Management of visible granulomas following periorbital injection of poly-L-lactic Acid

Injectable poly-L-lactic acid (PLA) is a recently FDA-approved soft-tissue filler. Although approved only for treatment of HIV-associated lipoatrophy, there has been increased interest in its use for cosmetic purposes. Here we describe a case of a granulomatous reaction to injectable PLA in the inferior periorbital region resulting in visible papules and discuss treatment options.

We review literature pertaining to medical and surgical treatment options for our patient, and we discuss relevant techniques for both the injection of PLA and the management of this complication with surgical techniques.

After failing several nonsurgical treatment options, our patient had excellent results with surgical excision of her persistent visible nodules. This technique is minimally invasive, provides definitive removal of the nodules, and can leave minimal residual scarring.

Given the high frequency of subcutaneous nodule formation reported in early trials of injectable PLA, it is important for physicians to be well informed regarding its potential side-effects and how to minimize risk of adverse reactions. Based on our experience, we suggest that surgical excision is an excellent treatment option for persistent papules and nodules that arise after injection of PLA in the periorbital area.