Usefulness of the Versajet Hydrosurgery System for the Removal of Foreign Body Granuloma

Materials used for cosmetic/reconstructive purposes can elicit foreign body reactions, resulting in granulomas. Foreign body granulomas are treated with intralesional corticosteroid injections and excisional surgery [1].

A 44-year-old woman presented with irregularities and areas of hardness across the forehead, glabella, and temple. She had undergone a cosmetic procedure involving the injection of an unknown material into these sites 10 years before. We diagnosed the case as foreign body granuloma. We administered 2 intralesional triamcinolone injections (20 mg/mL) at 1-month intervals, but the discomfort persisted. Therefore, we performed surgery using the Versajet hydrosurgery system. The patient was administered anesthesia via propofol, followed by local anesthesia with lidocaine. After 1-cm incisions in both suprabrow areas and 2-cm incisions in the temple area were made, dissection was performed subcutaneously (Fig. 1). We approached the target areas with the 15° Versajet handpiece to remove approximately 5 mL of granuloma fluid (Fig. 2). A postoperative compression dressing was maintained for 3 days to prevent hematoma. The swelling persisted for 1 month. After 3 months of follow-up, the irregularities had improved, and the patient was satisfied with the cosmetic outcomes (Fig. 3).

Fig. 1.

Incision site on both the temporal area and the suprabrow area (red line).

Fig. 2.

Versajet hydrosurgery system and the 15° handpiece device.

Fig. 3.

(A) Preoperative full-face anteroposterior view. (B) Postoperative view.

Versajet uses a razor-thin saline jet for tissue debridement and involves reduced scarring because of the smaller incisions. Sterile saline is used for tissue irrigation while the granulomas are removed; the remaining debris is washed out through a localized vacuum effect. The procedure can be completed quickly because the number of debridement sessions required decreases during the procedure [2,3]. Versajet may be a useful tool for the surgical removal of foreign body granulomas.