Correcting filler granulomas with ILT lasers
ILT - Interstitial Laser Treatment - is the first technique to effectively and permanently eliminate granulomas caused by permanent fillers. These granulomas come from 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, granulomas have always been treated with local injections of corticosteroids, antitumor 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 laser, on the other hand, evacuates most of the filler and definitively stops the inflammatory process without leaving any obvious traces.
How does the ILT laser work?
The laser light transmitted through an optical microfiber into the 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 necrotizes 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 very small incision may need to be made (especially when the granuloma is large) after about a month in order to completely eliminate 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. According to many experts, when a granuloma is formed, some bacteria colonize the surface contacting the injected substances and the tissue, causing a protective inflammatory reaction (the inflammatory molecules destroy the bacteria).
In reality, this is not what happens: the bacteria create a membrane that envelops and protects them: 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 bacterial reactivate after a short period of time, thus worsening the inflammatory phenomenon. The increase in temperature created by the laser, on the other hand, kills the bacteria and cures the inflammation
Filler Granuloma Removal - Courtesy of D. Cassuto, MD