The Natural History of Polymethylmethacrylate Microspheres Granulomas

Foreign Body Granulomas after All Injectable Dermal Fillers: Part 2. Treatment Options

“…Many patients, however, have experienced spontaneous improvement of their condition over time. 72 Therefore, at least five patients should be treated with every new regimen before it can be recommended as an effective therapy of foreign body granulomas (Table 2).…”

Inflammatory granuloma caused by injectable soft tissue filler (Artecoll)

“…Artecoll has 0.01% foreign body reaction, which is very low compared to other materials, since it rarely stimulates the host's immune system owing to the previously described benefits10. The time taken for granuloma formation is generally 6-24 months after the injection, but a few cases had been reported after 10 years9,11. In this case, the foreign body granuloma formed a month after the injection, implying that the risk of granuloma formation exists even within a short period of time.…”

“…A way to try to avoid this reaction is to inject Artecoll at the junction between the dermis and the subcutaneous fat4. Other risk factors related to granuloma formation are infection, psychological trauma, surgical maneuver, pregnancy, interferon treatment, etc., and these factors are considered to have certain effects on the host's immune system to induce abnormal foreign body reaction11-14. In this case, the patient had no particular medical history or risk factors related to granuloma formation; accordingly, she was regarded as a systematically healthy patient who may experience side effects related to filler injection.…”

Prevention and Treatment of Complications after Polymethylmethacrylate-Microspheres Injections

“…A series of publications on the advantages and disadvantages of PMMA fillers has been published recently, [8][9][10][11][12][13] and their possible complications have been mentioned in detail [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and reported to the FDA. Most of the published and presented granulomas have been caused by the impure Brazilian PMMA and Artecoll injected before 2006.…”

“…In a series of an unselected sequential group of nine patients with granulomas under conservative management, all granulomas resolved within 2 years. 19 Nevertheless, according to clinical experience, there are a number of patients resistant to steroid injections, requiring other treatment options such as bleomycin, minocycline, isotretinoin, allopurinol, azathioprine, imiquimod, or tacrolimus/FK506 cream. 37 The livid discoloration of some superficial sclerosing granulomas can be treated effectively by "flashing" with intense pulsed light in the same light wavelength range as targeting blood vessels.…”