Late-onset granuloma formation after poly-l-lactic acid injection

Storer, Molly; Euwer, Rebecca L.; Calame, Antoanella; Kourosh, Arianne Shadi

doi:10.1016/j.jdcr.2015.11.017

Cited by 13 publications

(13 citation statements)

References 6 publications

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“…Hyaluronic acid has been associated with necrosis, migrating granuloma, hypersensitivity, inflammation, and hyperpigmentation . Calcium hydroxylapatite has been linked to necrosis, filler displacement, and pain . Poly‐L‐lactic acid has been accompanied by granuloma and pain .…”

Section: Discussionmentioning

confidence: 99%

A multi‐center, open‐label, pilot study of allograft adipose matrix for the correction of atrophic temples

Gold

Kinney

Kaminer

et al. 2020

J of Cosmetic Dermatology

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Background Autologous fat grafting (AFG) and synthetic fillers are currently used in esthetic and reconstructive surgery. Challenges in AFG include inconsistent graft retention, donor site morbidities, insufficient harvest, and excessive harvesting times. An allograft adipose matrix (AAM) has been developed as an off‐the‐shelf alternative to AFG and synthetic fillers. Aims To evaluate the clinical safety and retention of an AAM over 24 weeks after treatment of bilateral atrophic temples. Patients/Methods Ten subjects (nine females, one male, aged 47‐69 years) with temple atrophy were enrolled in the IRB‐approved study. AAM (Renuva®, MTF Biologics, Edison, NJ) was injected (<3 mL) bilaterally into the atrophic temples of each subject. Volume retention, global improvement, and safety were evaluated at 1, 4, 8, 12, 16, 20, and 24 weeks. Biopsy specimens were obtained for adipogenic and angiogenic histological evaluation. Results The mean temple volume improved over the baseline and was retained throughout the study period. Fullness (measure of volume) increased immediately from 0 pretreatment to 2.8 post‐treatment (scale 0‐4 = none‐maximum). Fullness varied from 0.8 to 2.2 from weeks 1 through 12 and was 2.7‐3.0 from weeks 16‐24, around 75% increase from baseline. Furthermore, skin tone, smoothness, texture, and overall appearance also improved with 71% of subjects being satisfied to very satisfied with the results. Adverse events were minimal and histology revealed native tissue incorporation and remodeling. Conclusion AAM is safe and well tolerated, provides at least 6‐month volume retention, improves skin quality, and supports adipose tissue remodeling after treatment into temples.

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Section: Discussionmentioning

confidence: 99%

A multi‐center, open‐label, pilot study of allograft adipose matrix for the correction of atrophic temples

Gold

Kinney

Kaminer

et al. 2020

J of Cosmetic Dermatology

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“…The PLLA particles show signs of breaking down around 6 months and are gone by 9 months. There are a number of clinical and histological reposts showing the effect of Sculptra in vivo [ 9 , 10 , 11 ]. There is only one study by Kim et al in 2019 reporting the effect of Sculptra on collagen synthesis by fibroblasts (single culture) in vitro [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating the Effect of Biomaterials Such as Poly-(l-Lactic Acid) Particles on Collagen Synthesis In Vitro: Method Is Matter

Ray

2020

JFB

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Poly-l-lactic acid (PLLA), a synthetic, biocompatible, biodegradable polymer, has been safely used in several clinical applications in recent decades. Typically, SculptraTM, the commercially injectable PLLA in the form of microparticles, has been used as facial volumizer in the treatment of lipoatrophy in HIV patients. It also has various applications in tissue engineering by improving cell proliferation and adhesion. Sculptra™ can be categorised as a stimulatory filler as it stimulates the synthesis and deposition of fibrous tissue and collagen. Collagen is one of the most significant components of the extracellular matrix and beneficial for the normal physiology. It is also the structural component of a human body. In most of the studies, the effect of Sculptra on collagen synthesis was investigated in vivo and the majority of the data were from clinical and histological reports. There is only one study reporting this effect in vitro using fibroblasts. Here, we investigated whether PLLA in the form of nanoparticles can provide the same effect on collagen synthesis in fibroblasts as Sculptra. We surprisingly found that there was no stimulation of collagen in fibroblasts alone, whereas the co-cultures of fibroblast and macrophage had shown collagen stimulation by PLLA nanoparticles. It is also confirmed that collagen synthesis was caused by fibroblasts but not macrophages. Although further study needs to be conducted to evaluate its mechanism, our findings showed that choosing an appropriate method is essential for investigating the effect of PLLA or other biomaterials on collagen synthesis by fibroblasts in vitro.

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“…Poly‐ l ‐lactic acid (PLLA) is a synthetic polymer approved in the United States for the correction of HIV‐associated lipoatrophy and facial wrinkling 6 . PLLA induces a subclinical inflammatory response that stimulates proliferation of fibroblasts and subsequent collagen production and volumization of the dermis and subcutaneous tissue 7 . The most common adverse event recorded during initial clinical trials in HIV patients was the development of subcutaneous papules and nodules in and around areas of injection 8 .…”

Section: Poly‐l‐lactic Acid (Sculptra Sculptra Aesthetic)mentioning

confidence: 99%

“…The latter will contain a large number of foreign body giant cells and a strong cellular reaction, while the former will contain mostly just aggregates of injected PLLA. Late‐onset granuloma formation has been reported as far as 70 months after initial treatment 7 . Typical treatments include intralesional corticosteroids and 5‐fluorouracil, though some patients require systemic corticosteroids for complete resolution 12…”

Section: Poly‐l‐lactic Acid (Sculptra Sculptra Aesthetic)mentioning

confidence: 99%

Complications of non‐hyaluronic fillers

Kleinfelder

Glick

2020

Dermatological Reviews

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Background There are three non‐hyaluronic acid fillers available in the United States: Poly‐L‐lactic acid, calcium hydroxylapatite, and polymethylmethacrylate. Potential complications vary amongst the products. Aims To identify the most common and most concerning complications for the three FDA‐approved non‐hyaluronic acid fillers. Materials & Methods A comprehensive review of the literature was performed with key search words "complications," "non‐hyaluronic acid fillers," "poly‐l‐lactic acid," "calcium hydroxyapatite," and "polymethylmethacrylate." Results Similar to hyaluronic acid fillers, the most common adverse effects of non‐HA fillers are injection site reactions, and the most concerning events are cutaneous necrosis and blindness. Non‐HA fillers also have increased risk of papule, nodule, and granuloma formation. Discussion Papules and nodules arising early are likely to be technique‐dependent, while those arising later can be due to an immunologic foreign‐body response or infectious process. Histopathologic examination is required to diagnose a granuloma. Management of these complications requires intralesional and/or systemic corticosteroids, intralesional 5‐fluorouracil, surgical excision, and systemic antibiotics. Conclusion It is vital that injectors are experienced in proper injection technique. Even more importantly, injectors must have the knowledge to recognize and manage complications when they arise.

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Late-onset granuloma formation after poly-l-lactic acid injection

Cited by 13 publications

References 6 publications

A multi‐center, open‐label, pilot study of allograft adipose matrix for the correction of atrophic temples

A multi‐center, open‐label, pilot study of allograft adipose matrix for the correction of atrophic temples

Investigating the Effect of Biomaterials Such as Poly-(l-Lactic Acid) Particles on Collagen Synthesis In Vitro: Method Is Matter

Complications of non‐hyaluronic fillers

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