Post cosmetic injection cheek nodules

Case contributed by Dr Chris O'Donnell

Presentation

Palpable mass in the left cheek. The patient indicated to the ultrasonographer that she had had multiple cosmetic injections into the cheeks; unknown nature of the material.

Patient Data

Age: 45 years
Gender: Female
Ultrasound

Palpable mass on the left represents a non-descript hypoechoic mass (with through transmission) and absent blood flow in the subcutaneous tissues representing clumped filler.  Further smaller nodules in the left and indeed right cheek overlying the zygomas.

T2 hyperintense nodules in the subcutaneous tissues overlying the zygomas with subtle rim enhancement, the largest corresponding to the palpable lump (as indicated by the skin marker).

Case Discussion

Soft tissue fillers are increasingly being used for rejuvenation of the face.  Materials include mixed collagen and polymethylmethacrylate, calcium hydroxylapatite, bovine collagen, poly-L-lactic acid, and hyaluronic acid. They are generally very safe but can be associated with granulomatous (foreign body) reaction, especially hyaluronic acid. If injected too superficially, some can cause a skin reaction so injection may preferably be into the subcutaneous fat or even subperiosteal.  If the injection is into muscle, then the filler can clump by way of muscular contraction, even migrating far from the intended location overlying the anterior zygoma.

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Case information

rID: 43233
Published: 10th Mar 2016
Last edited: 16th Sep 2019
System: Head & Neck
Inclusion in quiz mode: Included

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