Novel Management of Granuloma Formation Secondary to Dermal Filler with Intralesional 1444 nm Nd:YAG Laser Technique

The New Frontier of JAK Inhibitors: Significant Therapeutic Response to Tofacitinib in a Patient With Granulomatous Reaction to Filler in the Buttocks

BACKGROUND

Recent research has demonstrated that Janus Kinase (JAK) inhibitors can be effective in treating refractory granulomatous diseases.

CASE PRESENTATION

We report the case of a 50-year-old woman who developed a granulomatous reaction following a filler injection in her buttocks.

MANAGEMENT

The patient was treated with tofacitinib, and after 1 year of therapy, the stiffness and swelling resolved without any side effects.

CONCLUSION

Tofacitinib appears to be a viable option for the treatment of granulomatous reactions to fillers.

1444-nm Nd:YAG for Laser-Assisted Lipolysis: A Minimally Invasive Technique for the Treatment of Pseudogynecomastia

Background

The options for treating pseudogynecomastia are limited, and there is a growing demand for noninvasive breast fat reduction. We evaluated the efficacy and safety of a laser-assisted lipolysis (LAL) device emitting 1444 nm for the treatment of pseudogynecomastia.

Methods

A total of 9 male patients diagnosed with pseudogynecomastia underwent laser procedure with a Nd:YAG laser emitting at 1444 nm. The goal was to generate adequate heat propagation and thermal action in the dermis as homogeneous as possible to induce fat cell lipolysis. The results were clinically evaluated by comparing pictures at baseline and 4 months later.

Results

An independent comparison of baseline and post-treatment pictures by a physician evaluator 4 months after treatment revealed significant improvement in all patients. Three subjects (33%) showed grade 4 improvement; 4 (44%) showed grade 3 improvement, and 2 (22%) showed grade 2 improvement. Breast sizes decreased in all patients 4 months after 1444-nm LAL. All patients experienced an incident-free postoperative period.

Conclusions

The LAL procedure performed in this study using 1444-nm Nd:YAG laser appears to be a very effective/comfortable outpatient solution to the problem for patients. It has proven a safe procedure, and all subjects in the study experienced a significant clinical improvement regarding their pseudogynecomastia, with a decrease in breast volume and visible skin contraction.

Laser treatment for adverse reactions to injectable facial filling: a systematic review

Facial filling is widespread in society, albeit associated with inherent risks. This review analyzes clinical studies using laser therapy for filler complications to assess its safety and efficacy as an alternative treatment. A literature search was conducted up until April 2023, encompassing five different databases: PubMed, Scopus, Embase, Web of Science, and Medline, to find clinical trials addressing patients who underwent laser treatment for adverse reactions to injectable facial filling. The outcome variables were the clinical assessment of the lesion and the occurrence of post-intervention complications/sequelae. The risk of bias was assessed using the ROBINS-I tool. In total, six studies were included, all classified as having a "moderate risk" of bias. A total of 533 patients underwent laser treatment for adverse reactions to injectable facial fillers. The diode laser was the most frequently utilized equipment, with positive results reported in five studies. Among all treated patients, 96.24% achieved partial or complete resolution, 0.22% experienced some sequelae or complications, and only 0.01% showed no improvement. Laser treatment can eliminate the necessity for surgical intervention for adverse reactions to injectable facial fillers, resulting in partial or complete improvement of the condition.