Granuloma after the Injection of Poly-D,L-Lactic Acid (PDLLA) Treated with Triamcinolone

Biostimulators are the latest trends in cosmetic procedures, substances such as PDLLA are used to induce collagen synthesis by a subclinical inflammatory reaction. We are describing a granuloma-like reaction case presentation 4 months after the application of PDLLA and its complete resolution with injections of triamcinolone. A 45-year-old female with any past medical history of allergies or immune diseases was injected with PDLLA on the mandibular border and cheek area to correct skin laxity. Four months after the application, the patient reported facial edema and granuloma-like reactions according to clinical examination on all the application areas. The ultrasound reports showed the presence of multiple nodules in the injection areas; therefore, we decided to apply triamcinolone to the granulomatous reaction areas 2 times a month and Prednisone 20 mg daily for 3 days followed by 10 mg for 2 days. After 4 applications, the adverse reaction was completely solved. Biostimulators are biocompatible and resorbable substances; however, nodules and/or granulomas have been reported as rare adverse events. Intralesional and oral steroids can allow us to treat this kind of adverse events.