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Multicenter Study
. 2025 Mar;31(3):899-910.
doi: 10.1111/odi.15143. Epub 2024 Oct 7.

Oral/Perioral Reactions to Injectable Soft Tissue Fillers: A Clinicopathological Multicentric Study

Fábio Ramoa Pires  1 , Aurélio Marcos Tsutyia Said  2 , Juliana de Noronha Santos Netto  3 , Danyel Elias da Cruz Perez  4 , Paulo Rogério Ferreti Bonan  5 , Helder Domiciano Dantas Martins  5 , Estela Kaminagakura  6 , Fábio de Abreu Alves  7 , Hercílio Martelli Júnior  8 , Renato Assis Machado  9 , Márcio Ajudarte Lopes  10 , Alan Roger Santos-Silva  10 , Pablo Agustin Vargas  11 , Brendo Vinicius Rodrigues Louredo  11 , María Elisa Vega-Memije  12 , Luis Enrique Cano-Aguilar  12 , Sonia Toussaint-Caire  13 , Mariene da Silva Monteiro  14 , Thamyres Campos Fonseca  14 , Mário José Romañach  14 , Aline Correa Abrahão  14 , José Manuel Aguirre-Urizar  15 , Irene Lafuente Ibáñez-de-Mendoza  15 , Mireya Olmedo-Campos  16 , Adalberto Mosqueda-Taylor  17
Affiliations
Multicenter Study

Oral/Perioral Reactions to Injectable Soft Tissue Fillers: A Clinicopathological Multicentric Study

Fábio Ramoa Pires et al. Oral Dis. 2025 Mar.

Abstract

Objective: To analyze the characteristics of a series of oral reactions to injectable soft tissue fillers.

Materials and methods: Cases diagnosed as oral reactions to injectable soft tissue fillers were selected from eight Pathology laboratories. Information was retrieved from the laboratory charts and from the review of the hematoxylin and eosin-stained histological slides.

Results: The 151 patients showed a mean age of 54.9 years, and 136 (90.1%) were females. Mean time of onset was 20.4 months, and the lips were the most frequent location (72.8%). Most cases presented as asymptomatic isolated nodules, with a mean size of 17.4 mm. Silicone (38.5%), polymethylmetacrylate (33%), and hyaluronic acid (11.9%) were the three most common fillers. Granulomas, foamy macrophages, and multinucleated giant cells were observed in 44%, 51.5%, and 65.3% of the cases, respectively. Time of onset was shorter for males (p = 0.033), and symptoms were common in the upper lip, buccal mucosa, and lower vestibule (p = 0.010). Foamy macrophages were more common in association with silicone and collagen (p < 0.001), whereas multinucleated giant cells were more common in association with polymethylmetacrylate, hydroxiapatite, and polylactic acid (p = 0.012).

Conclusion: Clinicians should consider reactions to injectable soft tissue fillers when evaluating asymptomatic submucosal nodules affecting the lips of adult/older females.

Keywords: filling; hyaluronic acid; lips; polymethylmetacrylate; reactions; silicone.

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References

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