How do I heal granuloma without steroid injections? (Photo)

Question

I have granulomas from juva derm on both cheeks which was confirmed by a biopsy ! I have had both cheeks dissolved and have had steroid injections which did not work but caused atropy doc wants to start prp to heal the granulomas is that safe ? If not what's my best options plz help

Kyle Coleman, MD · Answer

Although rare with juvederm and other hyaluronic acid fillers, granuloma formation can happen with any filler injections.  Treatment of granulomas involves the use of localized steroid injections with possible 5-flourouracil added.  Atrophy can be a risk of steroid injections, smaller injection amounts and precise placement can reduce this risk but won't remove the risk all together.   Other options for granulomas would be excision.  Use of oral antibiotics has been recommended and may be added to the regimen.  PRP injections would be unlikely to help and would be more experimental.

John J. Martin, Jr., MD · Answer

Very odd to get granulomas from Juvederm.  Also - don't see any atrophy here.  Looks like you have a large lump or nodule there.  If this is a true granuloma, you would need more steroid and some 5-fu.  If it doesn't resolve then could remove it.  PRP is not going to eliminate a granuloma.

Amiya Prasad, MD · Answer

Thank you for your question. I understand you had biopsy that confirmed the presence of granulomas in your cheeks, and that your doctor wants to use platelet-rich plasma (PRP) to help with the healing of the granulomas. You’re also concerned about atrophy or volume loss from the use of steroid injection.A bit of info about myself — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. We use PRP everyday in our practice for things like wrinkles, acne scars, scar tissue, and we even combine it with a material called Acellular matrix for the treatment of hair loss.The challenge of addressing granulomas with a steroid or antimetabolites is that there is a risk of the skin further diminishing, reduction, loss of fat, loss of dermis and generalized atrophy. PRP could have an indirect benefit, but as I’m aware, medical literature doesn’t show any evidence of direct improvement of granulomas with the use of PRP. Now, this does not mean that there may not be any possible benefit. Keep in mind that there is often a lag or gap between medical literature and clinical experience, and often times clinical experience is not even published in formal medical literature. It is not entirely impossible to assume that PRP could be directly beneficial in this scenario.PRP is a concentration of the healing and growth factors necessary for wound healing, so it stimulates blood supply and collagen. PRP can certainly play a role in improving overall tissue quality. In fact, I have observed in recent dermatology literature, that PRP has become more prominent in terms of its benefits in skin rejuvenation. However, whether or not it fully resolves the granuloma itself remains to be seen. In terms of practicality and safety, I think you are in a safe place. PRP is not likely to cause any harm as it is derived from your own blood. As long as proper sterile technique is applied, there should be no risk infection. In addition, as long as your doctor is watching you closely and seeing how things are going and consistently measuring and evaluating, I think it should be fine. You may have to be a little bit patient, but I certainly think that there is some value in considering PRP for skin rehabilitation.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Asif Pirani, MD, FRCS(C) · Answer

I don't know of any evidence for PRP therapy in treating granulomas.  Sounds fishy.The foregoing information provided is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only.You assume full responsibility for how you choose to use this information.Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition.

Hratch Karamanoukian, MD, FACS · Answer

There is no scientific evidence that costly PRP injections will help resolve this granuloma, if indeed it is a granuloma. Strategic, small and repeated steroid injections may help resolve this short of surgical excision with micocatheter suction.

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