title: Granulomatous reactions after injections of multiple aesthetic micro-implants in temporal combinations: a complication of filler addiction.
abstract: BACKGROUND
  Granulomatous reaction is a well-known complication following soft filler procedures. However, the diagnosis of filler-induced granulomas may be challenging because of the occasional reluctance of patients to report the previously performed aesthetic procedure.
  
  
  OBJECTIVE
  To describe a new clinical situation in which some patients, in the quest for physical perfection, become addicted to multiple sequential cosmetic injections, increasing the risk of adverse reactions.
  
  
  METHODS
  We describe three women who developed diffuse facial nodular tumefaction after multiple procedures of filler injections into their face that occurred at different times in the previous years.
  
  
  RESULTS
  Histopathology showed a granulomatous reaction including different combined substances that were identified with different types of micro-implants in the same biopsy.
  
  
  CONCLUSIONS
  Excessive demand of multiple cosmetic injections may increase the frequency of skin granulomatous reactions and can be included in the spectrum of similar addictive dysmorphophobic behaviours. Histopathology is the best mean to achieve the diagnosis.
authors.affiliation: Department of Health Sciences, IRCSS-AOU S.Martino-IST, DISSAL, Section of Dermatology, University of Genoa, Genoa, Italy.|Department of Surgical and Morphological Sciences, Anatomic Pathology Division, IRCSS-AOU S.Martino, University of Genoa, Genoa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Rongioletti
authors.affiliation: Mario Aresu Department of Medical Science, Section of Dermatology, University of Cagliari, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Atzori
authors.affiliation: Mario Aresu Department of Medical Science, Section of Dermatology, University of Cagliari, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ferreli
authors.affiliation: SC of Dermatology, AOU Cagliari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pau
authors.affiliation: SC of Dermatology, AOU Cagliari, Italy.
authors.forename: A L
authors.initials: AL
authors.lastname: Pinna
authors.affiliation: Dermatology Unit, IRCSS San Raffaele, Università Vita-Salute, Milano, Italy.
authors.forename: S R
authors.initials: SR
authors.lastname: Mercuri
authors.affiliation: Mario Aresu Department of Medical Science, Section of Dermatology, University of Cagliari, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Aste
authors.affiliation: Department of Pathology, Hopital Necker-Enfants Malades, AP-HP, Université Paris Descartes, France.
authors.forename: S
authors.initials: S
authors.lastname: Fraitag
mesh_terms: D000180:Acrylic Resins / Q000009:adverse effects; D000368:Aged; D016739:Behavior, Addictive / Q000150:complications; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000009:adverse effects*; D005148:Facial Dermatoses / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D005549:Foreign-Body Reaction / Q000139:chemically induced* / Q000473:pathology; D006099:Granuloma / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects; D008875:Middle Aged; D020034:Silicone Gels / Q000009:adverse effects; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000180:Acrylic Resins; D000067548:Dermal Fillers; D020034:Silicone Gels; C016680:polyacrylamide gels; D006820:Hyaluronic Acid