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Dr Tim Pearce
What is an Inflammatory Lesion?
An inflammatory lesion is a type of allergic reaction which is caused by infection or reaction to dermal filler treatments.
Inflammatory lesions are also sometimes referred to as inflammatory nodules.
The physical aspects of this reaction are dependant on which type of reaction the client is experiencing.
How to diagnose an Inflammatory Lesion
To diagnose inflammatory nodules from a dermal filler complication it needs to be broken down into 2 specific reaction types:
Type I Hypersensitivity
This type of reaction is a very rare filler complication.
The reaction is created by a mediated antibody.
It involves rapid inflammation of the tissues, swelling and oedema.
You must know how to manage this reaction to dermal filler as it can be life-threatening and has a rapid onset time.
Type IV Hypersensitivity
Type IV reactions have a delayed onset period (minimum of 48 to 72 hours).
They form multiple red tender lumps or skin nodules.
Type IV hypersensitivity is a cell rather than a mediated antibody; a reaction that damages tissues in the process of trying to destroy a foreign compound.
What methods can I use to prevent Inflammatory Lesions?
There are 5 variables you can control to help prevent this type of dermal filler complication.
- Patient selection
- Product selection
- Pre-procedure & injection technique
- Aftercare & safety netting
- Early diagnosis & treatment
Patient Selection:
Patients with a high risk of inflammatory nodules include anyone who is immunosuppressed, including anyone with systemic illness.
These patients may be at increased risk of infection and sterile nodule formation.
Avoid treating anyone with an active infection: especially oral, throat or skin infections.
Product Selection:
When it comes to reactions it’s my opinion that the best guide to product risk factors comes from the FDA approval process.
In the UK dermal fillers are not required to be tested on humans before being sold.
As a result, the data is unknown about rates of reactions to different dermal filler products.
Using a product that has at least been approved in the US gives some reassurance that the risk will be in the acceptable range.
Procedural:
Reducing the risk of nodule formation during the procedure is almost entirely about keeping a clean working practice.
It is essential to remove all makeup as this is often high in bacterial count.
Making sure the skin has been properly cleaned is vital as the skin can also carry bacteria.
Aftercare & Safety Netting:
Aftercare is primarily about reducing the risk of introducing bacteria or makeup into needle holes post-procedure.
Advise your patients about the importance of keeping the area clean and not introducing makeup.
Advise your patient to wash their hands and not to touch their face to give an extra layer of protection.
The client must wait a minimum of 24 hours before applying makeup.
Safety netting is an important part of aftercare advice.
Your patient must know what to look for, what is normal and what requires you to review them as soon as possible.
Early diagnosis makes this type of dermal filler complication easier to solve and it gives the clinician medicolegal protection if it is in the aftercare leaflet.
Make sure your patients know exactly why they should contact you, how they should contact you and what to do if you are not available so that they get the treatment they need as soon as possible.
