Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2021; 48(01): 10-14
DOI: 10.5999/aps.2020.01907
Cosmetic
Case Report

Catastrophic complications from filler injection on external genitalia

Byeong Soo Kwon 
Department of Plastic Surgery, Inje University Busan Paik Hospital, Busan, Korea
,
Jin Woo Kim 
Department of Plastic Surgery, Inje University Busan Paik Hospital, Busan, Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

Soft tissue filler injections are widely used due to their immediate effects, predictable results, and high stability. However, as the use of soft tissue filler injections has increased, various complications have been reported. We report a life-threatening complication in a patient who developed sepsis and necrotizing fasciitis. A 45-year-old woman presented with right leg pain and discharge from the labia majora. The patient had received a soft tissue filler injection of unknown composition 1 year earlier and had recently undergone incision and drainage for an inflammatory cystic nodule. Antibiotic treatment was administered for cellulitis, but the infection progressed to necrotizing fasciitis and sepsis. Fasciotomy and intensive care unit treatment improved the systemic infection, but the soft tissue filler injection site did not respond to treatment for 1 month. Thus, the injection site was covered with a pedicled vertical rectus abdominis musculocutaneous flap after wide excision. The area of skin necrosis on the leg was covered with split-thickness skin grafts. Infections occurring after soft tissue filler injections are related to biofilms, and treatment is sometimes difficult. Therefore, although soft tissue filler injections have a favorable safety profile, it is important to be aware of the risk of life-threatening complications.

Keywords

Genitalia - Fasciitis, necrotizing - Sepsis - Biofilms


Publication History

Received: 06 October 2020

Accepted: 10 November 2020

Article published online:
20 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • 1 Daines SM, Williams EF. Complications associated with injectable soft-tissue fillers: a 5-year retrospective review. JAMA Facial Plast Surg 2013; 15: 226-31
    CrossrefPubMedGoogle Scholar
  • 2 American Society of Plastic Surgeons (ASPS). Plastic surgery statistics report [Internet]. Arlington Heights, IL: ASPS; c2020 [cited 2020 Oct 1]. Available from: https://www.plasticsurgery.org/documents/News/Statistics/2019/plasticsurgery-statistics-full-report-2019.pdf
    Google Scholar
  • 3 Ferneini EM, Beauvais D, Aronin SI. An overview of infections associated with soft tissue facial fillers: identification, prevention, and treatment. J Oral Maxillofac Surg 2017; 75: 160-6
    CrossrefPubMedGoogle Scholar
  • 4 Ortiz AE, Ahluwalia J, Song SS. et al. Analysis of U.S. Food and Drug Administration data on soft-tissue filler complications. Dermatol Surg 2020; 46: 958-61
    CrossrefPubMedGoogle Scholar
  • 5 Urdiales-Galvez F, Delgado NE, Figueiredo V. et al. Treatment of soft tissue filler complications: expert consensus recommendations. Aesthetic Plast Surg 2018; 42: 498-510
    CrossrefPubMedGoogle Scholar
  • 6 Sclafani AP, Fagien S. Treatment of injectable soft tissue filler complications. Dermatol Surg 2009; 35 Suppl 2: 1672-80
    CrossrefPubMedGoogle Scholar
  • 7 Bailey SH, Cohen JL, Kenkel JM. Etiology, prevention, and treatment of dermal filler complications. Aesthet Surg J 2011; 31: 110-21
    CrossrefPubMedGoogle Scholar
  • 8 Yang Y, Sheng H, Gu Q. et al. Death caused by vaginal injection of hyaluronic acid and collagen: a case report. Aesthet Surg J 2020; 40: NP263-8
    CrossrefPubMedGoogle Scholar
  • 9 Redmond E, Forde JC, Flood HD. Filling the void: a case of sepsis following the injection of a penile bulking agent. BMJ Case Rep 2014; 2014: bcr2013203054
    CrossrefPubMedGoogle Scholar
  • 10 Han SW, Park MJ, Lee SH. Hyaluronic acid-induced diffuse alveolar hemorrhage: unknown complication induced by a well-known injectable agent. Ann Transl Med 2019; 7: 13
    CrossrefPubMedGoogle Scholar
  • 11 Park HJ, Jung KH, Kim SY. et al. Hyaluronic acid pulmonary embolism: a critical consequence of an illegal cosmetic vaginal procedure. Thorax 2010; 65: 360-1
    CrossrefPubMedGoogle Scholar
  • 12 Duan Y, Zhang L, Li S. et al. Polyacrylamide hydrogel pulmonary embolism: a fatal consequence of an illegal cosmetic vaginal tightening procedure: a case report. Forensic Sci Int 2014; 238: e6-10
    CrossrefPubMedGoogle Scholar
  • 13 Marusza W, Olszanski R, Sierdzinski J. et al. Treatment of late bacterial infections resulting from soft-tissue filler injections. Infect Drug Resist 2019; 12: 469-80
    CrossrefPubMedGoogle Scholar
  • 14 Rohrich RJ, Monheit G, Nguyen AT. et al. Soft-tissue filler complications: the important role of biofilms. Plast Reconstr Surg 2010; 125: 1250-6
    CrossrefPubMedGoogle Scholar
  • 15 Hall-Stoodley L, Stoodley P, Kathju S. et al. Towards diagnostic guidelines for biofilm-associated infections. FEMS Immunol Med Microbiol 2012; 65: 127-45
    CrossrefPubMedGoogle Scholar
  • 16 Singh S, Singh SK, Chowdhury I. et al. Understanding the mechanism of bacterial biofilms resistance to antimicrobial agents. Open Microbiol J 2017; 11: 53-62
    CrossrefPubMedGoogle Scholar
  • 17 El-Shafey ESI. Complications from repeated injection or puncture of old polyacrylamide gel implant sites: case reports. Aesthetic Plast Surg 2008; 32: 162-5
    CrossrefPubMedGoogle Scholar