A Case of Bilateral Cheek Foreign Body Granulomas Caused by Absorbable Filler

Abstract

The use of soft tissue fillers for cosmetic purposes has increased in recent years, accompanied by increasing complications. We report a case of foreign body granuloma after absorbable filler injection requiring surgical management. A subcutaneous cheek mass developed in a 60-year-old woman after hyaluronic acid and polycaprolactone-based filler (Ellansé) injection. The mass enlarged despite corticosteroid therapy, causing pain, sensory disturbance, orbital pressure, and visual discomfort. On referral, the lesion was at risk of skin invasion and was surgically excised. Histopathology confirmed foreign body granuloma. Five months later, cheek depression was reconstructed with an anterolateral thigh flap. Additional revisions, including fat injection, achieved near-complete contour restoration without recurrence. This case illustrates the potential for severe complications after filler injection and emphasizes the value of surgical and reconstructive techniques for both disease control and cosmetic recovery.