Dermal fillers: Dermal fillers alert

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Sir, a fit and well, middle-aged female presented in practice for a routine dental check-up. She had no presenting complaints, however, on examination unusual cream coloured nodules were noted within her lower vestibular region (Fig. 1). These were firm, non-mobile and painless.

Figure 1

Lower lip cream coloured nodules

There appeared to be no obvious explanation for these lesions; the adjacent teeth were sound and positive to sensibility tests, and radiographs confirmed there was no dental pathology to explain the presence of the nodules.

A thorough intra- and extra- oral examination revealed no other abnormalities, including no lymphadenopathy. On further questioning, the patient revealed she had had dermal fillers placed four days previously into the nasolabial and Marionette lines at another practice. She confirmed that this was a hyaluronic acid type filler (non-permanent). Based on this, our working diagnosis was intraoral extension of the dermal filler. Given the lack of sinister features to these nodules, the initial line of management taken was conservative.

At her four week follow-up appointment, the lumps had marginally reduced in size but were otherwise unchanged. She was seen again at two months with no changes. Conservative management was continued, and by her eight month review appointment, the nodules had entirely resolved (Fig. 2).

Figure 2

Lower lip of same patient after eight months

We would like to use this case to highlight that intraoral complications following dermal fillers is possible. The migration of dermal fillers into the oral cavity and presenting as nodules is a recognised phenomenon that has been reported.^1,2

As well as firm nodules, the intra-oral migration of dermal fillers can result in a granulomatous foreign body reaction, presenting as swellings or yellowish plaques which are usually painless.³