Granulomas after lip augmentation with hyaluronic acid: a case report

Cosmetologists often use hyaluronic acid fillers to rejuvenate the perioral area – smoothing wrinkles, filling furrows, increasing and eliminating lip asymmetries. Preparations based on HA are non-toxic and in most cases do not cause serious complications. Swelling, redness, discomfort, and bruising at the injection site often appear after contouring and resolve within a few days. However, in some cases, after lip augmentation with a hyaluronic acid filler, foreign body granulomas are formed. In the article estet-portal.com Dr. YA Algonaim and PD Solomon talk about the management of this complication using a case study.

• Clinical presentation: bilateral granulomas after lip augmentation with hyaluronic acid filler
• Discussion: Adverse events after hyaluronic acid fillers

Case presentation: bilateral granulomas after lip augmentation with hyaluronic acid filler

A 52-year-old female patient had her first lip augmentation procedure with a hyaluronic acid filler. The woman was satisfied with the result immediately after the correction, however, 4 weeks after the injections, she began to notice that nodules began to appear on both sides of the lower lip at the same time. The specialist who performed the procedure assured the patient that there was no need for therapy.

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Over the course of several months, the nodules gradually increased in size. After 3 years, the patient was referred to the author's institute for further evaluation and treatment. During the examination, the doctor revealed two non-erythematous nodules on both sides of the lower lip with a diameter of 1.5 cm each. On palpation, the nodules were dense, but did not cause pain.

 

 

Bilateral nodules after lip augmentation with HA filler

Patient consented to surgical removal of nodules under local anesthesia. In order to preserve the integrity of the vessels of the lower lip, the operation was performed in several stages: first, the formation on the left side was removed, and after three weeks – from the right. A through wedge excision followed by primary closure was performed. The patient tolerated the procedure well.

Read also: Granulomas after fillers: what a beautician should do

Pathological examination revealed severe granulomatous inflammation and focal necrosis. The granulomas contained large amounts of foreign material.

Discussion: Adverse events after hyaluronic acid fillers

The ideal filler should be safe, non-toxic, biocompatible, easy to use, and the results of its administration – predictable, long-term and reversible. Hyaluronic acid meets these criteria.

#opros#

HA is part of the extracellular matrix, as well as the connective tissues of the skin, cartilage, bones and synovial fluid. Therefore, this substance is not associated with the risk of immunogenicity, it is biocompatible and non-toxic.

Now hyaluronic acid fillers – the best on the aesthetic market.

The manufacturers extended the short half-life of HA by cross-linking, which prevents the process of natural degradation of the substance.

 

 

Photo immediately after surgical removal of a foreign body granuloma: primary closure of the defect on the right side

With age, the viscoelasticity and volume of facial skin decrease. This is partly due to a decrease in the amount and dysfunction of hyaluronic acid. Hyaluronic acid filler injections are used for:

• smooth marionette wrinkles;
• filling nasolabial folds;
• lip augmentation;
• cheekbone augmentations, etc.

Despite the safety of HA products, procedures using these fillers are associated with a number of adverse events.

Most common :

• redness;
• seals;
• edema;
• bruises.

Migration of material, which can lead to the formation of temporary nodules, papules, discoloration and allergic reactions, is also encountered in the practice of estheticians.

You may also be interested in: Hyaluronic acid lip correction: how to get a natural result and avoid complications

Delayed complications include foreign body granulomas, which occur in approximately 0.6% of patients. Sometimes practitioners, based on the results of one clinical examination alone, take the nodules for granulomas. It is important to differentiate nodules and granulomas. The first term is descriptive, while the second diagnosis requires histopathological examination.

A histopathological examination is required to confirm granuloma.

The causes of granulomas after lip augmentation and correction of other areas of the face with hyaluronic acid fillers are unknown, but it is assumed that the reaction of the recipient to protein residues of bacterial or avian origin is to blame. The second possible reason – the presence of impurities formed during the cross-linking of hyaluronic acid fillers.

In any case, patients should be warned about the likelihood of granulomas after HA lip augmentation and informed about the symptoms of this and other possible complications of contouring.

Based on Plast Surg Case Studies

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