RESUMEN
Though the incidence of complications and adverse events with dermatological fillers is inherently low, practitioners should be well versed in both prevention of filler complications and the treatment algorithms for addressing "granulomas," nodules, infection, and vascular compromise. Appropriate preventative measures, coupled with timely and effective treatment, are critically important for patient safety and satisfaction. In addition to the preventive measures and treatment algorithms outlined here, the authors emphasize that the broad classification and treatment of nodules as "granulomas" is likely to lead to ineffective treatment, or worse, unnecessary exposure to incorrect treatment. In practice, nodules are classified and treated based on clinical manifestation (eg, late vs early or noninflammatory vs inflammatory) rather than on histology. Indeed, classification of a nodule as a granuloma requires a histological examination, rarely available (or necessary) in clinical practice to guide treatment. Thus, the apparent inflammatory nature of the nodule and the time of onset should drive treatment approach. The treatment algorithms presented here are based on these clinically meaningful parameters.
Asunto(s)
Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Granuloma de Cuerpo Extraño/terapia , Ácido Hialurónico/efectos adversos , Reacción en el Punto de Inyección/terapia , Adulto , Antiinflamatorios/uso terapéutico , Rellenos Dérmicos/administración & dosificación , Femenino , Granuloma de Cuerpo Extraño/etiología , Humanos , Ácido Hialurónico/administración & dosificación , Hialuronoglucosaminidasa/administración & dosificación , Oxigenoterapia Hiperbárica , Incidencia , Reacción en el Punto de Inyección/epidemiología , Reacción en el Punto de Inyección/etiología , Inyecciones Subcutáneas/efectos adversos , Inyecciones Subcutáneas/métodos , Inyecciones Subcutáneas/normas , Masculino , Masaje , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Factores de Tiempo , Resultado del TratamientoRESUMEN
All fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of and accept these risks. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., too superficial an implantation of a long-lasting filler substance). Such adverse events can be treated with intradermal 5-fluorouracil, steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunologic phenomena such as late-onset allergy and nonallergic foreign body granuloma. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions shall remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granuloma in the subcutaneous fat.