The Poison Lab

Episode #12- Lethal Buttock Injection (And Other Toxicities of Illegal Cosmetic Body Fillers)

Episode Summary

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

Episode Notes

Music in this episode from pixabay.com

• Intro
  • Case report of hemolysis after sodium deoxycholate injection 
• History
• Epidemiology
  • ASPS stats
  • Florida Unlicensed Activity Unit 
  • Cost of surgeon fee for buttock implant 2018
  • Recent new stories
    • Botox and Bubbles grifter
    • Quick bio on cases mentioned in show
• Common injection practices
  • Feminizing body contouring (pumping parties)
  • Synthol muscles
  • Capsule face cosmetics
• Toxicity
  • Infection
    • Self explanatory
  • 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)
  • Granuloma
    • 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
• Case from the show
  • Some details changed for educational purposes