Incidental Finding of Restylane in a Deep Mohs Micrographic Surgical Margin

Abstract

Objective: Soft tissue augmentation is a mainstay of minimally invasive facial rejuvenation. Hyaluronic acid fillers, such as Restylane, have been used extensively for this purpose. Because it is so extensively used, Mohs surgeons should be aware that it may appear when surgical margins are histologically examined during micrographic surgery. Methods: Case report. Case Presentation: A 54-year-old woman referred for treatment of a squamous cell carcinoma of the left upper cutaneous lip. She was treated successfully with Mohs micrographic surgery. Restylane was identified as acellular blue foreign material in the hematoxylin-eosin stained frozen sections obtained from the biopsy. Subsequent inquiry to the patient revealed that Restylane had been injected 4 months previously. Discussion: Restylane is a hyaluronic acid filler that is commonly used to improve facial lines and rhytides. The clinical and histologic duration of Restylane is thought to approximate 6 to 9 months. It is important to recognize that when intraoperative frozen sections are examined, they may contain unexpected histologic features given the expanded use of cosmetic filling agents. Conclusion: It would be reasonable for Moh's surgeons to become aware of the different cosmetic filling agents and their histologic appearance and to include on presurgical questionnaires a question about past treatment with cosmetic fillers to avoid unexpected histologic findings.