of 10 patients with delayed adverse effects related to PLLA injections. The inclusion criterion was defined as the onset at least 6 months after PLLA use, with 1 or more of the following clinical signs: oedema, skin induration, swelling/tender nodules with or without discharge of pus or filler material. Several systemic manifestations were also included. Patients with immediate side effects were excluded. Patients underwent clinical management and long-term follow-up. Results: The average latency period to the onset of symptoms was 19.2 months (range: 6–60). Tender, inflammatory nodules and facial oedema were commonly seen. One case presented a systemic granulomatous disorder as a complication. After 50.2 months of average follow-up (range: 38–78), 5 patients are in remission, 4 have recurrent bouts and the last case has been lost to follow-up. Conclusion:Although infrequently, local and/or regional and/or systemic delayed and recurrent granulomatous reactions may complicate PLLA gel injections.

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“…Once the biofilm is activated it becomes an acute infection or may take a sub-acute course and result in a granulomatous response. The active infection can be controlled with antibiotics but may recur due to the underlying biofilm [8]. Chronicity and recurrence is the hallmark of biofilm reactivation.…”

Section: Discussionmentioning

confidence: 99%

Dental Procedures: Is it a Risk Factor for Injectable Dermal Fillers?

Ramzi

Kassim

George

et al. 2012

J. Maxillofac. Oral Surg.

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Dental procedures done in the vicinity of dermal fillers may result in complications of the dermal fillers such as infections which may mimic a dental infection. These infections of dermal fillers must be differentiated from facial cellulitis or from dental infection as treatment for infection from dermal fillers may be prolonged with repeated use of antibiotics, incision and drainage or removal of the filler material itself. Dental surgeons need to be aware of this potential risk in order to recognize and manage it appropriately.

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New-Fill Injections May Induce Late-Onset Foreign Body Granulomatous Reaction

Cited by 54 publications

References 6 publications

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes

Late-Onset Immune-Mediated Adverse Effects after Poly-<i>L</i>-Lactic Acid Injection in Non-HIV Patients: Clinical Findings and Long-Term Follow-Up

Dental Procedures: Is it a Risk Factor for Injectable Dermal Fillers?

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