Hypercalcemia associated with cosmetic injections: a systematic review

Area of Science:

• Endocrinology
• Dermatology
• Plastic Surgery

Background:

• Unapproved cosmetic injections like silicone and polymethylmethacrylate are widely used for body augmentation.
• These injections can cause foreign body granulomas and potentially life-threatening hypercalcemia.
• Systematic analysis of cosmetic injection-associated hypercalcemia literature is needed.

Purpose of the Study:

• To systematically analyze published literature on hypercalcemia associated with cosmetic injections.
• To extract and analyze data on patient demographics, injection types, hypercalcemia severity, management, and outcomes.

Main Methods:

• Systematic literature search for articles on hypercalcemia linked to cosmetic injections.
• Data extraction on patient demographics, injection substances, hypercalcemia characteristics, treatments, and outcomes.
• Analysis of identified patient cases and reported outcomes.

Main Results:

• 23 patients from 20 articles were identified, with a mean age of 49.83 years and female preponderance.
• Silicone was the most common agent (43.48%), with the buttock being the most frequent injection site (69.57%).
• Hypercalcemia occurred a mean of 7.96 years post-injection, often associated with elevated calcitriol (1,25(OH)2D) and low PTH, leading to renal failure in 82.35% of cases; two deaths occurred.

Conclusions:

• Hypercalcemia from cosmetic injections can be severe, life-threatening, and manifest years after the procedure.
• Cosmetic injection-associated granulomas are a critical consideration for non-PTH-mediated, non-malignant hypercalcemia, particularly in middle-aged females.
• Elevated calcitriol is a common finding, though not always present, in these cases.