What Causes Filler Granuloma and How to Treat It
Dermal fillers are widely used in aesthetic medicine to enhance facial volume, smooth wrinkles, and improve overall facial contours. However, despite their popularity and general safety, complications can arise.
One such complication is filler granuloma, a rare but significant foreign body reaction that can develop weeks, months, or even years after treatment. It is crucial for medical aestheticians to understand what causes filler granuloma, its symptoms, and the best strategies for treatment and prevention.
What Does Filler Granuloma Look Like?
A filler granuloma is a chronic inflammatory reaction caused by the body’s immune response to a dermal filler substance. It presents as firm, palpable nodules that can sometimes be painful, inflamed, or disfiguring. Unlike normal post-injection swelling or minor lumps, granuloma lip filler nodules persist and may gradually increase in size.
The immune system treats the filler material as a foreign substance, forming foreign body granulomas. These granulomas encapsulate the filler, creating a noticeable lump. The most common types are granuloma in lips after filler, cheek filler granuloma, and granuloma under eye after filler.
What Triggers Granuloma?
Granulomas can develop due to several factors, including the type of filler used, immune system response, injection technique, bacterial contamination, and delayed hypersensitivity reactions. Certain filler materials, especially non-biodegradable ones like silicone, are more likely to cause granulomas.
Biodegradable fillers, such as hyaluronic acid, have a lower risk but still can cause this complication. Some individuals have an overactive immune response, leading to the encapsulation of filler as the body tries to isolate it.
Poor injection technique, deep placement errors, or multiple injections in the same area can increase the risk of granuloma formation. Even minor bacterial contamination at the injection site can trigger a chronic inflammatory reaction.
Some granulomas form months or even years post-injection due to the body's evolving immune response. Lip filler granuloma and cheek filler granuloma are among the most common types due to the vascular nature of these areas and the frequent use of high-viscosity fillers.
What Are Filler Granuloma Symptoms?
Filler granuloma symptoms may include:
- Hard lumps or nodules that persist beyond the typical healing period.
- Pain or tenderness at the injection site.
- Redness and inflammation, which may worsen over time.
- Swelling that does not subside.
- Possible pus formation, indicating secondary infection.
The symptoms may mimic other complications such as nodules dermal filler granuloma or biofilm formation, making correct diagnosis crucial. Granulomas may also feel rubbery or firm to the touch, distinguishing them from softer filler irregularities or localised swelling. Patients may experience localised itching, warmth, or even colour changes in the affected area, for example allergic reaction to lip filler.
Procedure for Filler Granuloma Removal
Filler granuloma removal depends on the severity and type of filler used. Persistent granulomas often need targeted granuloma after filler treatment to prevent worsening symptoms and ensure a good aesthetic outcome.
Treatment options include corticosteroid injections to reduce inflammation, or, in severe cases, surgical excision. Filler granuloma ultrasound is a valuable tool to assess the size and location of the granuloma before deciding on treatment. Each treatment approach should be carefully selected based on the patient’s history and response to prior interventions.
Do Filler Granulomas Go Away?
Whether filler granulomas go away on their own depends on the severity of the reaction and the type of filler used. In some mild cases, the body may gradually break down and absorb biodegradable fillers like hyaluronic acid, leading to a slow resolution of granulomas.
However, for non-biodegradable fillers or cases where the immune response is strong, granulomas tend to persist and may even enlarge over time. Without treatment, they can cause chronic inflammation, fibrosis, or aesthetic concerns.
While some granulomas may resolve on their own, medical intervention is generally recommended to prevent complications and ensure the best aesthetic outcome.
How to Prevent Dermal Filler Granuloma?
Prevention is always preferable to treatment. Medical professionals can minimise the risk of granuloma from filler through proper aseptic techniques, correct filler selection, and continuous education.
Aesthetics complications training is crucial for professionals as it equips them with the knowledge and skills needed to recognise early signs of adverse reactions, implement effective treatment strategies, and ensure patient safety. By staying updated on the latest techniques and evidence-based management approaches, practitioners can minimise risks, improve patient outcomes, and handle complications before they worsen.
Avoiding overcorrection and selecting high-quality fillers can significantly lower the risk of delayed immune reactions. Pre-treatment screening and ensuring patients do not have contraindications can also help reduce occurrences. Educating patients on proper aftercare, monitoring for early signs of complications, and scheduling follow-ups can further reduce the likelihood of granuloma post-filler.
What Happens If a Granuloma Goes Untreated?
If a filler granuloma goes untreated, it may persist for months or even years, gradually becoming more noticeable and, in some cases, increasing in size. While some granulomas remain stable, others may continue to grow as the immune system attempts to isolate the filler material.
This prolonged inflammatory response can lead to chronic redness, tenderness, and discomfort. Over time, untreated granulomas can cause fibrosis, where excessive scar tissue forms around the granuloma, making it harder to dissolve or remove non-surgically.
In more severe cases, untreated granulomas can become infected or lead to further complications, such as migration of the filler material or the formation of abscesses. This can result in visible lumps, asymmetry, or even tissue damage that may require surgical intervention. Moreover, granulomas that develop around permanent or semi-permanent fillers are more challenging to manage, often necessitating aggressive treatments such as excision.
In Conclusion
Early diagnosis and appropriate filler granuloma treatment are crucial to preventing these complications and ensuring the best possible aesthetic and functional outcome. Understanding what causes granuloma from filler, recognising symptoms early, and employing the right treatment can lead to better patient outcomes.
Additionally, proper aesthetics complications training and patient screening can significantly reduce the risk. With careful practice and informed decision-making, aesthetic professionals can ensure safer and more effective treatment for their patients.