Dangerous to Remove Granuloma from Newfill and Restylane?

hi i have a question my aunt has a medium sized granuloma on her lips caused by newfill,and another 2 medium sized ones on both cheeks caused by restalyne.its been over 3 years and she wants to have them surgically removed but doctors told her its dangerous because they are not small and could damage nerves and muscles while being removed,she wants to know dont doctors have something called: nerve stimulator,and if it cant be removed surgically? what are her options? 

Doctor Answers (9)

Is that backwards?

+3

Dan,

I'm sorry to hear that your Aunt had adverse reactions to her treatments. Are you sure that the Restylane is not in the lip and the Newfill is not in the cheek. These would be more likely sites of injection for the materials. Removal of the lip material should be no problem with regard to any major nerve damage. She might lose some sensation in a small area just around the surgery site, but that's about it. To avoid scars on the cheeks she could try an injection of cortisone into the granulomas. Alternatively, depending on what part of the cheek they are in, she might be able to have them removed from inside the mouth.


Manhattan Plastic Surgeon
4.5 out of 5 stars 31 reviews

The granuloma can be removed

+2

Granulomas can be removed. The risk depends where they are and at what level the filler was injected. You then have to weigh the risks and benefits of having the granuloma removed versus living with the granuloma. It is hard to commend specifically on your case with you examining you and/or seeing photographs. It would be unusual for a nerve to be involved. Also, using a nerve stimulator does not prevent damage to nerves - it just stimulates the tissue to see if the nerve is in proximity to where you are working.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 54 reviews

Removing granulomas

+2

Granulomas are areas of walled off inflammation after injections of fillers. Restylane granulomas are rare unless large amounts have been injected.

You are best off consulting a board certified plastic surgeon who is familiar with the anatomy of the face. The chance of nerve injury would then be remote.

The chance of nerve injury or bleeding is much higher with a doctor not familiar with operating on the face.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 90 reviews

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Granulomas can be removed safely in these locations

+2

While the procedure is not complicated, your aunt should be aware that she is in essence trading a scar for the surgical removal of a granuloma.  You did not mention whether your aunt has had cortisone injections.  If not, it would probably be worth trying that first.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 4 reviews

Granuloma removal is safe with careful dissection

+2

Granulomas could be removed safely with careful dissection and avoidance of the critical anatomical structures. I would try to talk to a board certified plastic surgeon, and I'm sure he will be able to do it. Good Luck!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
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The removal can be done safely, usually no nerve stimulator is necessary

+2

We had to remove granulomas from Newfill/ Artefill that were done elsewhere in the past. It is usually a relatively simple procedure. Depends on the extent of granulomas - and we've seen some really extensive cases, and location. In any case, no nerve monitor is usually necessary, unless it was some extremely weird injection, done around facial nerve, etc. if, say, your aunt had an unusual deformity, or a dent left by tumor removal. I have not seen granulomas from Restylane. It is possible your aunt just has an accumulation of the product, and it is usually very easily removed by a small needle puncture or an enzyme injection.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon
4.5 out of 5 stars 16 reviews

Any trained plastic surgeon can do it without damaging nerves

+2

A granuloma is rare, but also very superficial.  Removing it should not jeopardize any nerves or muscles. Office procedure under local anesthetic. Side effect would be a small scar which would probably fade after a few months. 

E. Anthony Musarra II, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 7 reviews

Removing granulomas from the lip

+1

The lips are an excellent structure where dermal fillers can be used effectively. The dermal fillers when applied properly will create an even result with minimal to no scarring. However, it is uncommon but possible that he may have lumps in the lips from these dermal fillers. Your body may also cause an overreaction and create a granuloma. If this occurs, it is best to be evaluated by board-certified plastic surgeon with a great deal of experience with dermal fillers, lip surgery, and scar revision. They will be able to determine what your best options are and let you know what is possible to remove the granuloma leaving as small and the least noticeable scar possible.
 

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 60 reviews

Consider consultation with an ENT surgeon

+1
Some head and neck surgeons (also known as ENT surgeons or otolaryngologists) do use nerve stimulators during excisional procedures. Your aunt may wish to consult with this specialty for further information.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.