Facial Granulomas Secondary to Dermalive Microimplants

Abstract

Wrinkle reduction and the correction of skin defects using injectable aesthetic microimplants are now widely performed by dermatologists and plastic surgeons. In recent years, dermal filler substances containing polymer particle suspensions such as Bioplastique, Artecoll, and Dermalive are the most commonly used materials. These microimplants are permanent, non-biodegradable, and generally well tolerated, although various adverse reactions are still possible. We describe here a patient with facial granulomas secondary to Dermalive injections for correction of naso-labial folds and wrinkles. The particular shape of the injected particles allows for correct identification of the implanted material. Therefore, histopathologic examination is the best means to obtain the correct diagnosis of foreign body granuloma and to identify the type of filler particles. We discuss the histopathologic differential diagnosis among the granulomas secondary to the most commonly used aesthetic permanent filler materials.

Facial granulomas secondary to injection of semi-permanent cosmetic dermal filler containing acrylic hydrogel particles

“…The shape of the methacrylate microspheres, which are comparatively irregular and sharp edged structures in Dermalive, maybe an important factor in inducing a more severe granulomatous reaction. [5] Our patient's biopsy revealed numerous irregular crystalline structures of variable size and shape with uniform transdermal distribution [Figures 6,7]. The crystalline bodies enclosed sharply circumscribed, translucent, non-birefringent foreign bodies with variable diameter.…”

Keratoacanthoma-like Reaction after a Hyaluronic Acid and Acrylic Hydrogel Cosmetic Filler

“…A maximum of two or three injections at a 3‐month minimum interval is recommended to achieve optimal results. Local granulomatous reaction after application of Dermalive is rare and only a few cases have been described 1–9 …”

“…Factors related with granuloma development are a poor injection procedure, infection, or trauma. The correct deposition and adequate volume of the dermal filler decreases the risk of adverse reactions 1–9 …”

“…Said nodules were reportedly noticed 3 weeks to 2 years after initial injection. Dermalive can be easily identified on biopsies because the plastic fragments appear as polygonal, pink, translucent, irregular‐shaped, nonbirefringent, extracellular foreign bodies surrounded by a granulomatous reaction composed of epitheloid histiocytes, numerous multinucleate giant cells, and lymphocytes 1–9 …”

Extensive Granulomatous Reaction Occurring 1.5 Years after DermaLive Injection

“…Long‐term complications have only rarely been reported. These have consisted of difficult‐to‐treat granulomatous reactions that appeared months to years after initial exposure 1–9 . Although the FDA has not approved DermaLive, because of its availability in other countries, dermatologists in the United States can also encounter its long‐term complications.…”