Dermal Cosmetic Migration after Lip Augmentation Procedure: Clinical Management and Histological Analysis in a Case Report with Review of the Literature

Abstract

Lip augmentation procedures have become gradually more popular and common due to cultural tendencies and an increasing association of the appearance of the lips with both beauty and youth. Different dermal fillers have been proposed for lip augmentation—such as collagen, calcium hydroxylapatite, hyaluronic acid, and polylactic acid—which are used as temporary fillers. The present case report describes the histopathologic and clinical management of one case of HA filler migrating into the intraoral cheek, which caused discomfort by intraoral swelling. There is also a review of the relevant literature. A female patient, V.A., 34 years old, smoker, no allergies to drug and food substances, came to our attention. The patient was referred to the Department of Innovative Technology in Medicine and Dentistry of the University “G. D’Annunzio” of Chieti-Pescara in Italy by her dentist for the removal of a mass present in the right cheek. The clinical examination of the patient revealed a single mobile mass mimicking a soft tissue tumor in the right anterior cheek. The mass was palpable and approximately 2 cm long and was causing pain and swelling. The mucosa appeared healthy without ulcers. The filler, which had migrated into the cheek, was removed by reaching it with a scalped blade. The material was stored immediately in 10% buffered formalin and processed for histological analysis. The literature search was carried out in accordance with the criteria of the PICO guidelines. Observed histologically, the filler was surrounded by fibroblasts and a few inflammatory cells and giant cells without granuloma formation. The clinical diagnosis was swelling and discomfort caused by chewing trauma, while the histological examination excluded discomfort due to a foreign body reaction caused by the HA used for a lip augmentation procedure. In conclusion, the high-pressure and high-volume filler injections probably caused a detachment of the tissues, with the orbicularis oris muscle concurrently acting as a pump and moving the HA implant, causing migration to the area with low-density tissue such as the cheek.