The Management of Filler Nodules

Abstract

Introduction: Nonpermanent fillers are currently some of the most widely used treatments in medical aesthetics. Notwithstanding safety approval by the competent authorities, adverse effects can occur and have a tendency to be underestimated. Nodules are a particularly alarming event and not uncommon. Through the evaluation of articles in the literature and personal/professional practice, this study aims to provide guidelines for the prevention and therapeutic algorithm regarding the management of the nodules. Materials and Methods: We assessed 458 articles found in the literature and 1954 treatments performed over 36 months on 357 patients with 34 different devices. Results: The nodular lesions occurred in 2.6% of the cases, with a highly variable percentage depending on the device used. The main factors associated with these lesions were the type of device used, sun exposure, and weight loss. The occurrence of the nodules was doubled: in 45% of cases with acute inflammation and in 55% of cases with hardening of the implant. The therapeutic protocol used has significantly reduced the extent and duration of nodular lesions, ameliorating the prognosis. Conclusions: Work reported in the literature and through personal experience supports the spectrum of etiologies and a multifactorial pathogenesis: granulomatous reactions occur as a reaction to a foreign body caused by endogenous and exogenous factors. The course of treatment should correspond to the type of onset. The treatment for acute inflammation should be based on fluoroquinolones, oral prednisolone, hyaluronidase, and intralesional lincomycin. Hardening of the implant should be treated with 5-fluorouracil, hyaluronidase, suction, and drainage. Although the etiology is not recognized and pathophysiological mechanisms are not yet well understood, clinical evidence guides treatment. The guidelines for the prevention and treatment proposed by this study can be of great help to the practitioner for the management of adverse events.