Inflammatory granuloma caused by injectable soft tissue filler (Artecoll)

Artecoll (Artes Medical Inc., San Diego, CA, USA) has recently been developed as a permanent synthetic cosmetic filler. We experienced an inflammatory granuloma resulting from a previous injection of Artecoll at the upper lip, which was regarded as a rare side effect of this filler. A 50-year-old female patient complained of swelling, dull pain, and heat in the right upper nasolabial fold area, which had started one week before her visit to Kyungpook National University Hospital. The patient received topical steroid therapy at a local clinic, which was not effective. At the injection site, a hard nodule was palpated and erythema was observed with mild tenderness. Antibiotic treatment and subsequent incision and drainage did not result in complete cure of the facial swelling, and the facial swelling and pain persisted. Computed tomography showed a lesion approximately 1-cm in size without clear boundaries and relatively increased nodular thickening. Finally, a subdermal lesion was removed via an intraoral vestibular approach. The lesion was diagnosed as inflammatory granuloma by a permanent biopsy. The patient had healed at two months after the filler injection. Although the soft tissue filler is widely used for cosmetic purposes, there is potential for complication, such as the inflammatory granuloma should be considered before treatment.

Facial Foreign Body Granuloma Caused by Filler (Artecoll(R)) Injection / 대한피부과학회지

Artecoll(R) is a recently developed permanent synthetic cosmetic filler substance, composed of 75% bovine collagen and 25% polymethylmetacrylate (PMMA) microspheres of 30~40micrometer in diameter. It is used for the augmentation of deep wrinkles and is injected subdermally. We report the development of foreign body granulomas at the site of Artecoll(R) injections in the face of a 68-year-old woman. Our case demonstrates Artecoll(R) injection to wrinkles of the face can cause a delayed granulomatous reaction. This side effect can be irreversible and should be addressed in the informed consent.

Histology and Stroboscopic Findings after Injection of Artecoll(R) and Restylane(R) into Paralyzed Canine Vocal Fold: in vivo Canine Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of this study are to introduce Artecoll and Restaylane, that have been available for facial augmentation, as new materials for injection laryngoplasty, to investigate the mucosal wave of true vocal folds after the injection of these two materials into the true vocal fold, and to assess its biocompatibility and durability. SUBJECTS AND METHOD: After complete paralysisof the right recurrent laryngeal nerve of 6 Beagle dogs, the dogs were divided into the Artecoll injection group and the Restylane injection group, and Artecoll or Restylane was injected into vocalis muscle and vocal ligament. The recurrent laryngeal nerve of the opposite side was stimulated, the posterior commissure was sutured, and the mucosal wave of true vocal folds was examined by stroboscopy in in vivo canine study 1, 3, and 6 months after the injection. And, histopathological change of the injected materials after total laryngectomy was examined by hematoxylin and eosin (H & E) staining and masson trichrome staining. RESULTS: In both the Artecoll injection and the Restylane injection groups, the mucosal wave of true vocal folds was detected by stroboscopic examination until 6 months after the injection, and the difference of the mucosal wave of true vocal folds between these two groups was difficult to detect. Histological studies revealed that the injected materials remained in the vocal ligament and vocalis muscle and theses two materials were resorbed with time, Artecoll showing less resorption. These two materials were biocompatible and, particularly, Restylane showed less foreign body reaction. CONCLUSION: Since both Artecoll and Restylane are biocompatible and durable, they areconsidered as the suitable material for injection larygoplasty, and additional long-term studies are required.

PMMA microspheres (ARTECOLL(R)) injection for nasal ridge augmentation in the orthognathic surgery

Polymethyl-methacrylate(PMMA; Artecoll(R)) microspheres suspended 1 : 3 in a 3.5% collagen solution has been used as an injectable implant for long lasting correction of wrinkles and minor skin defects. The patients with mandibular prognathism have increased necessity for nasal augmentation.Usually these patients usually get an additional rhinoplasty after orthognathic surgery. The purpose of this study is to evaluate the result of PMMA injection for nasal ridge augmentation simultaneously with the orthognathic surgery. PMMAs were injected to the nasal dorsum of 13 patients with mandibular prognathism to augment the nasal ridge at the end of the orthognathic surgery. The cephalometric X-ray and clinical facial photograph were taken at 2, 4 and 6 months after operation. Using S-N line, we calculated the change of soft tisuue on the nasal ridge and also investigated the degree of patients satisfaction at 6 months after operation. Most of the patients were satisfied with their nasal ridge height status from moderate to good degree. The average amount of nasal ridge augmentation was 1.4 +/- 0.5 mm immediately after operation, 1.2 +/- 0.4 mm at 2 months after operation. The postoperative nasal ridge height seemed to be remained stable after 2 months. Intraoperative PMMA injection is considered to be simple and effective technique which can be used for the minor augmentation of nasal ridge in the orthognathic patients.