J Korean Soc Radiol.  2017 Oct;77(4):222-228. 10.3348/jksr.2017.77.4.222.

Ultrasonographic Features of Complications Associated with Injectable Fillers in the Cervicofacial Region

• Huh S
• Hong HS
• Ko ES
• Jeong SH

• KMID: 2392118
• DOI: http://doi.org/10.3348/jksr.2017.77.4.222

Abstract

PURPOSE
The aim of this study was to evaluate the ultrasonographic (US) features of complications associated with injectable fillers in the cervicofacial region.
MATERIALS AND METHODS
This retrospective study was approved by our Institutional Review Board. Thirty-nine patients (37 females and 2 males; mean age: 52 years; age range: 26-83 years), both symptomatic (n = 32) and asymptomatic (n = 7), who underwent cosmetic procedures in the cervicofacial area and US, were included.
RESULTS
All of the cases were classified into five types based on major US features, including (the most common feature) diffuse high echogenicity with posterior snow storming (n = 17, 39%). The other types included a hypoechoic nodule with high echoic lines (n = 10, 23%), a round hypoechoic nodule (n = 12, 27%), a heterogeneously echogenic lesion with internal echoic dots (n = 1, 2%) and an ill-defined non-mass-like fatty lesion (n = 4, 9%). The time between cosmetic injection and evaluation was variable (range: 3 weeks-21 years). Usually, the injected material was either unknown or illegal (n = 24). Ten patients underwent pathological evaluation. Many histological types of foreign body granulomas were evident.
CONCLUSION
Knowledge of the US features of complications associated with fillers may reduce the likelihood of misinterpreting the injected area as a true lesion, in turn decreasing unnecessary invasive procedures and costs for patients.

MeSH Terms

Ethics Committees, Research
Female
Foreign Bodies
Granuloma
Granuloma, Foreign-Body
Humans
Male
Retrospective Studies
Snow
Ultrasonography

Figure

• 

  Fig. 1 A 57-year-old woman underwent US for evaluation of migration of nodules in the forehead and the nasal root. She had a history of illegal injections into the forehead, nose, both nasolabial folds and chin. Transverse US scan of the chin reveals diffuse high echogenicity with posterior snow storming (type 1).

• 

  Fig. 2 A 51-year-old woman had a history of illegal filler injection into her cheeks, chin, and forehead 8 years earlier. She complained of migration of the injected materials and a palpable mass in her right cheek. A transverse US scan reveals a hypoechoic nodule with anterior and posterior high echoic lines (type 2, arrows).

• 

  Fig. 3 A 66-year-old woman had a history of collagen injection into the forehead, both glabellae, nasolabial folds, and the upper lip 4 years earlier. She underwent US because of a palpable mass in the forehead. A. A transverse scan of the forehead reveals a round hypoechoic nodule (type 3). B. Angulated foreign materials with multinucleated giant cells and an asteroid body are observed (hematoxylin and eosin staining, × 200). C. The foreign materials are negative for Alcian blue staining (× 200).

• 

  Fig. 4 A 49-year-old woman complained of a palpable mass in nasolabial folds of 1–2 months duration. She had been injected with collagen and steroid. A. A transverse US scan reveals an heterogeneously hyperechoic lesion with internal echoic dots (type 4). B. Biopsy reveals both acute and chronic inflammation and several multinucleated giant cells (hematoxylin and eosin staining, × 200).

• 

  Fig. 5 A 33-year-old woman complained of a palpable mass beneath the lower eyelid. She had a history of autologous fat injection at the same site 9 months earlier. US shows an ill-defined, nonmass-like fatty lesion (type 5, arrows).

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  Fig. 6 An 83-year-old woman underwent US for evaluation of an erythematous swelling in the anterior neck and the submandibular space. She had a history of illegal injections into the face and neck to smoothen wrinkles 5 years earlier. She did not initially disclose her previous history of an esthetic procedure. During US, she confirmed her history, and a biopsy was performed. A. Transverse US of the neck reveals high echogenicity with posterior snow storming (type 1) throughout the subcutaneous fatty layer, and a low echoic nodule with a peripheral hyperechoic rim and posterior enhancement (type 2, arrows). B. The US-guided gun biopsy specimen shows various vacuoles associated with chronic inflammation, fibrosis, and ill-defined granulomas (hematoxylin and eosin staining, × 100).

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