Management of visible granulomas following periorbital injection of poly-L-lactic Acid.
OBJECTIVE
Injectable poly-L-lactic acid (PLA) is a recently FDA-approved soft-tissue filler. Although approved only for treatment of HIV-associated lipoatrophy, there has been increased interest in its use for cosmetic purposes. Here we describe a case of a granulomatous reaction to injectable PLA in the inferior periorbital region resulting in visible papules and discuss treatment options.


METHODS
We review literature pertaining to medical and surgical treatment options for our patient, and we discuss relevant techniques for both the injection of PLA and the management of this complication with surgical techniques.


RESULTS
After failing several nonsurgical treatment options, our patient had excellent results with surgical excision of her persistent visible nodules. This technique is minimally invasive, provides definitive removal of the nodules, and can leave minimal residual scarring.


CONCLUSIONS
Given the high frequency of subcutaneous nodule formation reported in early trials of injectable PLA, it is important for physicians to be well informed regarding its potential side-effects and how to minimize risk of adverse reactions. Based on our experience, we suggest that surgical excision is an excellent treatment option for persistent papules and nodules that arise after injection of PLA in the periorbital area.
Department of Dermatology, Stanford University Medical Center, Stanford, California 94305, USA.
Daniel B
DB
Stewart
Greg S
GS
Morganroth
Maureen A
MA
Mooney
Joel
J
Cohen
Peter S
PS
Levin
Hayes B
HB
Gladstone
D000328:Adult; D002482:Cellulose / Q000009:adverse effects*; D003357:Cosmetic Techniques; D005260:Female; D015745:Granuloma, Foreign-Body / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007267:Injections; D019344:Lactic Acid / Q000009:adverse effects*; D008353:Mannitol / Q000009:adverse effects*; D019060:Minimally Invasive Surgical Procedures; D013508:Ophthalmologic Surgical Procedures; D009916:Orbital Diseases / Q000209:etiology / Q000601:surgery*; D011091:Polyesters; D011108:Polymers / Q000009:adverse effects*; D015361:Rhytidoplasty; D012871:Skin Diseases / Q000209:etiology / Q000601:surgery*
C482305:New-Fill; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; D008353:Mannitol; C033616:poly(lactide); D002482:Cellulose