Presentation
Chronic migraine and left facial paresthesia. No neurological deficit on examination.
Patient Data
Incidental symmetric facial dermal filler globules.
Contrast-enhanced MRI brain is otherwise normal.
Case Discussion
There were no intracranial abnormalities on the contrast-enhanced MRI brain to explain the patient's acute presentation.
Incidental finding of symmetric facial dermal filler injections bilaterally.
These appear hypointense on T1, hyperintense on T2 fat sat, and isointense on T2 fat sat. There is no abnormal enhancement on contrast administration.
There are no visualized local complications present, specifically no edema, no abscesses, no soft tissue sepsis/ cellulitis, and no nodular foreign body granulomas.
Location of injections: predominantly perioral, medial and middle superficial cheek, nasolabial folds, lips and minimally periocular (superolateral orbital region) in this instance. The glabella and marionette lines are spared.
T2 fat sat(axial and coronal) sequencing demonstrates these injections quite dramatically.
In this instance, based on the MR imaging appearance, these are likely water-based biological fillers(collagen or hyaluronic acid) or synthetic polyalkylimide and polyacrylamide hydrogels (PAAG).
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