Outcomes and Complications of Surgical Removal of Foreign Body Granulomas Due to Illicit Polymer Injection for Cosmetic Purposes

Abstract

Background There are several local complications associated with subcutaneous injection of illicit polymers, including: injection-site deformity, granulomas, and skin changes. Objectives To compare the postoperative complications and symptom flare in patients undergoing surgical excision of foreign-body granulomas. Methods We retrospectively examined data of patients who underwent surgical removal of foreign-body granulomas caused by polymer injection for cosmetic purposes with UAL, en bloc excision with primary closure, skin grafts, or free flaps during 2014–2020. Data collected included demographic and operative parameters. Postoperative complications, symptom flare, and time to flare were reported. Relationship between type of surgery and complications, symptom flare, and time to flare was determined through statistical analysis. Results The final cohort included 49 surgeries (42 primary and 7 secondary) in 35 patients. Overall complication rate was 28.9%, with no significant intergroup differences (30.8%, 20%, 66.7%, and 40%; p = 0.328). Wound dehiscence and skin burns were the main complications. An overall symptom flare of 35.1% in surgical treated areas over a mean period of 28.49 months was reported. Chi-squared test indicated statistical significance between type of surgery and symptom flare (p = 0.004) and between complications and flare (p = 0.013). Kaplan–Meier test for flare was statistically significant (p = 0.006) after comparison of the four groups. Conclusions Rate of postoperative complications was similar for each type of surgery. However, en bloc excision and reconstruction by either primary closure or free flap was associated with a significantly decreased rate of symptom flare and a longer symptom-free period.