Inflammatory Granuloma

Avoiding Danger Zones and Side Effects While Injecting Neurotoxins and Fillers Avoid Complications Inflammatory Granuloma

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler.

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Delayed Onset of Granulomas after Fillers

The term delayed (or late) onset nodules (DONs) isn’t a diagnosis as much as simply a descriptive term for nodules or areas of induration which occur at least two weeks after a dermal filler treatment. These nodules can occur with the use of any type of dermal filler.

Main Causes of Delayed Onset Nodules (DONs)

Delayed onset nodules (DONs) are a complication that can arise after dermal filler treatments. The causes of DONs are multifactorial and can be categorized into several key areas:

1. Immune Reactions

Delayed Hypersensitivity Reactions: These reactions involve the immune system responding to the filler material as a foreign body, leading to inflammation and nodule formation. This can occur weeks to months after the injection[3][4].
Autoimmune Conditions: Patients with active autoimmune diseases or those on immunomodulatory medications are at a higher risk of developing DONs[1].

2. Infections

Bacterial Contamination: Infection during the injection process, often due to skin bacteria such as Staphylococcus aureus, can lead to nodule formation. Proper sterilization techniques are crucial to prevent this[2][4].
Biofilms: These are colonies of bacteria that can form around the filler material, leading to chronic inflammation and nodule formation. Biofilms are particularly challenging to treat and may require long-term antibiotic therapy[3].

3. Product Characteristics

Filler Composition: The physical and chemical properties of the filler, such as viscosity, particle size, and the presence of impurities, can influence the likelihood of nodule formation. Fillers with higher immunogenicity or those that degrade into inflammatory byproducts are more likely to cause DONs[1][5].
Cross-linking and Purity: Variations in the manufacturing process, including the degree of cross-linking and the presence of endotoxins, can affect the filler’s immunogenicity. Higher purity fillers have been associated with lower rates of delayed inflammatory reactions[5].

4. Injection Technique

Improper Injection Technique: Factors such as injection depth, angle, pressure, and the number of penetration sites can contribute to nodule formation. Injections in highly mobile areas like the lips are particularly prone to DONs[1].
Practitioner Experience: Less experienced practitioners are more likely to cause complications due to improper technique or lack of anatomical knowledge[1].

5. Patient Factors

Genetic Predisposition: Some individuals may have a genetic predisposition to react more strongly to filler materials.
Previous Reactions: Patients who have had adverse reactions to fillers in the past are at a higher risk of developing DONs with future treatments[1].

Conclusion