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Complex Surgical Management of PDLLA-Induced Lower Eyelid Granulomas
Alessandro Garlaschi1, Giuseppe Colombo2, Andrea Dotto3
1Department of Breast Radiology, San Martino Hospital, University of Genoa, Genoa.
The Journal of Craniofacial Surgery
|April 27, 2026
Summary
Severe granulomatous reactions from Poly-D, L-lactic acid (PDLLA) injections can occur in the periorbital area. Surgical intervention may be necessary when conservative treatments fail, highlighting the need for careful technique and patient selection.
Area of Science:
- Dermatology
- Plastic Surgery
- Ophthalmology
Background:
- Poly-D, L-lactic acid (PDLLA) is a biostimulatory injectable for infraorbital rejuvenation.
- While generally safe, severe complications in the delicate periorbital region are not well-documented.
Purpose of the Study:
- To report a case of severe, delayed-onset granulomatous complications following periorbital PDLLA injections.
- To discuss the management challenges and outcomes in such cases.
Main Methods:
- A 67-year-old female received multiple periorbital PDLLA injections.
- She developed bilateral granulomatous nodules requiring conservative and surgical treatments.
- Histopathology confirmed foreign-body giant-cell granulomatosis.
Main Results:
- Conservative treatments (saline, radiofrequency, corticosteroids) were ineffective and led to atrophy.
- Surgical debridement and reconstruction were required, followed by a second procedure for ectropion and recurrent granulomas.
- Histopathology confirmed PDLLA-associated granulomas.
Conclusions:
- Improper PDLLA injection technique or product misuse can cause severe, persistent granulomatous reactions.
- Corticosteroids may worsen outcomes by causing atrophy in periorbital skin.
- Surgical excision is the definitive treatment in refractory cases, emphasizing careful patient selection and technique.
