Reply

Abstract

Sir: We thank Dr. Azizzadeh for the comments on the article “Late-Onset Infections and Granuloma Formation after Facial Polylactic Acid (New-Fill) Injections in Women Who Are Heavy Smokers.”1 We would like to address the issues presented by Dr. Azizzadeh. First, New-Fill has been in use for a variety of indications, including correction of human immunodeficiency virus lipodystrophy and lip atrophy, in addition to the common cosmetic indications for treatment of rhytides. We described granuloma formation with palpable nodules at the nasolabial folds after correction of rhytides (one of the principal indications for cosmetic use of New-Fill). In addition, we described a similar phenomenon at the lip vermilion when the New-Fill filler was injected to correct lip atrophy. In our view, the place of injection is not the main issue and was not part of our considerations. Second, we would like to mention that all of the patients were injected in different outpatient clinics and all of the patients were referred to our treatment after frustration with their physician’s failure to provide a satisfactory solution. Third, there are prior descriptions of adverse events after injections of New-Fill2,3; our experience was not unique. We must not forget that those women underwent a series of unpleasant treatments before their referral. Fourth, the late onset of the adverse effects described in our article suggests that granuloma formation and especially infection are not technique related. Although nodule formation is a well-known consequence of soft-tissue augmentation, not all dermal fillers cause this undesired effect and therefore may be preferred. Finally, our article is a case presentation depicting adverse events after filler injection. We may only suggest causality with smoking, but further research is necessary to establish it. Nevertheless, our center is a tertiary referral center, and we have seen more smokers with New-Fill late complications compared with other fillers. Oren Goldan, M.D. Gil Grabov-Nardini, M.D. Department of Plastic and Reconstructive Surgery Sheba Medical Center Ramat Gan, Israel