Successful Management of Delayed-Onset Complications from a Dermal Filler of Unknown Provenance

Abstract

Introduction: A 52-year-old woman presented with delayed-onset nodules in the malar and glabellar regions approximately 16 months after undergoing facial augmentation via injection of an unknown substance in China. Medical records for the procedure were not available. The authors performed an investigative review of fillers used abroad to determine possible treatment options for the patient. After discussion with general plastic surgeons in China, a treatment plan was initiated. Materials and Methods: Computed tomography of the head with 3-dimensional reformatting was performed to characterize the nature and extent of the interventions performed. The study revealed significant amounts of a subdermal substance in the malar and glabellar regions. Results: A cycle of treatment was performed involving the injection of lidocaine, triamcinolone, and fluorouracil into the affected areas accompanied by interspersed daily massage. The regimen proved effective, and there was clear reduction in the size and inflammation of the nodules. Conclusions: The modern age of facial rejuvenation features an increasing array of soft tissue fillers available to physicians performing facial augmentation. The expansion of available filling agents and the rising costs of domestic health care have resulted in an increase in the number of patients seeking elective cosmetic procedures abroad, and patients presenting with complications from cosmetic tourism are increasingly a part of the modern aesthetic practice. Maintaining a solid awareness of current usage trends of injectable filling agents and a thorough understanding of the management options for delayed-onset nodules are essential for mitigating complications from soft tissue fillers of unknown provenance.