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Management of Complications Caused by Permanent Fillers in the Face: A Treatment Algorithm

Cassuto, Daniel M.D.; Pignatti, Marco M.D.; Pacchioni, Lucrezia M.D.; Boscaini, Giulia M.D.; Spaggiari, Antonio M.D.; De Santis, Giorgio M.D.

Plastic and Reconstructive Surgery: August 2016 - Volume 138 - Issue 2 - p 215e-227e
doi: 10.1097/PRS.0000000000002350
Cosmetic: Original Articles
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Background: Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. Inflammatory reactions (often termed granulomas) to these materials can be functionally and socially disabling. Most therapeutic options used until now are nonspecific antiinflammatory treatments, targeting an ill-defined immune reaction of undefined cause. The minimally invasive intralesional laser treatment can remove the foreign substance and the inflammatory reaction with an 808-nm diode laser.

Methods: Two hundred nineteen consecutive patients referred from September of 2006 until June of 2013 for inflammatory reactions to permanent facial fillers and treated with this technique at the authors’ institution with a minimum 6-month follow-up were studied. All patients were screened with an ultrasound soft-tissue examination and the lesions were classified as either cystic (implants inserted by bolus injections) or infiltrating (as in microdeposit injection). The authors’ therapeutic approach is summarized in an algorithm: infiltrating patterns were treated with intralesional laser treatment alone, whereas cystic distribution cases were also drained through stab wound incisions. The mean patient age was 49 years (range, 23 to 72 years); 204 patients were women.

Results: Partial improvement was obtained in 30 percent of patients, whereas 8 percent discontinued the treatment because of a lack of satisfaction. Lesions disappeared completely in 62 percent. Complications included transient swelling in all cases, hematoma in 2 percent, secondary sterile abscess in 9.5 percent, and minimal scarring in 10 percent.

Conclusion: A problem-oriented systematic approach to inflammatory complications from permanent fillers is proposed, based on the comprehensive work from the past 7 years, with an overall improvement rate of 92 percent.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Modena and Milan, Italy

From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia; and private practice, Piazza Cinque Giornate 1, Milano.

Received for publication June 17, 2015; accepted March 16, 2016.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Giorgio De Santis, M.D., Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy, desantis.giorgio@unimore.it

Copyright © 2016 by the American Society of Plastic Surgeons