International Multicentric Study on Ultrasound Characteristics, Layer Location, and Corporal Distribution of Granulomas After Cosmetic Fillers Injections.

Abstract

Objectives: To provide insight into the characteristics, layer locations, and corporal distribution of the granulomatous reactions to cosmetic fillers.

Methods: An international retrospective multicentric study was performed in centers that scan complications of cosmetic fillers. Inclusion criteria were patients with previous injections of known cosmetic fillers confirmed by ultrasound and ultrasonographic features of granulomatous reactions such as hypoechoic nodules, pseudonodules, or hypoechoic tissue surrounding the deposit regions. The ultrasound studies followed the published guidelines for performing dermatologic ultrasound examinations.

Results: A total of 240 cases met the criteria. The leading fillers previously injected were 50.4% hyaluronic acid, 18.8% poly-L-lactic acid, 8.3% polymethylmethacrylate, 6.3% calcium hydroxyapatite, and 3.8% silicone oil. The main regions of granulomas were the lower lid, infraorbital, and medial cheek in 41.7%, the perioral region and lips in 19.2%, the lateral jaw and cheek in 14.6%, and the chin, pre-jowl, and medial jaw in 12.5%. The layers involved by the granulomatous reaction were hypodermis in 37.1%, the deep fat pad in 8.9%, the periosteum in 5.8%, the combination of hypodermis, deep fat pad, and muscle in 5.8%, and the combination of hypodermis, fascia, subfascial, deep fat pad, and muscle in 5.4%. The predominant corporal locations were the face, submandibular, and anterior neck, with 95.8% being 87.5% in the face.

Conclusion: Ultrasound can provide valuable and detailed anatomical information supporting diagnosis and management as well as valuable insights into the granulomatous reactions to fillers.