There are not many case reports in the literature that document complications from the use of synthol in bodybuilders. However, there are several reports of complications in patients after injections of paraffin, sesame- and walnut oil [1,4-7]. They all share common histological findings with an inflammatory foreign body reaction, fibrosis and extensive vacuolation [6]. The latter is also known for producing a ‘Swiss cheese’ appearance [5,6], while individual cysts are named according to the injected material, for example, oleoma or paraffinoma [6,7].
Such enhancement oils do not increase muscular strength or performance and are used solely for cosmetic purposes [1]. In the presented case, our patient was under social pressure to use synthol to improve his appearance. However, two years after the injections, the increasing fibrosis and concomitant disfigurement of the muscular appearance caused embarrassment due to his negative body image. Other potential side effects that have been reported include oil embolism, myocardial infarction, cerebral stroke, ulcers and infections [3,6].
