Filler Granulomas removal

Removal of granuloma - Courtesy of D. Cassuto, MD

What are filler complications?

Filler injections to fill in volumetric deficits and remove wrinkles is one of the most widely used aesthetic procedures in the world. The increased demand and growth for different types of fillers means that the complication rate linked to these injections is also steadily increasing. Non-absorbable fillers remain in the tissue for years and can potentially cause inflammatory problems at any moment. Inflammatory complications after injecting non-absorbable fillers are often called granulomas. This term means inflammatory lesions that appear as nodules characterised by significant macrophage proliferation, giant multinucleated cells, proteins, fibroblasts and angiogenesis. This is a histological definition. In the absence of a histological diagnosis, we prefer to speak of “inflammatory nodules”. These lesions are nodules that are structured in an orderly and distinctive manner, depending on the pathogen that triggered their formation.

What solution does Eufoton® offer for removing filler granulomas?

Understanding a treatment that was both effective and minimally invasive at the same time, it was the late Dr Ovidio Marangoni who performed the first cases in Italy in 2006. As a result, a medical team together with Eufoton® have studied for years the positive effects of using lasers to try to solve these complications. Let's look at the process and the effects.
I.L.T. Intralesional Laser Treatment - is the first technique to effectively and permanently treat chronic inflammatory lesions caused by permanent fillers. This is a swelling and hardening that can occur around the area where fillers were injected due to a rejection of the substances used, which may not integrate perfectly with the tissue. To date, these lesions have always been treated with local injections of corticosteroids, anti-tumor drugs or with surgery. The results, however, are never satisfactory: in most cases, there is only a temporary improvement with the risk of obvious scaring, atrophy and tissue depressions. The Eufoton laser, on the other hand, evacuates most of the filler and definitively stops the inflammatory process without leaving any obvious traces.

How does the Eufoton® laser work?

The filler laser light transmitted through an optical microfiber into the nodule or granuloma works at three levels.
Firstly, it warms the area, melting the filler. Being heat sensitive, all permanent fillers pass from the solid state to the liquid state due to this thermal effect. The molten substance comes out of the microscopic hole used to insert the optical fiber. Secondly, the increase in temperature caused by the laser coagulates the inflammatory tissue that always generates around the granuloma. A sterile pus therefore forms, which also emerges from the small holes. In some cases a new small incision may need to be made (especially when the granuloma is large) after about a month in order to completely spill the material. It is also hypothesized that the laser acts on the so-called "biofilm", a still unproven phenomenon, but which is increasingly accepted by industry experts. With the term “biofilm”, we mean a mucopolysaccarides mucosa created by bacteria that envelops and protects them, against which the immune system is not effective and is incapable of destroying. The inflammation process therefore does not shut off and it becomes chronic. This would explain why drugs only have temporary success: after their effect, the reaction starts up again. The presence of bacteria would explain the very high percentage of recurrence after treatments with cortisone and other immunosuppressive agents. For ablative surgery, there is another explanation for the poor efficacy: the surgeon “spreads” the biofilm bacteria around the area with the scalpel. The bacteria reactivate after a short period of time, thus worsening the inflammatory phenomenon. The increase in temperature caused by the laser, on the other hand, kills the bacteria and cures the inflammation.

What are the advantages of this treatment?

Interlesional laser treatment is in fact the only technique capable of effectively and permanently removing the foreign substance/non-absorbable filler together with an inflammatory reaction with a minimally invasive procedure, without leaving scars or obvious signs.
Filler Granuloma ILT - LASEmaR® 800 | Courtesy of Daniel Cassuto MD

Filler Granuloma ILT - LASEmaR® 800 | Courtesy of Daniel Cassuto MD


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