101
|
Grusha YO, Sheptulin VA. [Ophthalmological complications after contour plastic]. Vestn Oftalmol 2020; 136:108-112. [PMID: 33084287 DOI: 10.17116/oftalma2020136061108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ophthalmological complications after filler injections for aesthetic improvement in various regions of human face are extremely rare. Among them, blindness is considered the most dangerous and almost irreversible. Over 100 cases of vision loss, described by specialists from different countries of Asia, Europe and North America, give evidence that real statistics may be significantly higher. While autologous fat is the most frequent cause of blindness, partial vision recovery was described after hyaluronic acid filler and calcium hydroxyapatite injections. This article attempts to summarize the data from available publications and inform the specialists about the potential risk areas, clinical manifestations, as well as preventive and treatment methods in case such complications do develop.
Collapse
Affiliation(s)
- Y O Grusha
- Research Institute of Eye Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | |
Collapse
|
102
|
Kapoor KM, Murthy R, Hart SLA, Cattin TA, Nola PF, Rossiter AP, Singh R, Singh S. Factors influencing pre-injection aspiration for hyaluronic acid fillers: A systematic literature review and meta-analysis. Dermatol Ther 2020; 34:e14360. [PMID: 33002269 DOI: 10.1111/dth.14360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/01/2020] [Accepted: 09/23/2020] [Indexed: 02/01/2023]
Abstract
Pre-injection aspiration of hyaluronic acid filler is a well-recognized yet controversial safety technique. Many consider aspiration to be an important safety measure to prevent inadvertent intravascular filler injection. To assess factors influencing pre-injection aspiration by understanding the relationship between aspiration time and a range of product, needle, and procedural characteristics. We conducted a systematic review and meta-analysis of data, adopting the preferred reporting items for systematic reviews and metaanalyses guidelines. Our literature search identified four articles presenting data on variables associated with aspiration time for different HA filler brands. Statistical models pooling data from the four articles suggest a robust association between aspiration time and a filler's elastic modulus (G'), drop weight (cohesivity), and cross-sectional area of the needle lumen. However, there is insufficient evidence to confirm a robust association between aspiration time and HA concentration, viscous modulus (G″), needle length, and pullback volume. A deeper understanding of the relationship between product, needle, and procedural characteristics, and aspiration time can provide a sound base for discussing the role of pre-injection negative aspiration as a safety measure. The understanding of the effect of various factors on preinjection aspiration would further benefit from studies under clinical conditions.
Collapse
Affiliation(s)
| | - Rachna Murthy
- Department of Ophthalmology and Oculoplastic Surgery, FaceRestoration, London, UK
| | | | | | | | - Anthony Paul Rossiter
- Centre of Excellence for Biosecurity Risk Analysis, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Shobhna Singh
- Nitai Medical and Cosmetic Centre, Melbourne, Victoria, Australia
| |
Collapse
|
103
|
Rosengaus F, Nikolis A. Cannula versus needle in medical rhinoplasty: the nose knows. J Cosmet Dermatol 2020; 19:3222-3228. [PMID: 32991042 DOI: 10.1111/jocd.13743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/20/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022]
Abstract
The use of hyaluronic acid (HA) fillers has become a popular alternative for nose remodeling, although poor understanding of the nasal anatomy has resulted in adverse events and generated some controversy. Among them, is the question of where and when to use cannulas vs needles. Through multiple cadaver dissections, clinical experience and the review of medical literature the authors conclude the use of needle over cannula is preferred, assuring a correct injection plane lying fully against the bone or cartilage. Although blunt in nature, cannulas may lead to difficulty in determining with precision the exact depth of product placement and contribute to more dissection of adjacent structures. Thorough knowledge of the highly variable nasal anatomy, including vessel depth location is of outmost importance in avoiding adverse events. Good patient selection is critical where most noses for augmentation rhinoplasty and some reduction rhinoplasty candidates where the goal is to camouflage the dorsal hump are amenable to medical rhinoplasty, unless there is reduced skin elasticity of nasal soft tissues or distortion of anatomy from surgery or trauma. Appropriate product selection is important for effective results. The authors suggest fillers with low cohesivity and high lifting capacity. Finally, we suggest a technique referred as Rhinosculpting base in the use the use of three conceptual elements: facial analysis, light reflection, and use of HA gel as a cartilage graft, in combination with the detailed injection technique presented in this article, which ensures a safer and satisfying treatment outcome.
Collapse
Affiliation(s)
- Frank Rosengaus
- Facial Plastic Surgery, Ultimate Medica, México City, México
| | - Andreas Nikolis
- Department of Plastic Surgery, McGill University, Montreal, QC, Canada.,Erevna Innovations Inc., Westmount, QC, Canada
| |
Collapse
|
104
|
Oh SM, Kim JY, Han S, Lee W, Kim I, Hong G, Oh W, Moon H, Seo C. Development and Usability of a Virtual Reality-Based Filler Injection Training System. Aesthetic Plast Surg 2020; 44:1833-1842. [PMID: 32710202 PMCID: PMC7508957 DOI: 10.1007/s00266-020-01872-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/04/2020] [Indexed: 01/02/2023]
Abstract
Purpose As filler procedures have increased in popularity, serious injection-related complications (e.g., blindness and stroke) have also increased in number. Proper and effective training is important for filler procedure safety; however, limitations exist in traditional training methods (i.e. anatomical illustrations and cadaver studies). We aimed to describe the development process and evaluate the usability of a virtual reality (VR)-based aesthetic filler injection training system. Materials and Methods We developed the virtual reality hardware for the training system and a short guide, with a lecture regarding safe filler injection techniques. One hundred clinicians who attended a conference tested the training system. Participants completed system usability scale (SUS) and satisfaction questionnaires. Results Nearly half of the participants were aged 35–50 years, and 38% had more than 5 years of aesthetic experience. The mean SUS score was 59.8 (standard deviation, 12.23), with no significant differences among the evaluated subgroups. Approximately 76% of participants provided SUS scores of more than 51, indicating acceptable usability. Participants aged 35–50 years were more likely to rate the system as having poor usability than were those aged < 35 years (odds ratio = 5.20, 95% confidence interval: 1.35–20.08). Conclusions This study was the first to develop and explore the usability of a VR-based filler training system. Nearly three-fourths of participants indicated that the training system has an acceptable level of usability. However, assessments in precise target audiences and more detailed usability information are necessary to further refine the training system. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Electronic supplementary material The online version of this article (10.1007/s00266-020-01872-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Ju Young Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gi, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Seungho Han
- Department of Anatomy, Medical College of Choongang University, 84 Heukseok-ro Dongjak-gu, Seoul, Republic of Korea.
| | - Won Lee
- Yonsei E1 Plastic Surgery Clinic, Anyang, Republic of Korea
| | - Il Kim
- Mania Mind CEO, Seoul, Republic of Korea
| | - Giwoong Hong
- SAMSKIN Plastic Surgery, Seoul, Republic of Korea
| | - Wook Oh
- Samsung Feel Clinic, Seoul, Republic of Korea
| | | | - Changmin Seo
- Department of Anatomy, Medical College of Choongang University, Seoul, Republic of Korea
| |
Collapse
|
105
|
Grablowitz D, Ivezic‐Schoenfeld Z, Federspiel IG, Gehl B, Kopera D, Prinz M. Long‐term effectiveness of a hyaluronic acid soft tissue filler in patients with facial lipoatrophy, morphological asymmetry, or debilitating scars. J Cosmet Dermatol 2020; 19:2536-2541. [DOI: 10.1111/jocd.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Daisy Kopera
- Department of Dermatology Medical University of Graz Graz Austria
| | | |
Collapse
|
106
|
Pedron IG, Cavalcanti RR, Gaujac C, Shinohara ÉH. Comments on Bouaoud and Belloc, 2020: "Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review". JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:751-752. [PMID: 32977037 DOI: 10.1016/j.jormas.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- I G Pedron
- Departament of Periodontology, Implantology, Oral Surgery and Stomatology, Universidade Brasil, São Paulo, Brazil
| | | | - C Gaujac
- Departament of Oral and Maxillofacial Surgery, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, Brazil
| | - É H Shinohara
- Departament of Oral and Maxillofacial Surgery, Hospital Dr. Vivaldo Martins Simões, Osasco, Brazil
| |
Collapse
|
107
|
Modarressi A, Nizet C, Lombardi T. Granulomas and nongranulomatous nodules after filler injection: Different complications require different treatments. J Plast Reconstr Aesthet Surg 2020; 73:2010-2015. [PMID: 32928687 DOI: 10.1016/j.bjps.2020.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 06/07/2020] [Accepted: 08/01/2020] [Indexed: 11/17/2022]
Abstract
Dermal fillers are widely used for facial rejuvenation and reconstruction and present fewer risks than surgical approaches. Nevertheless, several complications may occur, including nodule formation. A nodule is a clinical sign corresponding to different etiologies, such as overcorrection, infection, allergic reaction, or granuloma. However, their treatment represents a diagnostic challenge. We present a retrospective review of 26 consecutive patients who underwent a biopsy for facial nodule formation more than 3 months after filler injections, to determine the diagnosis of the nodule and type of filler used. All patients were women (mean age, 57.8 years). Some patients suffered from different localizations: lip, 14 cases; nasolabial folds, 6; cheeks, 5; infraorbital region, 5; the glabella, 2; the temporal region, 1; and chin, 1 case. Only 5 (19.2%) patients knew the type of filler used, and in another 4 cases, the injector was able to provide some information. In 65.4% of cases, the filler type was unknown. Histopathological analysis revealed a "granulomatous" nodule in 30 sites and a "non-granulomatous" nodule in 4 cases. Concerning the type of filler, 5 different histopathological patterns were found. Our results demonstrate that a clinical history and histopathological analysis whether to confirm or not to confirm the diagnosis of granuloma and to identify the type of filler are essential tools to achieve an accurate diagnosis of the problem-oriented treatment of nodules after dermal filler injections. We propose an algorithm for the management of nodules after filler injection.
Collapse
Affiliation(s)
- Ali Modarressi
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Christophe Nizet
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland
| | - Tommaso Lombardi
- Laboratory of Histopathology, Division of Stomatology, University of Geneva, Geneva, Switzerland
| |
Collapse
|
108
|
Koziej M, Polak J, Hołda J, Trybus M, Hołda M, Kluza P, Moskała A, Chrapusta A, Walocha J, Woźniak K. The Arteries of the Central Forehead: Implications for Facial Plastic Surgery. Aesthet Surg J 2020; 40:1043-1050. [PMID: 31651024 DOI: 10.1093/asj/sjz295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The forehead has substantial importance as an aesthetic unit. The central and supraorbital parts of this area are supplied by the supratrochlear (ST) and supraorbital (SO) arteries as well as the recently defined paracentral (PA) and central arteries. OBJECTIVES The authors aimed to assess the morphometry of the vessels of the forehead in the context of plastic surgery and minimally invasive cosmetic procedures. METHODS This research included 40 cadavers directed for forensic autopsy and subjected to postmortem computed tomography angiography. In total, 75 hemifaces were examined for the course and location of arteries relative to the bones and surrounding structures. RESULTS The arteries were observed as follows: ST in 97.3%, SO in 89.3%, and PA in 44.0%. The PA can be expected in the 13-mm-wide zone starting 2 mm laterally from the midline. The ST should be expected in the 10-mm-wide area extended laterally from the tenth millimeter from the midline, and the SO should be expected in the slightly wider (11 mm) area extending laterally from the 20th millimeter from the midline. For the proximal main trunks of the ST and SO arteries, we observed no overlap between the zones of occurrence, whereas the zones for the PA and ST main proximal trunks did overlap. No distinctive central artery was observed in the midline region of the forehead, but instead a network of small vessels in the midline region was visible. CONCLUSIONS The ST is the main and most conservative artery of this region and the PA is the most variable. A unique and detailed anatomical map was created to better understand the vasculature of the forehead area.
Collapse
Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Polak
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Hołda
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Kluza
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Moskała
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Chrapusta
- The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Woźniak
- Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
109
|
Goodman GJ, Magnusson MR, Callan P, Roberts S, Hart S, McDonald CB, Clague M, Rudd A, Bekhor PS, Liew S, Molton M, Wallace K, Corduff N, Arendse S, Manoharan S, Shamban A, Heydenrych I, Bhatia AC, Peng P, Pavicic T, Kapoor KM, Kosenko DE. A Consensus on Minimizing the Risk of Hyaluronic Acid Embolic Visual Loss and Suggestions for Immediate Bedside Management. Aesthet Surg J 2020; 40:1009-1021. [PMID: 31693068 PMCID: PMC7427155 DOI: 10.1093/asj/sjz312] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Hyaluronic acid fillers have a satisfactory safety profile. However, adverse reactions do occur, and rarely intravascular injection may lead to blindness. Currently there is no internationally recognized consensus on the prevention or management of blindness from hyaluronic acid filler. Objectives The authors sought to give guidance on how to minimize the risk and optimize the management of this rare but catastrophic adverse reaction. Methods A multinational group of experts in cosmetic injectables from multiple disciplines convened to review current best practice and develop updated consensus recommendations for prevention and bedside intervention if visual loss occurs after cosmetic injection of hyaluronic acid filler. Results The consensus group provided specific recommendations focusing on the consenting process, prevention, and early management of visual impairment related to intravascular hyaluronic acid filler injection. Conclusions Although visual loss due to filler injections is rare, it is important that both patient and physician be aware of this risk. In this paper the authors describe methods and techniques available to reduce the risk and also document suggested initial management should a clinician find themselves in this situation. Level of Evidence: 5 ![]()
Collapse
Affiliation(s)
- Greg J Goodman
- Monash University and Chief of Surgery at the Skin and Cancer Foundation, Victoria, Australia
| | | | | | | | | | | | | | - Alice Rudd
- Alfred Hospital, Prahran, Victoria, Australia
| | - Philip S Bekhor
- University of Melbourne, Department of Paediatrics and Director of the Laser Unit, Department of Dermatology, Royal Childrens’ Hospital, Parkville, Victoria, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
110
|
Goodman GJ, Liew S, Callan P, Hart S. Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australas J Dermatol 2020; 61:217-225. [PMID: 32201935 PMCID: PMC7497045 DOI: 10.1111/ajd.13273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
Facial aesthetic treatment with injectable neuromodulators and hyaluronic acid fillers is well established, with favourable safety profiles and consistent outcomes. As with any medical treatment, adverse events and complications may occur. Adverse events associated with these products are typically transient and mild to moderate in severity. Serious adverse events, such as infection and intravascular occlusion, are rare. Proper patient selection, consent and counselling, preparation and impeccable injection technique are important risk reduction strategies. Both clinicians and patients must be alert to the signs and symptoms of complications so that appropriate treatment can be started promptly. In this article, the authors review the current literature and provide their consensus recommendations for minimising adverse outcomes when treating patients with botulinum toxin or hyaluronic acid fillers.
Collapse
Affiliation(s)
| | - Steven Liew
- Shape ClinicDarlinghurstNew South WalesAustralia
| | | | - Sarah Hart
- Skin InstituteRemuera, AucklandNew Zealand
| |
Collapse
|
111
|
Choe HR, Woo SJ. Subtenon retrobulbar hyaluronidase injection for ophthalmic artery occlusion following facial filler injection. Int J Ophthalmol 2020; 13:1170-1172. [PMID: 32685410 DOI: 10.18240/ijo.2020.07.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hye Rim Choe
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Republic of Korea
| |
Collapse
|
112
|
Habib SM, Schelke LW, Velthuis PJ. Management of dermal filler (vascular) complications using duplex ultrasound. Dermatol Ther 2020; 33:e13461. [PMID: 32495477 DOI: 10.1111/dth.13461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sayed M Habib
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leonie W Schelke
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter J Velthuis
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
113
|
Localization and Topography of the Arteries on the Middle Forehead Region for Eluding Complications Following Forehead Augmentation: Conventional Cadaveric Dissection and Ultrasonography Investigation. J Craniofac Surg 2020; 31:2029-2035. [PMID: 32604295 DOI: 10.1097/scs.0000000000006644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Forehead augmentation with filler injection is one of the most dangerous procedures associated with iatrogenic intravascular injection resulting in the severe complications. Nonetheless, few studies have determined the explicit arterial localization and topography related to the facial soft tissues and landmarks. Therefore, this study aimed to determine an arterial distribution and topography on the middle forehead region correlated with facial landmarks to grant an appropriate guideline for enhancing the safety of injection. Nineteen Thai embalmed cadavers were discovered with conventional dissection and 14 Thai healthy volunteers were investigated with ultrasonographic examination on the middle forehead. This study found that at the level of mid-frontal depression point, the transverse distance from the medial canthal vertical line to the superficial and deep branches of supraorbital artery were 9.1 mm and 15.1 mm, respectively. Whereas the depths from the skin of these arteries were 4.1 mm and 4.3 mm, respectively. Furthermore, the frontal branch of superficial temporal artery was detectable in 42.1% as an artery entering the forehead area. At the level of lateral canthal vertical line, the vertical distance of frontal branch was 31.6 mm, and the depth from skin of the artery was 2.7 mm. In conclusion, a proper injection technique could be performed based on an intensive arterial distribution and topography, and ultrasonographic examination before the injection is also suggested in order to restrict the opportunity of severe complications.
Collapse
|
114
|
The Functional Anatomy of the Ophthalmic Angiosome and Its Implications in Blindness as a Complication of Cosmetic Facial Filler Procedures. Plast Reconstr Surg 2020; 146:745. [DOI: 10.1097/prs.0000000000007155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
115
|
Safety Assessment of High- and Low-Molecular-Weight Hyaluronans (Profhilo®) as Derived from Worldwide Postmarketing Data. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8159047. [PMID: 32685528 PMCID: PMC7327616 DOI: 10.1155/2020/8159047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022]
Abstract
Background At present, dermal fillers based on hyaluronic acid (HA) represent the most popular intervention of dermoesthetic medicine for the treatment of skin aging. Recent studies have shown that the combination of HA chains of different lengths and molecular weights improves tissue repair and regeneration through a synergistic mechanism. Profhilo® is a product available that has been on the market since 2015 and is based on stable, hybrid, and cooperative complexes (HyCoCos) produced by means of NAHYCO® Hybrid Technology, which is an innovative thermal process that rules out the use of any chemical reagents. The result is a filler with high biocompatibility and low viscosity that favors optimal diffusion at the tissue level to obtain the target bioremodeling of the facial contour. The objective of this review is to provide data from the overall postmarketing experience after 3 years of use and more than 40,000 patients treated with the medical device. Methods All spontaneous postmarketing adverse event (AE) reports received from physicians and healthcare professionals worldwide between February 9, 2015, and February 8, 2018, associated with the use of the studied medical device and sent to the IBSA global safety database were analyzed. Results In total, 12 adverse event reports were logged in the global database, and none were considered serious. Early-onset injection site reactions, i.e., swelling, edema, redness, ecchymosis, and erythema, were the most frequently observed. Late-onset local reactions (e.g., swelling, nodules) followed. The genesis of these reactions was considered, both by the reporting physician and IBSA, as being local reactions of hypersensitivity and/or due to inappropriate injection techniques. In no case was the product held liable for direct damage. All events resolved without any complications according to the treatment guidelines. Two late-onset reactions were collected. Conclusions Although underreporting of minor events cannot be ruled out, the overall number of reports is very low, thereby supporting the high tolerability and safety of the product. After 3 years of postmarketing experience, the safety profile of the studied medical device is favorable and consistent with the product information.
Collapse
|
116
|
Retroperitoneal Fibrosis after Chronic Abscesses of Silicone Fluid Fillers in a Case of Gluteal Augmentation. Case Rep Med 2020; 2020:7236295. [PMID: 32565824 PMCID: PMC7290857 DOI: 10.1155/2020/7236295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
Filler injection or implantation is a progressing revolutionary subject. Although the widely available kinds in many implications are considered safe, post filler adverse events are not uncommon. These reactions range from mild reactions such as edema or erythema to detrimental reactions such as recurrent infected granuloma or vascular occlusion, which are predominantly related to non-FDA approved materials. Here, we presented a patient with a significant history of gluteal augmentation using unlicensed silicone who developed extensive retroperitoneal fibrosis complicated by deep venous occlusions and obstructive uropathy.
Collapse
|
117
|
Chayangsu O, Wanitphakdeedecha R, Pattanaprichakul P, Hidajat IJ, Evangelista KER, Manuskiatti W. Legal vs. illegal injectable fillers: The adverse effects comparison study. J Cosmet Dermatol 2020; 19:1580-1586. [PMID: 32418301 DOI: 10.1111/jocd.13492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Over the past decades, soft-tissue filler injections have become an essential part of cosmetic practice worldwide. Due to the increasing demand, unlicensed practitioners venture in performing this minimally invasive procedure, injecting illegal fillers that pose serious complications. OBJECTIVES To compare the adverse effects of legal and illegal soft-tissue fillers injected by licensed and unlicensed practitioners. MATERIALS AND METHODS A 10-year retrospective, descriptive, single-center study conducted at the outpatient dermatology department and skin laser center at Siriraj Hospital from January 2009 to December 2019. Patients were identified as having treatment-related complications. Their demographic data, clinical history, and injection history were reviewed. RESULTS Forty patients with mean age of 37 years old were included in the study. Thirty-five of them (87.5%) were female. Illegal soft-tissue fillers were used in 28 patients (70%) and were performed by unlicensed practitioners (18 cases, 64.3%, P = .001). Adverse effects from illegal fillers (26 cases, 92.9%) developed longer than legal fillers (7 cases, 58.3%) (P = .017). Symptoms significantly lasted longer in patients injected with illegal fillers, 10 (0.07-288) weeks, as compared to patients injected with legal fillers 0.75 (0.14-72) weeks (P = .01). Injections from illegal fillers resulted to foreign body reaction (22 cases, 78.6%) and infections (6 cases, 21.4%). Vascular complications were identified in legal fillers injections (5 cases, 41.7%). CONCLUSIONS The incidence of adverse effects and complications from soft-tissue filler injections are superior when performed by novice injectors and unlicensed practitioners using illegal fillers. Proper training of filler injections, selection of appropriate fillers, and early recognition of adverse effects are critically important to the success of treatments.
Collapse
Affiliation(s)
- Onjuta Chayangsu
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Penvadee Pattanaprichakul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Inneke Jane Hidajat
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Dermatology, Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kristy Elleza R Evangelista
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Dermatology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
118
|
Invited Discussion on: Vision Loss Associated with Hyaluronic Acid Fillers-A Systematic Review of Literature. Aesthetic Plast Surg 2020; 44:945-946. [PMID: 32112194 DOI: 10.1007/s00266-019-01606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 10/24/2022]
|
119
|
Evaluation of Intraarterial Thrombolysis in Treatment of Cosmetic Facial Filler-Related Ophthalmic Artery Occlusion. Plast Reconstr Surg 2020; 145:42e-50e. [PMID: 31881603 DOI: 10.1097/prs.0000000000006313] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With an increase in recent years in the number of people receiving cosmetic facial injection treatments of hyaluronic acid, the incidence of hyaluronic acid embolism has also increased commensurately. Hyaluronic acid embolism leads to serious complications, including blindness, eye and eyelid movement disorders, skin necrosis, and cerebral embolism. However, there is a lack of robust clinical evidence regarding the benefits of treatment for hyaluronic acid embolism by intraarterial thrombolysis therapy. METHODS This study included 24 patients with a decrease in visual acuity and other complications induced by facial hyaluronic acid injection. Patients underwent emergency intraarterial thrombolysis therapy by injection of hyaluronidase (500 to 1500 units) alone or hyaluronidase (750 to 1500 units) combined with urokinase (100,000 to 250,000 units), followed in both cases by a general symptomatic treatment and nutritional therapy. RESULTS Ten (42 percent) of 24 patients ultimately had improvements to visual acuity, even when the clinical application of the thrombolytic treatments had passed the recommended window for optimal treatment. In all cases, patients' facial skin necrosis was restored to nearly normal appearance. In addition, the authors found that hyaluronidase combined with urokinase was a more effective therapy than hyaluronidase alone. CONCLUSIONS The authors' results indicate that intraarterial thrombolysis therapy is beneficial to patients suffering from blindness induced by hyaluronic acid embolism. The therapy was shown to be worthy of clinical application because it alleviated the impairment to patients' vision and was also beneficial in the recovery from other serious complications, including eye movement disorder, eye edema, headaches, and skin necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
120
|
Suh DH, Ahn HJ, Seo JK, Lee SJ, Shin MK, Song KY. Monopolar radiofrequency treatment for facial laxity: Histometric analysis. J Cosmet Dermatol 2020; 19:2317-2324. [PMID: 32319176 DOI: 10.1111/jocd.13449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/26/2020] [Accepted: 04/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A monopolar radiofrequency device can be used in facial tightening. The device targets the dermis and fibrous septae, and the treatment results in immediate collagen contraction and the induction of subsequent collagen remodeling. AIMS We aimed to evaluate the histometric change of the subjects treated with a monopolar radiofrequency device using a novel tip. MATERIALS AND METHODS Eleven subjects with skin types III and IV participated in the study. They received a single session of a monopolar radiofrequency on the face, and biopsies were performed before treatment, and 2 and 6 months after the treatment. Hematoxylin and eosin, Masson trichome, and Victoria blue stains were used. An image analysis was performed using the Image J software. The dermal density of collagen and elastic fiber, and the coherency of collagen fibers were assessed in the papillary, upper reticular, and lower reticular dermises, respectively. RESULTS The monopolar radiofrequency treatments led to improvements in collagen fiber density and coherency. In the Masson trichome staining, the collagen fiber densities were 0.736 ± 0.06 and 0.652 ± 0.063 before treatment and increased to 0.773 ± 0.044 (P = .018) and 0.686 ± 0.05 (P = .045) in the papillary and lower reticular dermises, respectively. The density of the elastic fibers in all parts of the dermis showed a tendency to increase after treatment, though not statistically significantly. The mean coherency was higher after than before treatment. CONCLUSIONS In this in vivo study, we found that the collagen and elastic fiber densities and architectural structures were improved after treatment.
Collapse
Affiliation(s)
| | - Hye-Jin Ahn
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jong-Kil Seo
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | | | - Min Kyung Shin
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kye Young Song
- Department of Pathology, Kuro Sungsim Medical Center, Seoul, Korea
| |
Collapse
|
121
|
Hendrickx B, Waked K, Mespreuve M. Infrared Thermally Enhanced 3-Dimensional Time of Flight Magnetic Resonance Angiography Imaging for the Visualization of the Arteries of the Face. Aesthet Surg J Open Forum 2020; 2:ojaa020. [PMID: 33791645 PMCID: PMC7671261 DOI: 10.1093/asjof/ojaa020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The face is known for its extreme variation in vascular anatomy. Furthermore, the rapidly increasing number of filler treatments leads to an increase in severe filler-associated complications (such as skin necrosis and blindness) due to intra-arterial injection. Visualizing a patient’s individual complete facial arterial anatomy in a contrast- and radiation-free way has not been published before. This innovative imaging technique could, therefore, enhance the safety of minimally invasive surgical procedures as it provides a harmless way to map the arteries of the face. Objectives Evaluate a newly developed imaging technique to visualize the arteries of the face in a noninvasive and radiation-free manner. Methods The individual arterial facial anatomy of 20 volunteers was studied by an imaging technique, combining infrared (IR) facial warming and 3-dimensional (3D) time of flight (TOF) magnetic resonance angiography (MRA). The source and maximum intensity projection images were assessed by 2 investigators, familiar with the anatomy of the face. Results The MRA technique visualized most of the main facial arteries, albeit in a variable way. The main facial branches of the external carotid artery (facial, angular, supralabial, and superficial temporal arteries) were illustrated well, whereas the visualization of the internal carotid branches (supratrochlear and supraorbital arteries) and nasal branches (dorsal nasal and lateral nasal arteries) was less consistent. Conclusions The combination of IR “heat-induced enhancement” and a 3D-TOF MRA sequence may actually be an important step toward the visualization of the variable facial vascular anatomy in a noninvasive, radiation-free, and contrast-free manner.
Collapse
Affiliation(s)
- Benoit Hendrickx
- Department of Plastic and Reconstructive Surgery, AZ Zeno, Knokke-Heist, Belgium
| | - Karl Waked
- Department of Plastic and Reconstructive Surgery, UZ Brussel, Jette, Belgium
| | - Marc Mespreuve
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| |
Collapse
|
122
|
Azizzadeh B, Fitzgerald R, Massry G, Smith E. Subunit Approach to Facelifting and Facial Rejuvenation. Facial Plast Surg Clin North Am 2020; 28:253-272. [PMID: 32503713 DOI: 10.1016/j.fsc.2020.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Facial analysis techniques traditionally separate the upper, middle, and lower facial thirds as distinct entities without guidance in achieving aesthetic youthfulness. There is now an opportunity to develop better analytical tools and specific algorithms to help create an overall harmony to the face and restore a youthful appearance. Facial anatomic subunits have similar three-dimensional qualities based on underlying anatomic structures, craniofacial skeletal modeling, superficial and deep facial fat compartments, skin thickness, facial muscle activity, and curvature (flat, convex, concave). This article discusses using the relationships of the facial anatomic subunits to obtain more consistent and natural facial rejuvenation outcomes.
Collapse
Affiliation(s)
- Babak Azizzadeh
- Division of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90024, USA; Department of Facial Plastic and Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, 9401 Wilshire Boulevard, Suite 650, Beverly Hills, CA 90212, USA.
| | - Rebecca Fitzgerald
- Rebecca Fitzgerald MD Inc, 321 N Larchmont Blvd #906, Los Angeles, CA 90004, USA
| | - Guy Massry
- Beverly Hills Ophthalmic Plastic and Reconstructive Surgery, 150 S Robertson #314, Beverly Hills, CA 90211, USA; Division of Oculoplastic Surgery, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Erin Smith
- Department of Facial Plastic and Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, 9401 Wilshire Boulevard, Suite 650, Beverly Hills, CA 90212, USA
| |
Collapse
|
123
|
Saputra DI, Kapoor KM. Management of noninflammatory nodule in chin after a large volume bolus injection of hyaluronic acid filler. Dermatol Ther 2020; 33:e13424. [PMID: 32307855 DOI: 10.1111/dth.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
As most Asian women desire to have an "inverted triangle" appearance for face, there is an increasing trend to give a large volume bolus (LVB) injection in the submental region of the chin for its lengthening. Hyaluronic acid (HA) dermal fillers are very popular for facial contouring and reshaping, including the chin area. Filler injection in the submental area has been a popular method to lengthen the chin. Placing an LVB of HA filler material at one place can present as the formation of lump or nodule after injection. We present a case of formation of a nodule in the submental area after injection of a single LVB of filler. The nodule was injected with hyaluronidase 3 months after its formation, and a near-complete resolution was seen immediately. Complete disappearance of the nodule was found at follow-up after 10 days. LVB of HA filler can give rise to the formation of noninflammatory nodules after filler injection in the immediate post-injection period. Knowledge of the type of filler material and presenting features can help in instituting the correct line of treatment for the resolution of signs and symptoms. Also 0.5 mL of filler can be recommended as maximum size of single LVB, based on the mathematical calculations.
Collapse
Affiliation(s)
| | - Krishan Mohan Kapoor
- Department of Plastic Surgery, Fortis Hospital, Mohali, Punjab, India.,Anticlock Clinic, Chandigarh, India
| |
Collapse
|
124
|
Ho TVT, Cerrati EW, Gandhi ND, Kalbag A, Dayan SH. Premaxillary Injection for Perioral Rejuvenation and Lip Enhancement. Aesthet Surg J 2020; 40:560-567. [PMID: 31077308 DOI: 10.1093/asj/sjz108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This is the first study to evaluate the effect of premaxillary filler injection on nasal tip projection, upper lip projection, and upper lip vermilion height. OBJECTIVES The primary objective of this study was to analyze the change in nasal tip projection (measured by the Goode ratio) and the change in upper lip projection (measured by the Z angle) following premaxillary hyaluronic acid injection. A secondary objective was to measure the change in upper lip vermilion height. We hypothesized that treated subjects will show an increase in nasal tip projection, upper lip projection, and upper lip vermilion height. METHODS Twenty volunteer patients with signs of perioral aging or poor upper lip projection were enrolled in this prospective cohort study and underwent premaxillary hyaluronic acid filler injection between November 2017 and June 2018. Nasal tip projection, upper lip projection, and upper lip vermilion height were assessed from baseline and posttreatment photographs based on the Goode ratio, Z angle, and lip vermilion height ratio, respectively. RESULTS No significant change was noted between pre- and posttreatment Goode ratio measurements (P = 0.841). There was a significant decrease in Z angle and therefore significant increase in upper lip projection with treatment (P < 0.001). The lip vermilion height ratio demonstrated a trend of increased upper lip vermilion height but this did not achieve statistical significance (P = 0.561). CONCLUSIONS Premaxillary filler treatment resulted in a significant increase in upper lip projection. Premaxillary filler injection when performed in a safe manner is a valuable treatment option for perioral rejuvenation. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Thuy-Van T Ho
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, IL
| | - Eric W Cerrati
- Division of Otolaryngology, University of Utah, Salt Lake City, UT
| | | | | | - Steven H Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
125
|
Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:550-555. [PMID: 32205302 DOI: 10.1016/j.jormas.2020.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical revision rate of rhinoplasty is from 5% to 15% in literature. OBJECTIVE OF REVIEW In the context of post-rhinoplasty deformities, we aim to investigate the modalities of using injectables, their impacts on revision rate of rhinoplasty as well as their influences on the surgical strategy. TYPE OF REVIEW We realized an international literature review to collect informations on main studies reporting series of exclusive secondary medical rhinoplasties or mixed primary/secondary medical rhinoplasties, as well as per-operative injection. SEARCH STRATEGY The databases of the National Library of Medicine, Cochrane Library, Embase and Web of science were explored using the following Boolean string: (rhinoplasty OR nose) AND (injectable OR fillers OR hyaluronic acid OR calcium hydroxylapatite). The search was limited to the English language literature for studies published from 2007 up to December 2019. RESULTS Fifteen cohort studies were included. Hyaluronic acid was the most commonly used injectable for rhinoplasty revision. Patient satisfaction rates varied between 80% and 100%. Reinjections were necessary in about 20 to 50% of cases whatever the used injectables. Minor complications (swelling, bruising, erythema) were frequent after filler injections (4%). Severe complications such granulomas or vascular embolism causing skin necrosis/visual impairment were rare (0.4%). Their physiopathology, management and prevention are detailed. CONCLUSIONS The use of injectables seems to reduce the need of secondary surgical rhinoplasties. It can be expected that an evolution in surgical practices will result from injectables using, but it will be possible only if the technique is perfectly understood to avoid potentially serious vascular complications.
Collapse
|
126
|
Rauso R, Tartaro G, Chirico F, Zerbinati N, Albani G, Rugge L. Rhinofilling with hyaluronic acid thought as a cartilage graft. J Craniomaxillofac Surg 2020; 48:223-228. [PMID: 32107120 DOI: 10.1016/j.jcms.2020.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/26/2019] [Accepted: 01/22/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION There is great demand for nonsurgical aesthetic procedures. In this case series, the authors describe their stepwise technique of injecting hyaluronic acid (HA) into the nose to yield pleasing, stable results. CASE SERIES A total of 148 patients underwent minimally invasive rhinoplasty by injection of HA filler. Anatomic contraindications for the procedure were a large dorsal hump, extreme tip projection, or excessive nasal deviation. HA injections were made in a specific order to reshape and stabilize the nose; the surgical plan was conceptually similar to placement of cartilage grafts. Patients indicated their satisfaction with the surgical results on a visual analog scale. Immediately after the procedure, all patients had transient redness and slight swelling at the injection site; this resolved spontaneously by 24 h posttreatment. Vascular impairment developed in 1 patient and was managed with hyaluronidase. In general, patients expressed a high level of satisfaction. Thirty-two patients returned for a "touch-up" filler injection 1 year posttreatment. DISCUSSION Nasal reshaping by HA injection can be carried out quickly, safely, and effectively with minimal patient discomfort or downtime. Care must be given to select patients who are indicated for this procedure, and meticulous pretreatment planning is necessary.
Collapse
Affiliation(s)
- Raffaele Rauso
- Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Gianpaolo Tartaro
- Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Fabrizio Chirico
- Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Nicola Zerbinati
- Department of Dermatology, University of Insubria, Varese, Italy
| | - Giada Albani
- Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli" Naples, Italy.
| | - Luigi Rugge
- Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli" Naples, Italy
| |
Collapse
|
127
|
Rauso R, Zerbinati N, Franco R, Chirico F, Ronchi A, Sesenna E, Colella G, Tartaro G. Cross-linked hyaluronic acid filler hydrolysis with hyaluronidase: Different settings to reproduce different clinical scenarios. Dermatol Ther 2020; 33:e13269. [PMID: 32061001 DOI: 10.1111/dth.13269] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
Skin necrosis is the most severe complication arising from hyaluronic acid (HA) injection. To avoid skin necrosis, hyaluronidase should be injected along the course of the involved artery, to allow blood flow restoration. We evaluated the ability of hyaluronidase to degrade a HA filler in two simulated clinical situations-a compression case and an embolization case-to identify differences in the hyaluronidase injection. In the compression case, a bolus of HA filler was directly soaked in hyaluronidase solution; in the embolization case, a vein harvested from a living patient was filled with the same HA filler and then soaked in hyaluronidase. We then evaluated the quantity of HA remaining after 2 hr. While we found hydrolysis of HA in both cases, in the compression case, we detected almost complete hydrolysis, whereas in the embolization case we observed a reduction of the 60%. Our results support the hypothesis that vessel compression can be resolved with only one injection of hyaluronidase, while in the case of vascular embolization, repeated perivascular injections should be performed owing to the reduction of hyaluronidase activity.
Collapse
Affiliation(s)
- Raffaele Rauso
- Maxillo-Facial Complex Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Zerbinati
- Department of Dermatology, University of Insubria, Varese, Italy
| | - Renato Franco
- Pathological Anatomy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Andrea Ronchi
- Pathological Anatomy Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery Complex Unit, University of Parma, Parma, Italy
| | - Giuseppe Colella
- Maxillo-Facial Complex Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianpaolo Tartaro
- Maxillo-Facial Complex Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
128
|
Christen MO, Vercesi F. Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics. Clin Cosmet Investig Dermatol 2020; 13:31-48. [PMID: 32161484 PMCID: PMC7065466 DOI: 10.2147/ccid.s229054] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022]
Abstract
Compared to other domains, tissue engineering and esthetics have dramatically expanded in recent years, leading to both major biomedical advances and futuristic perspectives. The two share a common approach based on biomaterials, especially polymers. This paper illustrates this with the example of polycaprolactone (PCL), a polymer synthesized in the early 1930s, and one of its most recent applications, a PCL-based collagen stimulator, a filler used in esthetics. PCL is biocompatible and biodegradable. Its specific physicochemical and mechanical properties, viscoelasticity and ease of shaping led to the production of PCL-based products with various shapes and durations dependent on its biodegradation kinetics. PCL has been safely used in the biomedical field for more than 70 years, from sutures to tissue and organ replacement by 3D printing. The PCL-based collagen stimulator is composed of PCL microspheres suspended in a carboxymethyl-cellulose gel carrier providing immediate and sustained volumizing effects when injected; the morphology, the biocompatibility of the PCL microspheres embedded with the collagen fibers produced all contribute to the creation of a unique 3D scaffold for a sustained effect. Its safety has been investigated in clinical studies and vigilance surveys. Recently published experts' recommendations on injection modalities and techniques should help further optimize treatment outcome and safety. This paper also integrates reviews and recommendations on the prevention and management of adverse events related to dermal and subdermal fillers including the PCL-based collagen stimulator. In addition, in terms of efficacy and safety, this product benefits from its daily clinical use in esthetics worldwide and continuous extensive fundamental and clinical research, both on it and the PCL polymer. Forthcoming data from further investigations will reinforce knowledge of the product and procedures in the field.
Collapse
|
129
|
|
130
|
The dangers of dermal fillers. Br J Oral Maxillofac Surg 2019; 58:243-244. [PMID: 31862119 DOI: 10.1016/j.bjoms.2019.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/19/2019] [Indexed: 11/21/2022]
|
131
|
Lima VGDF, Regattieri NAT, Pompeu MF, Costa IMC. External vascular compression by hyaluronic acid filler documented with high-frequency ultrasound. J Cosmet Dermatol 2019; 18:1629-1631. [PMID: 30838729 DOI: 10.1111/jocd.12901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
We present a case report of a hyaluronic acid filler-induced complication documented using high-frequency ultrasound. We regard the scientific value of the case as indicating the benefit that ultrasound provides for the management and documentation of this complication. This technology has been becoming increasingly widespread in the care of patients who experience unwanted effects of hyaluronic acid filler because it can be used for the high-resolution visualization of skin layers as well as the differentiation of filler types and their relationships with adjacent tissues (via gray scale or B-mode ultrasound) and blood vessels (via color Doppler ultrasound). In addition, it was possible to conclude that external vascular compression causes clinical repercussions, a fact that is often questioned by some dermatologists. This questioning is based on the vast vascularization and anastomosis of arteries of the face, which should permit compensation for vascular compression. However, in this case, there was no doubt that compression caused a region of low output with the clinical manifestation of peri-oral pallor. Ultrasound was used to document the compression of a vessel by the filler; after application of hyaluronidase, increased vessel lumen and clinical reversal of hypoperfusion in the affected area were observed.
Collapse
Affiliation(s)
| | | | - Marcelo Faro Pompeu
- Hospital Universitário de Brasilia, Universidade Federal de Brasília, Brasília, Brazil
| | | |
Collapse
|
132
|
Lindgren AL, Welsh KM. Inadvertent intra-arterial injection of deoxycholic acid: A case report and proposed protocol for treatment. J Cosmet Dermatol 2019; 19:1614-1618. [PMID: 31714002 DOI: 10.1111/jocd.13214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/21/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
Deoxycholic acid (ATX-101) is a secondary bile acid that was approved as an injectable drug for the reduction of submental fat. Necrosis, an uncommon but serious adverse event, can occur due to inadvertent superficial injection or intra-arterial injection of the acid. The management of the intra-arterial injection of deoxycholic acid has not been well characterized. Here, we discuss methods to decrease the risk of such injections and draw on existing protocols for the inadvertent intra-arterial injection of sclerotherapy solutions and dermal fillers to propose a safe, practical approach to treatment. A case report is presented of a 42-year-old woman who received a deoxycholic acid injection for the correction of submental fullness, which was complicated by the inadvertent intra-arterial injection of the acid. The adaptation of published treatment protocols for the inadvertent injection of sclerosing solutions and dermal fillers allowed for a good outcome in this patient. The inadvertent intra-arterial injection of deoxycholic acid is a rare event. The risk of such injections can be reduced with attention to injection technique and can be managed successfully following the adaptation of protocols in the literature for similar events from vascular compromise due to dermal fillers and sclerosing solutions.
Collapse
|
133
|
Tran AQ, Staropoli P, Rong AJ, Lee WW. Filler-Associated Vision Loss. Facial Plast Surg Clin North Am 2019; 27:557-564. [DOI: 10.1016/j.fsc.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
134
|
DeLorenzi C. Commentary on: Anatomical Variations in the Course of Labial Arteries: A Literature Review. Aesthet Surg J 2019; 39:1236-1240. [PMID: 30657849 DOI: 10.1093/asj/sjy339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
135
|
Koziej M, Trybus M, Hołda M, Polak J, Wnuk J, Brzegowy P, Popiela T, Walocha J, Chrapusta A. Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic Procedures. Aesthet Surg J 2019; 39:1151-1162. [PMID: 30721996 DOI: 10.1093/asj/sjz028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The facial artery (FA) is the main blood vessel supplying the anterior face and an understanding of its anatomy is crucial in facial reconstruction and aesthetic procedures. OBJECTIVES The aim of this study was to assess the many anatomical features of the FA utilizing a multidimensional approach. METHODS Head and neck computed tomographic angiographies of 131 patients (255 FAs) with good image quality were evaluated. The FA was classified according to its termination pattern, course, and location with reference to soft tissue/bone surrounding structures. RESULTS In total, each branch was present as follows: the submental artery (44.8%), the inferior labial artery (60%), the superior labial artery (82.2%), the lateral nasal artery (25.1%), and the angular artery (42.5%). The most common FA course was the classic course, situated medially to the nasolabial fold (27.1%). In total 65.5% of the arteries were located medially to the nasolabial fold, and only 12.3% of them were totally situated lateral to the nasolabial fold. The median distance (with quartiles) from the inferior orbital rim reached the FA after the superior labial artery branched off in 50.2% of cases and was 36.6 mm (33.4; 43.3). The angle between the FA and the inferior border of the mandible was 49.8o (31.9; 72.4). The horizontal distances between the oral commissure and naris to the FA were 8.5 ± 4.0 mm and 12.1 ± 6.7 mm, respectively. CONCLUSIONS An anatomical map summarizing the major measurements and geometry of the FA was generated. The detailed anatomy and relative positioning of the FA should be considered to avoid any unexpected complications in plastic surgery.
Collapse
Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, The Ludwik Rydygier Hospital, Krakow, Poland
- The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Hołda
- Department of Anatomy, Jagiellonian University Medical College
| | - Jakub Polak
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jakub Wnuk
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Paweł Brzegowy
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Tadeusz Popiela
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College
| | - Anna Chrapusta
- Head of The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| |
Collapse
|
136
|
Samizadeh S, Pirayesh A, Bertossi D. Anatomical Variations in the Course of Labial Arteries: A Literature Review. Aesthet Surg J 2019; 39:1225-1235. [PMID: 30204834 DOI: 10.1093/asj/sjy235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nonsurgical lip enhancement using dermal fillers is a very popular procedure. The trend for enlarged lips has been popularized by media and social media. The lips have considerable aesthetic and functional importance, in addition to having a complex anatomy. Serious complications, including vascular compromise or occlusion leading to cutaneous necrosis and blindness, can occur as the result of lip enhancement using dermal fillers. Therefore, aesthetic practitioners require an in-depth understanding of the anatomy and vasculature of the lips and the perioral area prior to providing lip enhancement using dermal fillers. OBJECTIVES This literature review aimed to summarize existing data describing the origin, path, and depth of the superior and inferior labial arteries, and to help aesthetic practitioners in providing safer injections to the lips. METHODS A literature search was carried out to summarize the available data describing the origin, path, and depth of the labial arteries. RESULTS Analysis of the literature revealed that the labial arteries display great variability with respect to path (distribution), presence, and location. CONCLUSIONS Increasing the volume of lips through injections of dermal filler needs to be undertaken with caution, and awareness of the anatomical variation in artery location and path is a crucial concept that is essential when injecting the lips.
Collapse
Affiliation(s)
| | | | - Dario Bertossi
- Maxillofacial and ENT Surgeon, University of Verona, Verona, Italy
| |
Collapse
|
137
|
|
138
|
Reversal of Post-filler Vision Loss and Skin Ischaemia with High-Dose Pulsed Hyaluronidase Injections. Aesthetic Plast Surg 2019; 43:1337-1344. [PMID: 31236610 DOI: 10.1007/s00266-019-01421-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/04/2019] [Indexed: 01/07/2023]
Abstract
Nose filler injections are very popular in many Asian countries to improve nose shape and projection. However, due to the vascular supply of nose from the ophthalmic artery and its communication with branches of the facial artery in this region, there could be a possibility of ophthalmic complications in case of an accidental intra-arterial injection of filler material. This may cause devastating complications of partial or complete vision loss with or without associated cutaneous ischaemic changes. We present a case report of a patient who developed features of vascular involvement after two ml of HA filler injection in the nasal dorsum, tip and columella. The patient initially developed tell-tale signs of impending skin necrosis in the nasal and forehead skin followed by ptosis, severe pain and progressive vision loss in the right eye until a point where the patient could only perceive light. The patient was managed with multiple doses of hyaluronidase in the involved skin and two doses of retrobulbar injection for vision loss. Significant recovery in the skin and ophthalmic components occurred within 20 days of filler injection. This case demonstrates that recovery of the ischaemic ophthalmic and cutaneous changes secondary to probable intra-arterial injection could be accomplished using combined retrobulbar and periorbital intracutaneous injections of high-dose pulsed hyaluronidase. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
139
|
The Role of Hyaluronidase for the Skin Necrosis Caused by Hyaluronic Acid Injection-Induced Embolism: A Rabbit Auricular Model Study. Aesthetic Plast Surg 2019; 43:1362-1370. [PMID: 31139914 DOI: 10.1007/s00266-019-01398-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Skin necrosis is considered the most serious complication of hyaluronic acid dermal filler injection procedures. To effectively treat skin necrosis, hyaluronidase injection is one of the essential preventative treatments, and yet optimal complication management remains an unmet need. Therefore, this paper investigates the effects of hyaluronidase injection timing on the treatment of skin necrosis. METHODS In an in vitro experiment, the carbazole method was used to determine the degradation time of hyaluronic acid gels in a large volume of hyaluronidase. In vivo experimental rabbit ear models were developed to simulate the skin necrosis caused by hyaluronic acid and the test animals distributed into five groups. Except one control group, the other four groups were injected with a large volume of hyaluronidase as treatment at 2 h, 4 h, 8 h and 16 h, respectively, after models were built. The necrosis degree of models was analyzed with necrotic area and histologic examination on the postoperative 7th day. Besides, temperatures of rabbit ears were observed to demonstrate the healing process of flap models. RESULTS The average necrotic area of flaps in the 2-h and 4-h injection groups showed a significant difference compared with that of the control group (p < 0.05; p < 0.05). The histologic examination showed that there were HA embolisms, vascular thrombolytic recanalization and arteriovenous thromboses in the survival area. In addition, the mean temperatures of the rabbit ear flaps fluctuated over time and showed clear differences between distal and proximal parts. CONCLUSIONS The area of flap necrosis positively correlates with injection timing of the large volume of hyaluronidase. More importantly, when injection timing is within 4 h, treatment effectiveness will be significantly improved. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
140
|
Embolization of Bio-Alcamid Gluteal Injections in a Female Patient with Patent Foramen Ovale Leading to ARDS and Embolic Stroke. REPORTS 2019. [DOI: 10.3390/reports2040023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bio-Alcamid is a non-FDA approved permanent dermal filler with a few known adverse effects including granuloma formation at injection site, skin infections, abscess and painful inflammation. Embolization of Bio-Alcamid has not been reported and likely represents a very rare complication. We present the case of a thirty-one-year-old female who presents with cough, dyspnea, hemoptysis, fever, and pleuritic chest pain several hours after receiving Bio-Alcamid gluteal injections. The patient’s symptoms progress rapidly and, within three days, she develops acute respiratory failure requiring intubation. A chest x-ray consistent with acute respiratory distress syndrome (ARDS) is viewed. Concurrently, a 2D echocardiogram reveals a patent foramen ovale (PFO) and severe pulmonary hypertension. Five weeks after initial presentation to the emergency department, the patient demonstrates flaccid quadriplegia, is poorly responsive when sedation is held, and her CT scan of the brain showed multifocal infarcts involving bilateral cerebral hemispheres. A CT of the abdomen reveals renal and splenic infarcts. This case study presents a rare complication of a nonbiodegradable dermal filler, Bio-Alcamid.
Collapse
|
141
|
Rayess HM, Svider PF, Hanba C, Patel VS, DeJoseph LM, Carron M, Zuliani GF. A Cross-sectional Analysis of Adverse Events and Litigation for Injectable Fillers. JAMA FACIAL PLAST SU 2019; 20:207-214. [PMID: 29270603 DOI: 10.1001/jamafacial.2017.1888] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Injectable fillers are increasing in popularity as a noninvasive option to address concerns related to facial aging and volume loss. To our knowledge, there have been no large-scale analyses of adverse events and associated litigation related to filler injections. Objectives To determine risks of injectable fillers and analyze factors raised in litigation related to injectable fillers. Design, Setting, and Participants In this cross-sectional review, the US Food and Drug Administration's (FDA) manufacturer and user facility device experience (MAUDE) database was evaluated for complications from the use of the following fillers: Juvederm, Restylane, Belotero, Sculptra, Radiesse, Artefill, Bellafill, and Juvederm Voluma from 2014 to 2016. The Westlaw Next database was used to identify jury verdicts. Main Outcomes and Measures Complications were organized by type of filler used, location of injection, and severity. Intra-arterial injections without sequelae and those resulting in blindness or necrosis were considered severe complications. Factors raised during the litigation process were also analyzed. Results Of 1748 adverse events analyzed, most cases stemmed from cheek (751 [43.0%]) or lip (524 [30.0%]) injection. Commonly reported adverse events reported included swelling (755 [43.2%]) and infection (725 [41.5%]). Among FDA-reported complications, blindness was significantly associated with dorsal nasal injections (P < .001). Vascular compromise with and without sequela of dermal necrosis and blindness were significantly associated with Radiesse injections P < .001. Of the 9 malpractice cases identified, two-thirds involved allegations of inadequate informed consent, and the median award in cases resolved with payment was $262 000. Conclusions and Relevance Although specific complication profiles vary by material and injection site, common adverse events associated with injectable fillers include swelling and infection. More serious events include vascular compromise, resulting in necrosis and blindness; these events are also raised in cases involving litigation. This analysis illustrates the importance of outlining these risks in a comprehensive preoperative informed consent process. Level of Evidence NA.
Collapse
Affiliation(s)
- Hani M Rayess
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Curtis Hanba
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | | | | | - Michael Carron
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Giancarlo F Zuliani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| |
Collapse
|
142
|
Surek CC, Said SA, Perry JD, Zins JE. Retrobulbar Injection for Hyaluronic Acid Gel Filler-Induced Blindness: A Review of Efficacy and Technique. Aesthetic Plast Surg 2019; 43:1034-1040. [PMID: 31065750 DOI: 10.1007/s00266-019-01388-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/13/2019] [Indexed: 11/30/2022]
Abstract
While blindness after hyaluronic acid gel filler injection occurs only very rarely, it represents a devastating complication for the patient and the surgeon. Retrobulbar injection with hyaluronidase is the only known potential means of reversing this adverse event. However, positive outcomes remain anecdotal. We have attempted to review the current literature regarding possible efficacy and detail the indications and technique to be utilized, if hyaluronidase retrobulbar injection is to be attempted. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Christopher C Surek
- Plastic Surgery Department, University of Kansas Health System, Kansas City, KS, USA
| | - Sayf A Said
- Plastic Surgery Department, Cleveland Clinic, 9500 Euclid Ave, A60, Cleveland, OH, 44195, USA
| | - Julian D Perry
- Cole Eye Institution, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - James E Zins
- Plastic Surgery Department, Cleveland Clinic, 9500 Euclid Ave, A60, Cleveland, OH, 44195, USA.
| |
Collapse
|
143
|
Ansari ZA, Choi CJ, Rong AJ, Erickson BP, Tse DT. Ocular and cerebral infarction from periocular filler injection. Orbit 2019; 38:322-324. [PMID: 30376386 DOI: 10.1080/01676830.2018.1537287] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/14/2018] [Indexed: 06/08/2023]
Abstract
A 20-year-old woman presented with loss of vision in her right eye and a "black nose" after receiving hyaluronic acid filler injections in her right glabella 1 month prior. Her vision was no light perception, and external examination revealed resolving skin necrosis at the nasal tip. A dilated fundus exam showed a fibrotic membrane emanating from a pale optic nerve and a diffusely atrophic retina with sclerotic vessels. An MRI demonstrated scattered right-sided parietal lobe infarcts. These findings were consistent with inadvertent cannulation of the supraorbital artery, followed by injection of filler into the internal carotid circulation. The product traveled in a retrograde fashion, occluding the right ophthalmic artery, right dorsal nasal artery, and arterial segments to the Circle of Willis. This case highlights the importance of understanding the complex vascular architecture of the periorbita and the mechanism by which such occlusions occur.
Collapse
Affiliation(s)
- Zubair A Ansari
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
| | - Catherine J Choi
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
- b Ophthalmic Plastic Surgery, Bascom Palmer Eye Institute , Miami , FL , USA
| | - Andrew J Rong
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
| | | | - David T Tse
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
- b Ophthalmic Plastic Surgery, Bascom Palmer Eye Institute , Miami , FL , USA
| |
Collapse
|
144
|
Assessing Retrobulbar Hyaluronidase as a Treatment for Filler-Induced Blindness in a Cadaver Model. Plast Reconstr Surg 2019; 144:315-320. [DOI: 10.1097/prs.0000000000005806] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
145
|
|
146
|
Koziej M, Trybus M, Hołda M, Wnuk J, Polak J, Brzegowy P, Popiela T, Walocha J, Tomaszewski K, Chrapusta A. The Superficial Temporal Artery: Anatomical Map for Facial Reconstruction and Aesthetic Procedures. Aesthet Surg J 2019; 39:815-823. [PMID: 30351355 DOI: 10.1093/asj/sjy287] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The superficial temporal artery (STA), a terminal branch of the external carotid artery, supplies multiple regions of the scalp and face. Knowledge of the STA is important for reconstructive and aesthetic procedures of the head and face. OBJECTIVES The aim of this study was to map the STA in relation to anatomical landmarks. METHODS Computed tomographic head angiographies of 215 patients were included in this study; the final analysis comprised 419 STAs. The STA's main branches and variants were identified. The diameters of the STA and its frontal and occipital branches were measured, and the distance between the STA tree and anatomical landmarks was delineated. RESULTS Frontal and parietal branches were recorded in 98.1% and 90.7% of patients, respectively. The mean diameters, measured 1 and 7 cm from the STA bifurcation for the frontal branch, were 0.97 ± 0.32 and 0.81 ± 0.26 mm, respectively, and for the parietal branch, the diameters were 0.96 ± 0.28 and 0.76 ± 0.23 mm, respectively. The STA bifurcation point was located above the zygomatic arch (ZA) in 75.6%, below in 14.7%, and on the ZA in 9.7% of patients. The mean distance from the ZA center to the STA bifurcation was 16.8 ± 16.0 mm. CONCLUSIONS The STA artery and its main branches follow a conservative course, and serious anatomical variations are relatively rare. The STA and its main branches may be localized using simple anatomical landmarks. An anatomical map showing artery-free zones in the lateral forehead region was presented, which may prove useful for plastic, reconstructive, and aesthetic surgeons. Level of Evidence: 4.
Collapse
Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College
- Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Hołda
- Professor and Head of the Department of Anatomy, Jagiellonian University Medical College
| | - Jakub Wnuk
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Jakub Polak
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Paweł Brzegowy
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Tadeusz Popiela
- Radiologist and Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma University Hospital, Krakow, Poland
| | - Jerzy Walocha
- Professor and Head of the Department of Anatomy, Jagiellonian University Medical College
| | - Krzysztof Tomaszewski
- Professor and Head of the Department of Anatomy, Jagiellonian University Medical College
| | - Anna Chrapusta
- Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| |
Collapse
|
147
|
Smith C, Srivastava D, Nijhawan RI. Optimizing Patient Safety in Dermatologic Surgery. Dermatol Clin 2019; 37:319-328. [DOI: 10.1016/j.det.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
148
|
Practical Approach and Safety of Hyaluronic Acid Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2172. [PMID: 31624663 PMCID: PMC6635180 DOI: 10.1097/gox.0000000000002172] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/08/2019] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Soft-tissue filler use has grown considerably related to the increasing popularity of minimally invasive cosmetic procedures. Hyaluronic acid products are currently the most utilized soft-tissue fillers. Proper working knowledge of individual products, limitations to use, and anatomic principles can improve outcomes. Prevention is key to minimize complications; however, when present, complications must be managed methodically. Complications are categorized based on the timing of presentation and include early, late, and delayed. Vascular compromise and tissue necrosis are among the most devastating complications seen with filler use. Nodules can be related to an inflammatory or infectious etiology but should be distinguished as treatment varies. Hyaluronidase is mandatory to have available as a reversal agent for hyaluronic acid products and can be used in treatment for many complications and untoward sequela.
Collapse
|
149
|
Khunkhet S, Rattananukrom T, Thanasarnaksorn W, Suchonwanit P. Alopecia Induced by Autologous Fat Injection into the Temporal Area: Case Report and Review of the Literature. Case Rep Dermatol 2019; 11:150-156. [PMID: 31244640 PMCID: PMC6587213 DOI: 10.1159/000500710] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/01/2019] [Indexed: 01/06/2023] Open
Abstract
Alopecia secondary to facial filler injections is a highly unusual sequela. Only 2 cases of hyaluronic acid-induced alopecia have been reported to date. Accumulating evidence suggests vascular compromise as its etiology, which can be accidental intravascular injection or external compression by overfilled materials. We hereby present, to the best of our knowledge, the first case of localized nonscarring and scarring alopecia secondary to autologous fat grafting and review the literature regarding filler-induced alopecia.
Collapse
Affiliation(s)
- Saranya Khunkhet
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wilai Thanasarnaksorn
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
150
|
Ueland HO, Nilsen RM, Rødahl E, Jensen SA. Hyaluronic acid is superior to autologous fat for treatment of temporal hollowing after lateral orbital wall decompression: A prospective interventional trial. J Plast Reconstr Aesthet Surg 2019; 72:973-981. [DOI: 10.1016/j.bjps.2018.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
|