title: Management of Complications Caused by Permanent Fillers in the Face: A Treatment Algorithm.
abstract: BACKGROUND
  Nonresorbable substances are still injected to enhance soft-tissue volumes and fill subcutaneous defects. Inflammatory reactions (often termed granulomas) to these materials can be functionally and socially disabling. Most therapeutic options used until now are nonspecific antiinflammatory treatments, targeting an ill-defined immune reaction of undefined cause. The minimally invasive intralesional laser treatment can remove the foreign substance and the inflammatory reaction with an 808-nm diode laser.
  
  
  METHODS
  Two hundred nineteen consecutive patients referred from September of 2006 until June of 2013 for inflammatory reactions to permanent facial fillers and treated with this technique at the authors' institution with a minimum 6-month follow-up were studied. All patients were screened with an ultrasound soft-tissue examination and the lesions were classified as either cystic (implants inserted by bolus injections) or infiltrating (as in microdeposit injection). The authors' therapeutic approach is summarized in an algorithm: infiltrating patterns were treated with intralesional laser treatment alone, whereas cystic distribution cases were also drained through stab wound incisions. The mean patient age was 49 years (range, 23 to 72 years); 204 patients were women.
  
  
  RESULTS
  Partial improvement was obtained in 30 percent of patients, whereas 8 percent discontinued the treatment because of a lack of satisfaction. Lesions disappeared completely in 62 percent. Complications included transient swelling in all cases, hematoma in 2 percent, secondary sterile abscess in 9.5 percent, and minimal scarring in 10 percent.
  
  
  CONCLUSIONS
  A problem-oriented systematic approach to inflammatory complications from permanent fillers is proposed, based on the comprehensive work from the past 7 years, with an overall improvement rate of 92 percent.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Modena and Milan, Italy.|From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia; and private practice, Piazza Cinque Giornate 1, Milano.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cassuto
authors.affiliation: Modena and Milan, Italy.|From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia; and private practice, Piazza Cinque Giornate 1, Milano.
authors.forename: Marco
authors.initials: M
authors.lastname: Pignatti
authors.affiliation: Modena and Milan, Italy.|From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia; and private practice, Piazza Cinque Giornate 1, Milano.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Pacchioni
authors.affiliation: Modena and Milan, Italy.|From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia; and private practice, Piazza Cinque Giornate 1, Milano.
authors.forename: Giulia
authors.initials: G
authors.lastname: Boscaini
authors.affiliation: Modena and Milan, Italy.|From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia; and private practice, Piazza Cinque Giornate 1, Milano.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spaggiari
authors.affiliation: Modena and Milan, Italy.|From the Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia; and private practice, Piazza Cinque Giornate 1, Milano.
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Santis
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D019468:Disease Management; D005145:Face / Q000601:surgery*; D005260:Female; D005549:Foreign-Body Reaction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007267:Injections; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D012060:Rejuvenation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials