Paraffinoma

Disease Description (Causes and Symptoms)

• Definition: Paraffinoma is a chronic foreign-body granuloma that develops in response to paraffin (or other mineral oils) injected into the body, accompanied by a foreign-body reaction and extensive fibrosis. Histologically, it is a lipogranuloma characterized by fat necrosis, multinucleated giant cells, and fibrosis.
• Cause: The main cause is the injection of paraffin or mineral oil for cosmetic purposes, such as volume enhancement of the face, breasts, or genitals.
• Pathophysiology: As the non-absorbable injected oil remains in the tissue for a long time, it induces a chronic exogenous foreign-body reaction, resulting in giant-cell granulomas, fibrosis, and obstruction of blood and lymphatic vessels. Over time, it may progress to tissue necrosis, ulceration, and infection.
• Main symptoms: Skin discoloration, swelling (lump), itching, localized warmth, pain, chronic inflammation, abscesses, ulcers, and skin necrosis at the injection site. Complications may include scarring, deformity, and chronic infection.

Treatment Methods

• Diagnostic approach
  • The clinical history (history and timing of injection), physical examination, and observation of the lesion are important.
  • Imaging tests: Ultrasound helps assess the boundaries and liquefaction of the subcutaneous lesion; CT or MRI helps evaluate the extent of deep penetration and involvement of surrounding structures.
  • Tissue examination (biopsy): May be performed for definitive diagnosis, and findings of lipogranuloma, multinucleated giant cells, and fibrosis may be identified.
• Standard treatment
  • The definitive treatment is surgical excision to completely remove the foreign material as much as possible. If residual paraffin remains, the risk of recurrence is high.
  • The defect after excision is repaired through reconstructive surgery, such as primary closure, skin grafting, or local or full-thickness skin flaps.
  • In cases of extensive or deep infiltration, staged (partial) excision or multiple surgeries and reconstruction are planned.
• In cases of acute infection or abscess
  • Incision and drainage and appropriate antibiotic treatment. Definitive excision is planned after the infection is controlled.
• Medical and conservative treatment (adjunctive)
  • Short-term topical or systemic steroids may be used to reduce inflammation, but they are not a definitive removal method.
  • Laser treatment or cryotherapy may be attempted to relieve symptoms, but they are not recommended as definitive treatments.
• Lifestyle management and precautions
  • Self-treatment attempts (massage, applying heat, self-drainage, etc.) are prohibited because they may cause spread and worsening of the infection.
  • Infection and inflammation should be controlled first before surgery, and excision should be entrusted to an experienced plastic surgeon or dermatologist.
  • Incomplete removal commonly leads to recurrence and persistent complications (ulceration, necrosis, and deformity).
• Complications
  • Chronic infection, recurrent abscesses, skin necrosis and ulceration, severe scarring and deformity, and, rarely, reported potential for malignant transformation in areas of long-standing chronic inflammation.
• Prognosis
  • The prognosis varies depending on the completeness of removal. Complete excision and appropriate reconstruction may result in good functional and cosmetic outcomes. Incomplete or delayed treatment increases the likelihood of chronic disease, recurrence, and severe scarring.

Checklist Before an Outpatient Visit (Including Sample Questions)

• Items to prepare (bring to the appointment)
  • A list of currently taken medications (including anticoagulants and antiplatelet agents)
  • A history of previous surgeries, injections, and injections of substances (when and what substance, if known)
  • History of allergies (including medications and anesthetics)
  • Previous test results (blood tests, imaging tests, biopsy results, etc.)
  • Photos of the lesion (showing changes since the onset of symptoms)
  • A symptom diary (when symptoms began, changes in symptoms, patterns of worsening or improvement, and whether there has been fever, pain, or drainage)
• Examples of questions to record in advance and bring to the outpatient visit
  • Have you recently had a fever, localized warmth, or pus (drainage)?
  • When did the symptoms begin, and how have they progressed (including whether the injection occurred years or decades ago)?
  • Information about the medical institution and practitioner who performed the cosmetic procedure (if available)
  • Whether you have any underlying conditions (such as diabetes or immunosuppression)

Examples of General Questions to Ask the Doctor

• Is the diagnosis of this condition certain? What additional tests (imaging or biopsy) are needed?
• Is surgical removal possible at this point? What are the risks of surgery and the expected results?
• Are there any medications or treatments recommended to relieve symptoms besides surgery?
• How long is the recovery period after surgery, and how should the scar be managed?
• How likely is recurrence, and how should it be managed if it recurs?

Examples of Condition-Specific Questions

• Based on my lesion (as assessed from photos and imaging), can it be completely removed by complete excision? If foreign material remains, how should it be managed?
• If the skin defect is large after surgical removal, will a skin graft or flap surgery be necessary? What type of reconstruction and scar location should be expected?