Facial paraffinoma treated with a bipolar radiofrequency device
Article first published online: 5 JUN 2014
© 2014 The International Society of Dermatology
International Journal of Dermatology
Volume 54, Issue 1, pages 89–91, January 2015
How to Cite
Kim, H. K., Kim, B. J., Kim, M. N., Kim, S. Y., Kim, S. E., Mun, S. K., Kim, H. and Park, W. S. (2015), Facial paraffinoma treated with a bipolar radiofrequency device. International Journal of Dermatology, 54: 89–91. doi: 10.1111/j.1365-4632.2012.05844.x
- Issue published online: 22 DEC 2014
- Article first published online: 5 JUN 2014
Paraffinoma is a granulomatous foreign body reaction that results from the injection of oily substances containing long-chain acyclic hydrocarbons. Paraffin or mineral oil injections are used for tissue augmentation, elimination of wrinkles, and treatment of male pattern baldness. Paraffinoma has a distinctive histopathological pattern that demonstrates the substitution of normal subcutaneous tissue by cystic spaces of different sizes. The most definitive treatment for paraffinoma is surgical excision but, in cases with severe adhesion, successful excision is very difficult.
Radiofrequency represents the most recent skin-rejuvenation technique in the field of esthetic medicine and has allowed patients to reduce flaccidity, wrinkles, and skin aging by generating thermal effects at the treated site. We present a case of facial paraffinoma that was unresponsive to conservative treatment but successfully treated with radiofre-quency therapy. After three treatment sessions, the lesions had almost cleared, and the patient was satisfied with the results.
A 61-year-old woman visited our clinic with a 1-month history of an asymptomatic violaceous, indurated plaque on the left cheek, which had been increasing gradually in size (Fig. 1a). She had received cosmetic paraffin injections to both cheeks three years prior to visiting our clinic.
Laboratory investigations, including complete blood count, electrolytes, liver function test, and urinalysis, were within normal limits. Histopathological examination revealed dense inflammatory infiltrates involving the entire dermis and non-caseating epithelioid granulomas. Round or ovoid-shaped clear vacuoles of various sizes were scattered in the dermis (Fig. 2). A diagnosis of paraffinoma was made, and she received systemic and intralesional corticosteroid therapy. Unfortunately, the lesion was refractory to these treatments. Because the patient did not want surgical excision and post-surgical scars, we decided to treat the lesion with a less invasive modality after obtaining the patient's informed consent.
We treated the indurated lesion with a bipolar radiofrequency device (INNOFill; PACIFIC PHARMA, Seoul, Korea). The system consists of a main body part, disposable needle-electrode with luer lock syringe, and foot switch (Fig. 3). It generates bipolar electric waves, emitting either a 1 or 2 MHz sine wave. It has maximum output power equal to 20 W. Treatment was performed under local anesthesia using 2% lidocaine hydrochloride solution (Jeil Pharmaceutical, Daegu, Korea). We inserted the needle-electrode through a tiny puncture in the mandibular angle and penetrated along the indurated skin lesion. We used a frequency of 1 MHz, power of 20 W and 21-gage electrode size. Bipolar radiofrequency was emitted through the needle electrode, and treatment duration was 1 min/session. Then, after radiofrequency treatment, we gently massaged the treated area for three minutes. A total of three treatments were performed at 4-week intervals, and the patient was followed up for one year. Excellent post-treatment outcomes were observed (Fig. 1b), which have been sustained for one year.
Subcutaneous injection of liquid paraffin for cosmetic purposes was first practiced in the 20th century. Eckstein replaced liquid viscous paraffin with melted solid paraffin, which has a higher melting point and thus is not prone to changing shape with changing body temperature when used to create a facial prosthesis. Unfortunately, even with initial good results, secondary or late severe complications may appear due to the dispersion of paraffin. Foreign body granulomas, a delayed complication of paraffin injections, are also known as “paraffinomas”, “lipogranulomas”, or “sclerosing lipogranulomas” according to their etiology. These are distinguished from other granulomatous reactions that have similar histological appearances but do not result from foreign materials. Characteristically, complications appear a few years after injection, with severe symptoms and clinical signs. Complete surgical excision is still considered to be the most definitive treatment for paraffinomas, but the treatment of choice for the facial area is intralesional administration of corticosteroids. Glucocorticoids, both intralesional and oral, are often used because of their immunosuppressant and anti-inflammatory properties.
Radiofrequency is one of the most innovative recent dermatological techniques for rejuvenating the skin. It produces an electrical current that generates heat due to the resistance of components of the dermis and subcutaneous tissues. Radiofrequency treatment creates thermal coagulation zones, known as radiofrequency thermal zones, in the dermis or subcutaneous layer.
There are two major therapeutic mechanisms of radiofrequency in the treatment of paraffinoma. First, radiofrequency may induce a wound-healing response that activates dermal remodeling and replacement of radiofrequency thermal zones with new collagen and elastin. Second, heat generated by radiofrequency may cause aggregated paraffin substances to melt, allowing horizontal dispersal of paraffin droplets by manual manipulation after radiofrequency therapy.
To the best of our knowledge, this is the first reported case of facial paraffinoma successfully treated using a bipolar radiofrequency device. By sharing our experience, we propose that radiofrequency is an effective and safe modality of treatment for paraffinoma. Controlled studies with larger numbers of patients are needed to confirm the effects of radiofrequency for paraffinoma.
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