Abstract

Objectives: Case report: A 48-year-old healthy woman underwent an aesthetic procedure using Calcium Hydroxylapatite filler intradermally performed by a non-medical injector. According to the medical consensus, the best treatment results can be achieved by combining 5-FU with triamcinolone and diluting using 2% lidocaine. However, both substances are inaccessible in Poland. Instead, we used medication that is available within our country leading to a similar therapeutic outcome we would like to share with the audience. Introduction: The product was injected intradermally with the "deposit technique" in the neck and decollete areas.It resulted in the formation of visible nodules and granulomas. In our case, due to the limited accessibility of the recommended medications, we altered the treatment protocol recommended in publications. Materials / method: We used medication that is available within our country leading to a similar therapeutic outcome: 25 mg/ml bevacizumab; dose: 0,5 mg and 6,43 mg betamethasone dipropionate; dose: 1 ml vial mixed with 2% lidocaine. This treatment was repeated every 4 weeks. Additionally we injected tropocollagen with citric acid and nicotinamide in order to support metabolism within the nodules. Before the first treatment session we performed a surgical biopsy for a hist-pat exam. Upon microscopic examination the entire lesion represents a classical example of foreign body granuloma. Results: Our treatment protocol including injectable tropocollagen with citric acid (CA) and nicotinamide for the valuable nature of CA - it is a powerful accelerant for cellular metabolism that also helps minimize scar tissue formation. CA activates the cell apoptosis through the caspase-dependent pathway, which is beneficial in which is beneficial in case of granulomas and nodules and, at the same time, increases the skin renewal rate. Altering the treatment protocol led to a satisfactory outcome. Conclusion: The described situation occurred due to several reasons: a. access to and use of a medical product by an unlicensed injector b. usage of incorrect technique and plane - intradermal deposits c. hot baths which increased the inflammatory reaction. Calcium Hydroxylapatite is an effective and relatively safe biostimulatory filler, however, it should never be used or sold to unlicensed entities without medical education. The proposed treatment is an effective alternative to the international consensus. It is also necessary to continue developing the treatment guidelines for the best accessibility.