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An injection granuloma is the body's reaction for a retained foreign body or substance. It can resolve with a simple incision and drainage. If it does not -- you may need to have it excised and repaired properly.
An injection granuloma occurs when a medication is inadvertently injected into the fat rather than the muscle. This causes fat necrosis (fat death), scar formation, and sometimes calcium deposits. If the patient can not recall receiving an injection, these can feel like a soft tissue mass and occasionally lead to an erroneous diagnosis of sarcoma. Even under the microscope, this can be a tricky diagnosis. I remember as a pathology resident, this can pose a very difficult call in evaluating a breast mass...that tissue being a fairly common area for fat necrosis. It is felt that women develop more of these injection granulomas due to the larger amount of subcutaneous fat. There may be a hormonal reason for this also. Decreased blood flow (hypovolemia), also makes one more prone to an injection granuloma. The fact that you were in anaphylaxis (to what?) made you more susceptible to an injection granuloma. It may be best treated with judicious, dilute corticosteroid. Your physician must be careful since steroids too can cause granulomas. However, they do often break them up, hence their use in this situation. Otherwise, they can be excised by a surgeon. By the way, send a thank you note to the person who handled your emergency each of your birthdays!
The vast majority of Hyaluronidase patients are new to my practice. I typically charge between $4-600 for a Hyaluronidase treatment and half the amount if subsequent treatment visits are necessary. If one my own patients are in need of this treatment, then I would not charge them.
A couple things about hyaluronidase 1. It takes 2-3 days to dissolve the filler 2. It may take an additional 2 weeks for absorption of filler/hyaluronidase to occur 3. It may take a couple more months for the skin and local swelling of tissue to resolve Most of the effect is seen...
There is no set amount or guideline for dissolving hyaluronic acid with hyaluronidase. Similar to what Dr. Janjua suggested, we usually use a ratio slightly less than a one to one ratio. In our experience, it is prudent to inject in small amounts, adding more as needed. Much will also depend...
