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 ? nature of the material

Patient Data

Age: 45
Gender: Female
Modality: 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.

Modality: MRI

T2 hyperintense nodules in the subcutaneous tissues overlying the zygomas with subtle rim enhancement, the largest corresponding to the palable 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.  Some if injected too superficially can cause a skin reaction so injection may preferably be into the subcutaneous fat or even subperisoteal.  If the injection is into muscle, then the filler can clump by way of muscular contraction even migrating way from the intended location overlying the anterior zygoma.

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Case Information

rID: 43233
Case created: 1st Mar 2016
Last edited: 10th Mar 2016
System: Head & Neck
Inclusion in quiz mode: Included

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