Periorbital Lipogranuloma after Autologous Fat Injection for Facial Augmentation = Periorbital Lipogranuloma after Autologous Fat Injection for Facial Augmentation

다국어 초록 (Multilingual Abstract)

Autologous fat injection for facial augmentation has been increasingly popular in recent years because of the procedure`s cost-effectiveness and the lower risk of allergic reactions compared to synthetic filler injection^1,2. Generally, it provides good results, but few complications such as hematoma, skin contour irregularities, or fat embolism have been reported3. Recent reports have described lipogranuloma formations but such case reports are sparse^1-5. Herein, we report a rare case of periorbital lipogranuloma formation following autologous fat injection. A 50-year-old woman presented with periorbital masses detected 1 month ago. This patient had received autologous fat injection on both periorbital areas, cheeks and the forehead at a local plastic surgery clinic 12 months ago. She was remaining well until a year after the procedure, when round and firm masses were identified in the injection site. On physical examination, there were asymptomatic, two, 0.1∼ 0.2 cm sized subcutaneous masses palpable and fixed at the inferomedial side of the left periorbital area (Fig. 1). A skin biopsy showed the characteristic features of lipogranuloma which are composed of numerous lipid vacuoles with fat necrosis and diffusely infiltrated histiocytes and lymphocytes (Fig. 2A∼C). The lesions were completely removed by biopsy and she is under close follow up. There are only few reported cases of lipogranuloma after facial autologous fat injection. Although it is a rare condition, high clinical suspicion is necessary since the complication has increased along with the popularity of the procedure. There are two hypotheses regarding the mechanism of lipogranuloma formation⁴. One is endogenous lipid degeneration secondary to allergic reactions, infection, or trauma, and the other is an inability to metabolize exogenous lipids in the tissue interstitium which causes a foreign body reaction ⁴. The mechanisms in our patient seem to be exogenous since the lesion was formed at the site of injection and the patient did not have any events related to endogenous lipogranuloma formation. Regional spread from the forehead by gravity and facial muscle movement may also have played a role in forming periorbital mass^3,5. The extremely thin skin of the periorbicular area is suggested to be a contributing factor for migrating lipogranuloma formation⁴. Diagnostic support with radiologic imaging studies can be provided, but a definite diagnosis can be established by histological examination. This case illustrates the importance of considering lipogranuloma in patients presenting with a newly developed facial mass. To the best of our knowledge, this is the first reported case of lipogranuloma after autologous fat injection in the Korean dermatologic literature.