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.

No potential conflict of interest relevant to this article was reported.

• References

• 1 Lee JM, Kim YJ. Foreign body granulomas after the use of dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment. Arch Plast Surg 2015; 42: 232-9
• 2 Siemers F, Stang FH, Namdar T. et al. Removal of accidental inclusions following blast injury by use of a hydrosurgery system (Versajet^TM). Injury Extra 2010; 41: 83-4
• 3 Cubison TC, Pape SA, Jeffery SL. Dermal preservation using the Versajet hydrosurgery system for debridement of paediatric burns. Burns 2006; 32: 714-20

Publication History

Received: 04 April 2017

Accepted: 07 July 2017

Article published online:
20 April 2022