Are Reabsorbable Dermal Fillers Safe For The Lips?
Injectable hyaluronic acid derivatives are the most used re‐absorbable dermal fillers for soft tissue augmentation and volume expansion. Their utilization is considered overall safe and well tolerable because of biocompatibility and biodegradability of hyaluronic acid, with minimal adverse events secondary to the intradermic injection. But rarely, late, or early adverse reactions may occur.

A 50‐year‐old woman, had undergone filler injection for lip augmentation 10 years earlier. She presented a slowly growing nodular lesion (Figure 1) of the right lower hemi‐lip of hard consistency, not ulcerated, painless, and without signs of infection.

After performing surgical excision & sending the sample for histopathological examination, it was found that the lesion was mainly composed of many clear polygonal spaces, surrounded by fibrous collagen, small lymphocytes, macrophages with occasional cytoplasmic clearing, and sparse multinucleated giant cells, pointing at long‐standing FBG. With Alcian Blue stain, the material filling the polygonal spaces was stained in light blue and appeared irregularly condensed toward the center

By confocal laser scanning microscopy, the doctors could detect more intense autofluorescence of the peripheral content of the lacunae, which progressively vanished toward the center, with a sort of onion‐skin pattern.

Key learnings & takeaway's of this case:-
1. This is a case of a female patient showing a delayed onset (10 years later) of a sclerosing granulomatous reaction due to the intradermal filler (poly‐hydroxyethyl‐methacrylate suspended in hyaluronic acid) injection for lip augmentation.
2. Filler adverse effects can be classified according to the technical procedure, onset (early or late), filler type, and host factors.
3. Technical errors may be due to too much or too little volume injection, incorrect depth or wrong localization of filler placement, and inappropriate product choice, the latter possibly being the most relevant topic.
4. Bumps and lumps following superficial filler placement usually are visible immediately after the injection or shortly thereafter, while necrosis due to intra‐arterial injection becomes evident within a day
5. Late complications, instead, may develop over weeks, months, or even years after the injection and may include diffuse chronic inflammation, nodular outgrowth (usually granulomas), late allergic reactions, hypertrophic scars, and telangiectasia.
6. HA preparations with a longevity of approximately 6 months (with highly variable molecular weight and cross‐linking properties) are the most commonly used fillers and considered the safest.

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