Risk of Granulomas with Fillers?

Question

I was planning to get fillers (restylane or juvederm) for my nose to mouth lines (administered by a fully qualified plastic surgeon). But I'm really worried about the risk of granulomas. What is the probability of these occuring? And how severe are they? Realistically can they be treated? Any information would be greatly appreciated. I usually have no problems with allergies, infections etc

David Hansen, MD · Answer

Most filler in the U.S. don't cause granulomas except silicone. Anything is possible but realistically all the other fillers do great. Granulomas can be controlled with cortisone injections or excisions.

Eric M. Joseph, MD · Answer

Formation of nodules or bumps after a well-performed Injectable Filler treatment is rare. When bumps occur, they are usually due to overcorrection (injecting too much filler), superficial placement, or rarely foreign-body granulomata which may have redness. 

	In my clinical experience with Silikon-1000, a permanent off-label silicone-filler, foreign-body granulomata occur in 0.03% of patients. These have been self-limited in all of my patients, and may be treated with dilute triamcinolone injections, topical hydorcortisone, and IPL treatments to reduce redness. I have seen resolution in all of my patients.

	You should discuss your concerns with your physician. If your physician is reputable and experienced in the art of using fillers for facial rejuvenation, you will likely have a favorable result.

	I hope this is helpful for you.

Brent Moelleken, MD · Answer

Hyaluronic acid products such as Juvederm, Restylane, Prevelle and Hydrelle have very low incidence of granuloma formation.

	In my opinion, greater problems occur with ArteFill, Artecoll, PMMA, silicone, NuFill and other semipermanent and permanent fillers.  Problems also are greater when the fillers are used in large amounts in a single area, either compressing the tissues (especially in the nose) or creating a large non-living object within the body that can become infected.

Peter A. Aldea, MD · Answer

Despite over nearly 40 years since the release of Collagen, we have yet to have access to a PERFECT filler. Today's fillers are much safer, more durable and user friendly than earlier fillers. However, some of today's fillers are safer and more easily tolerated and have a lower incidence of granuloma, nodules and foreign body reactions than others. Hyaluronic acid fillers (Restylane, Perlane, Juvederm) have a great safety record and the lowest rate of granulomas than other fillers (such as Sculptra, Radiesse and others).
Fillers are not right for everyone. If you are not willing to take any risks whatsoever you should not have fillersregardless of their proven safety record.

Dr. Peter Aldea

Joseph Campanelli, MD · Answer

The fillers that have an increased risk of granuloma formation include silicone, polymethylmethacrylate (PMMA) microspheres and poly-L lactic acid (PLLA). Improved technique and processing have decreased the incidence of this complication. The hyaluronic acids do not have a significant risk of this complication.

Risk of Granulomas with Fillers?

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