• #11-1. Tissue Response and Granuloma



    Dr. Ik-soo Koh of Petit Noble Plastic Surgery is a well-known authority on dermal filler procedures. He is the President of APAS (Association of Petit Aesthetic Surgery) and leads various academic seminars on minimally invasive aesthetic procedures. Recently, he is being recognized in China and Japan for his expertise in the field. This series will provide our readers an in-depth and extensive look into the current dermal filler market. The series will focus on major issues in the field. The topic of this month's issue is “Tissue Response and Granuloma.”


    Tissue Response is The Precursor of Granuloma.



    Granuloma refers to a permanent mass that is caused by dermal filler injection. It is very hard to the touch with irregular rock-like texture and grows larger in time. It is a serious problem as it can persist even after the filler has been fully absorbed in the body.


    However, granuloma develops after repeated tissue response and can be prevented if tissue responses are dealt with appropriately. Any hyaluronic acid filler has the potential risk but certain products are more likely than others to cause granuloma. Making a well-informed choice of the filler can help lower the risk of granuloma.


    If Edema Persists, Tissue Response Should Be Suspected.


    Tissue response from dermal filler injection can manifest in the form of repeated development and subsiding of edema in the area of injection. The swelling returns when the patient’s immunity is compromised due to a cold or menstruation. Tissue response may arise due to toxicity of the filler ingredients, unstable cross-linking, osmotic pressure, PH imbalance, and purity of the original ingredients, etc.


    Tissue response may also include fever and mild pain, and patients need to be closely monitored for these symptoms after treatment. Tissue response tends to develop at the site of treatment to spread to surrounding areas and can easily be resolved with oral anti-inflammatory agent. However, the medication will only temporarily reolve the swelling and the doctor needs to take other measures to prevent further worsening. 


    -To be continued

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