Lethal Buttock Injection (And Other Toxicities of Illegal Cosmetic Body Fillers)

In this episode Ryan and Toxo dissect the fascinating underbelly of illegal cosmetic procedures and breakdown the toxicities that arise from them.

Intro

Epidemiology

Recent new stories

Common injection practices

Toxicity

Filler embolism

Review 1, Review 2, Review 3
Filler lodges in pulmonary vasculature->clotting, bleeding, inflammation
95% occur within 72 hours
Primarily respiratory symptoms (cough/hypoxemia)
Chest x ray ground glass opacity
Treat with supportive care (oxygen all the way through ECMO) +/- steroids
Filler Blindness
CRAO from body filler
No effective treatment (exception, can use hyaluronidase if filler is hyaluronic acid)

Inflammatory nodules from prolonged filler exposure
May occur months to year after injection
Illegal cosmetic= frequently lipogranuloma due to oil being present in many illegal cosmetic
Granulomatous hypercalcemia
Excess calcitriol production from ganuloma causes hyperCA
Can be extremely delayed (up to 28 years)
Recurrence up to 45%
Treat with standard therapies (fluid, bisphosphonate) + steroids and/or ketoconazole to turn down granuloma CYP27B1 calcitriol production