Multiple Cases of Facial Disfigurement From Filler Use and One Injector

Abstract

Purpose: To present a case of facial disfigurement from an injectable permanent filler and describe the consequences to patients exposed to the same injector (common source outbreak). Methods: Case report and discussion of a common source outbreak after a group of persons developed complications years after permanent filler given by one injector. Results: A 39-year-old transgender model underwent polymethylmethacrylate (Artefill) facial filler injections to the lips, cheeks, and chin in 2018. A year later, the patient presented to the emergency room with severe facial swelling and difficulty breathing. Treatments have included 4 surgeries to remove filler and scar tissue and chronic low-dose oral steroid therapy. Upon questioning the patient, 6 additional people suffered from similar facial swelling years after injection by the same injector. The injector cannot be located. Conclusions: Care must be taken in giving all facial fillers, particularly permanent ones. When one source patient is identified, questioning the patient’s knowledge of others affected is critical to help manage an epidemic problem and to report a rogue injector. Physicians have a duty to investigate and report such cases.