RE: Resection of oil injection fillers is definitive treatment for recurrent inflammatory complication.
References
1. Graeme Prosperi-Porta, Christopher Oleynick, Stephen Vaughan. Myositis from intramuscular oil injections in a bodybuilder. CMAJ 2020;192:E480-E480.
2. Singh, Mansher MD; Solomon, Isaac H. MD, PhD; Calderwood, Michael S. MD, MPH; Talbot, Simon G. MD Silicone-induced Granuloma After Buttock Augmentation, Plastic and Reconstructive Surgery - Global Open: February 2016 - Volume 4 - Issue 2 - p e624 doi:
3. Sharobaro VI, Manturova NE, Ivanov YV, Avdeev AE, Zabozlaev FG, Telnova AV. [Injected non-absorbable fillers in large volumes]. [in Russian] Khirurgiia (Mosk). 2019;(4):42-51. doi:10.17116/hirurgia201904142, 10.17116/hirurgia201904142
4. Crocco E, Pascini M, Suzuki N, Alves R, Proença T, Lellis R. Minocycline for the treatment of cutaneous silicone granulomas: A case report. J Cosmet Laser Ther. 2016;18(1):48-9. doi: 10.3109/14764172.2015.1052514. Epub 2016 Jan 25.
5. Paul S, Goyal A, Duncan LM, Smith GP. Granulomatous reaction to liquid injectable silicone for gluteal enhancement: review of management options and success of doxycycline. Dermatol Ther. 2015 Mar-Apr;28(2):98-101. doi: 10.1111/dth.12204. Epub 2015
The case report in the ‘Practice’ section by Prosperi-Porta et al1 highlights a common problem related to the use of ‘fillers’ to increase or sculpt muscle size/definition. It was disappointing to read that the case was not complete, in that discussion on surgical management and outcome was not properly reported. Treatment with tetracycline antibiotics (ex. minocycline, doxycycline), steroids (ex. prednisone, prednisolone), and immune-modulating medications (ex. etanercept) can be trialed.2 Resection, for well-circumscribed foreign materials, is the definitive treatment for ongoing inflammatory response related to this injected foreign body.
In this case resection was successful. The foreign material was excised from the bilateral anterior upper arms, from within the subcutaneous fat and superficial biceps brachii muscles. Pathology of the specimens removed added no new information to that reported. The patient has had no further episodes of localized inflammation of the biceps since surgery 10 months ago.
In areas of the body that are easily seen, surgical resection can leave scars and contour deformities that can be disturbing to the individual. A recent article by Sharobaro et al3 highlights this problem. Patient education regarding the long term complications of injectable materials is imperative. As seen in the patient reported by Prosperi-Porta et al, chronic inflammation, pain, and impairment can result from fillers. Surgical resection can be performed to remove localized foreign bodies, but can lead to permanent, non-correctable secondary aesthetic deformities. Excision is not technically possible for patients with extensive fillers and/or resultant granulomas.4,5