CHEEK NODULE

HISTORY

57 year old woman presented with a 6 month history of a dense nodule in the subcutaneous malar cheek. Biopsy on 3/31/2017 revealed a foreign body reaction granuloma with polarizable foreign body. Kenalog injection of the mass was performed a few months before without improvement. There is no history of Sculptra or other fillers injected in the tumor area. There is a remote history of lip filler injection and a forehead lift.

DISCUSSION

This 57-year-old woman presented with a six-month history of a dense nodule in the subcutaneous malar cheek. The patient presented for excisional biopsy. At the time, dissection revealed this to be smooth multinodular mass approximately 1.2 cm in diameter. It had characteristics of a granuloma typically arising from injection of Sculptra. Histological evaluation confirmed this to be granuloma with polarizable foreign bodies. Surprisingly, the patient has had no history of Sculptra injections or any other filler in that area. 15 years previously, the patient admitted to having had a brow lift with a cheek lift. At that time, the cheek lift may have been supported by an implantable and dissolvable device (Endotine) that would extend to the area in question. What is surprising about this patient is the delay in the appearance of the granuloma more than 10 years after having dissolvable foreign body in that area.