Download PDF
CC BY 4.0 · Surg J (N Y) 2022; 08(01): e69-e79
DOI: 10.1055/s-0042-1743524
Original Article

Delayed Granulomas as a Complication Secondary to Lip Augmentation with Dermal Fillers: A Systematic Review

Lily Nguyen Trinh 
1   Department of Otolarynology- Head and Neck Surgery, School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
2   Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Institution, Boston, Massachusetts
,
Kelly Christine McGuigan
3   Department of Otolarynology- Head and Neck Surgery, School of Medicine, Kimmel Medical College, Thomas Jefferson University Sidney, Philadelphia, Pennsylvania
,
Amar Gupta 
4   Department of Otolaryngology - Head and Neck Surgery, Facial Plastic Surgery, Los Angeles, California
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Lip augmentation with dermal filler is rising in popularity. There are generally minimal side effects that are mild and transient. However, long-term complications may occur and include lumps, bumps, nodules, or granulomas. To better understand this uncommon but challenging outcome, we aim to perform a thorough systematic review of the published literature related to nodule or granuloma formation after cosmetic soft tissue augmentation of the lips.

Methods A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in April 2021 and included PubMed, ScienceDirect, Embase, Google Scholar, and Cochrane databases. The Medical Subject Headings (MeSH) terms used included the following terms: “lip filler,” “hyaluronic acid,” “lip injection,” “lip augmentation,” “silicone,” “poly-L-lactic acid,” “calcium hydroxyapatite,” “polymethylmethacrylate,” “complications,” “reaction,” “granuloma,” and “nodule.” All studies were reviewed by two independent reviewers. Any discrepancies were resolved by a third reviewer.

Results The initial search for filler-related nodules or granulomas yielded 2,954 articles and 28 were included in the final analysis containing 66 individual cases of lip nodules. All but one patient was female. The mean age was 50 years. Nodules presented on average 35.2 months or 2.9 years after initial treatment. Thirty-seven nodules underwent histological analysis, the majority of which identified the presence of a foreign-body granuloma. Silicone was the most reported filler used followed by hyaluronic acid. Most cases resolved following multiple treatments including oral antibiotics or steroids followed by surgical excision.

Conclusion Understanding the sequelae of lip augmentation with filler products allows clinicians to provide safe and effective treatment. Nodules that present months to years following dermal treatment may represent a foreign-body granuloma. A combination of oral antibiotics, intralesional or oral steroids, and surgical excision successfully treated the majority of cases in our study.

Keywords

lip augmentation - fillers - nodules - granulomas - systematic review


Publication History

Received: 21 October 2021

Accepted: 20 January 2022

Article published online:
03 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hotta TA. Lip enhancement: physical assessment, injection techniques, and potential adverse events. Plast Surg Nurs 2018; 38 (01) 7-16
    CrossrefPubMedGoogle Scholar
  • 2 Luthra A. Shaping lips with fillers. J Cutan Aesthet Surg 2015; 8 (03) 139-142
    CrossrefPubMedGoogle Scholar
  • 3 Gupta A, Miller PJ. Management of lip complications. Facial Plast Surg Clin North Am 2019; 27 (04) 565-570
    CrossrefPubMedGoogle Scholar
  • 4 Philipp-Dormston WG, Goodman GJ, De Boulle K. et al. Global approaches to the prevention and management of delayed-onset adverse reactions with hyaluronic acid-based fillers. Plast Reconstr Surg Glob Open 2020; 8 (04) e2730
    CrossrefPubMedGoogle Scholar
  • 5 Sadeghpour M, Quatrano NA, Bonati LM, Arndt KA, Dover JS, Kaminer MS. Delayed-onset nodules to differentially crosslinked hyaluronic acids: comparative incidence and risk assessment. Dermatol Surg 2019; 45 (08) 1085-1094
    CrossrefPubMedGoogle Scholar
  • 6 Modarressi A, Nizet C, Lombardi T. Granulomas and nongranulomatous nodules after filler injection: different complications require different treatments. J Plast Reconstr Aesthet Surg 2020; 73 (11) 2010-2015
    CrossrefPubMedGoogle Scholar
  • 7 Dionyssopoulos A, Nikolis A, Patsatsi A, Sotiriadis D. Granulomas of the lips: a rare complication after injection of polylactic acid for aesthetic augmentation. J Plast Reconstr Aesthetic Surg 2007; 60 (09) 1079-1080
    CrossrefPubMedGoogle Scholar
  • 8 Alijotas-Reig J, Fernández-Figueras MT, Puig L. Pseudocystic encapsulation: a late noninflammatory complication of hyaluronic acid filler injections. Dermatol Surg 2013; 39 (11) 1726-1728
    CrossrefPubMedGoogle Scholar
  • 9 Grippaudo FR, Di Girolamo M, Mattei M, Pucci E, Grippaudo C. Diagnosis and management of dermal filler complications in the perioral region. J Cosmet Laser Ther 2014; 16 (05) 246-252
    CrossrefPubMedGoogle Scholar
  • 10 Curi MM, Cardoso CL, Curra C, Koga D, Benini MB. Late-onset adverse reactions related to hyaluronic acid dermal filler for aesthetic soft tissue augmentation. J Craniofac Surg 2015; 26 (03) 782-784
    CrossrefPubMedGoogle Scholar
  • 11 Goldman A, Wollina U. Polymethylmethacrylate-induced nodules of the lips: clinical presentation and management by intralesional neodymium:YAG laser therapy. Dermatol Ther (Heidelb) 2019; 32 (01) e12755
    CrossrefPubMedGoogle Scholar
  • 12 Sanchis-Bielsa JM, Bagán JV, Poveda R, Salvador I. Foreign body granulomatous reactions to cosmetic fillers: a clinical study of 15 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 2009; 108 (02) 237-241
    CrossrefPubMedGoogle Scholar
  • 13 Ledon JA, Savas JA, Yang S, Franca K, Camacho I, Nouri K. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options. Am J Clin Dermatol 2013; 14 (05) 401-411
    CrossrefPubMedGoogle Scholar
  • 14 Christensen LH. Host tissue interaction, fate, and risks of degradable and nondegradable gel fillers. Dermatol Surg 2009; 35 (Suppl. 02) 1612-1619
    CrossrefPubMedGoogle Scholar
  • 15 Rongioletti F, Atzori L, Ferreli C. et al. Granulomatous reactions after injections of multiple aesthetic micro-implants in temporal combinations: a complication of filler addiction. J Eur Acad Dermatol Venereol 2015; 29 (06) 1188-1192
    CrossrefPubMedGoogle Scholar
  • 16 Ficarra G, Mosqueda-Taylor A, Carlos R. Silicone granuloma of the facial tissues: a report of seven cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94 (01) 65-73
    CrossrefPubMedGoogle Scholar
  • 17 Lee JM, Kim YJ. Foreign body granulomas after the use of dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment. Arch Plast Surg 2015; 42 (02) 232-239
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Chen TA, Mercado CL, Topping KL, Erickson BP, Cockerham KP, Kossler AL. Disseminated silicone granulomatosis in the face and orbit. Am J Ophthalmol Case Rep 2018; 10: 32-34
    CrossrefPubMedGoogle Scholar
  • 19 Requena C, Requena L, Alegre V. et al. Adverse reaction to silicone simulating orofacial granulomatosis. J Eur Acad Dermatol Venereol 2015; 29 (05) 998-1001
    CrossrefPubMedGoogle Scholar
  • 20 Tonin B, Colato C, Bruni M, Girolomoni G, Affiliations MD. Late granuloma formation secondary to hyaluronic acid injection. Dermatol Online J 2020; 26 (07) 13030/qt9fj4f3ts
    CrossrefPubMedGoogle Scholar
  • 21 Lupo MP. Hyaluronic acid fillers in facial rejuvenation. Semin Cutan Med Surg 2006; 25 (03) 122-126
    CrossrefPubMedGoogle Scholar
  • 22 Marusza W, Mlynarczyk G, Olszanski R. et al. Probable biofilm formation in the cheek as a complication of soft tissue filler resulting from improper endodontic treatment of tooth 16. Int J Nanomedicine 2012; 7: 1441-1447
    PubMedGoogle Scholar
  • 23 Jiang B, Ramirez M, Ranjit-Reeves R, Baumann L, Woodward J. Noncollagen dermal fillers: a summary of the clinical trials used for their FDA approval. Dermatol Surg 2019; 45 (12) 1585-1596
    CrossrefPubMedGoogle Scholar
  • 24 Bhojani-Lynch T. Late-onset inflammatory response to hyaluronic acid dermal fillers. Plast Reconstr Surg Glob Open 2017; 5 (12) e1532
    CrossrefPubMedGoogle Scholar
  • 25 Goldman A, Wollina U. Intralesional neodymium YAG laser to treat complications of polymethylmethacrylate. Open Access Maced J Med Sci 2018; 6 (09) 1636-1641
    Google Scholar
  • 26 Kaczorowski M, Nelke K, Łuczak K, Hałoń A. Filler migration and florid granulomatous reaction to hyaluronic acid mimicking a buccal tumor. J Craniofac Surg 2020; 31 (01) e78-e79
    CrossrefPubMedGoogle Scholar
  • 27 Alcântara CEP, Noronha MS, Cunha JF, Flores IL, Mesquita RA. Granulomatous reaction to hyaluronic acid filler material in oral and perioral region: a case report and review of literature. J Cosmet Dermatol 2018; 17 (04) 578-583
    CrossrefPubMedGoogle Scholar
  • 28 Fernández-Aceñero MJ, Zamora E, Borbujo J. Granulomatous foreign body reaction against hyaluronic acid: report of a case after lip augmentation. Dermatol Surg 2003; 29 (12) 1225-1226
    CrossrefPubMedGoogle Scholar
  • 29 Edwards PC, Fantasia JE, Iovino R. Foreign body reaction to hyaluronic acid (Restylane): an adverse outcome of lip augmentation. J Oral Maxillofac Surg 2006; 64 (08) 1296-1299 , discussion 1299
    CrossrefPubMedGoogle Scholar
  • 30 Farahani SS, Sexton J, Stone JD, Quinn K, Woo SB. Lip nodules caused by hyaluronic acid filler injection: report of three cases. Head Neck Pathol 2012; 6 (01) 16-20
    CrossrefPubMedGoogle Scholar
  • 31 Park TH, Seo SW, Kim JK, Chang CH. Clinical experience with hyaluronic acid-filler complications. J Plast Reconstr Aesthet Surg 2011; 64 (07) 892-896
    CrossrefPubMedGoogle Scholar
  • 32 Alghonaim YA, Solomon PD. Bilateral lower-lip foreign body granuloma secondary to hyaluronic acid injection. Plast Surg Case Stud 2016; 2 (02) 16-17
    CrossrefPubMedGoogle Scholar
  • 33 Wang LL, Thomas WW, Ditre CM, Friedman O. Silicone granuloma formation associated with dermal injection. Ear Nose Throat J 2018; 97 (1–2): E52-E53
    CrossrefPubMedGoogle Scholar
  • 34 Schmidt-Westhausen AM, Frege J, Reichart PA. Abscess formation after lip augmentation with silicone: case report. Int J Oral Maxillofac Surg 2004; 33 (02) 198-200
    CrossrefPubMedGoogle Scholar
  • 35 Hamilton DG, Gauthier N, Robertson BF. Late-onset, recurrent facial nodules associated with injection of poly-L-lactic acid. Dermatol Surg 2008; 34 (01) 123-126 , discussion 126
    CrossrefPubMedGoogle Scholar
  • 36 Dijkema SJ, van der Lei B, Kibbelaar RE. New-fill injections may induce late-onset foreign body granulomatous reaction. Plast Reconstr Surg 2005; 115 (05) 76e-78e
    CrossrefPubMedGoogle Scholar
  • 37 Bigatà X, Ribera M, Bielsa I, Ferrándiz C. Adverse granulomatous reaction after cosmetic dermal silicone injection. Dermatol Surg 2001; 27 (02) 198-200
    PubMedGoogle Scholar
  • 38 Maly A, Regev E, Meir K, Maly B. Tissue reaction to liquid silicone simulating low-grade liposarcoma following lip augmentation. J Oral Pathol Med 2004; 33 (05) 314
    CrossrefPubMedGoogle Scholar
  • 39 Alijotas-Reig J, Garcia-Gimenez V, Vilardell-Tarres M. Late-onset immune-mediated adverse effects after poly-L-lactic acid injection in non-HIV patients: clinical findings and long-term follow-up. Dermatology 2009; 219 (04) 303-308
    CrossrefPubMedGoogle Scholar
  • 40 Akrish S, Dayan D, Taicher S, Adam I, Nagler RM. Foreign body granulomas after injection of Bio-alcamid for lip augmentation. Am J Otolaryngol 2009; 30 (05) 356-359
    CrossrefPubMedGoogle Scholar
  • 41 Baumann LS, Halem ML. Lip silicone granulomatous foreign body reaction treated with aldara (imiquimod 5%). Dermatol Surg 2003; 29 (04) 429-432
    PubMedGoogle Scholar
  • 42 da Costa Miguel MC, Nonaka CFW, dos Santos JN, Germano AR, de Souza LB. Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler. Int J Oral Maxillofac Surg 2009; 38 (04) 385-387
    CrossrefPubMedGoogle Scholar
  • 43 Friedmann DP, Kurian A, Fitzpatrick RE. Delayed granulomatous reactions to facial cosmetic injections of polymethylmethacrylate microspheres and liquid injectable silicone: a case series. J Cosmet Laser Ther 2016; 18 (03) 170-173
    CrossrefPubMedGoogle Scholar
  • 44 Weyand B, Menke H. Case report: adverse granulomatous reaction (Granuloma formation) and pseudomonas superinfection after lip augmentation by the new filler DermaLive®. Eur J Plast Surg 2008; 30: 291-295
    CrossrefPubMedGoogle Scholar
  • 45 Martin LHC, Hankinson PM, Khurram SA. Beauty is only mucosa deep: a retrospective analysis of oral lumps and bumps caused by cosmetic fillers. Br Dent J 2019; 227 (04) 281-284
    CrossrefPubMedGoogle Scholar