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Cattelan L, Dayan S, Fabi SG. Optimal Practices in the Delivery of Aesthetic Medical Care to Patients on Immunosuppressants and Immunomodulators: A Systematic Review of the Literature. Aesthet Surg J 2024; 44:NP819-NP828. [PMID: 38967686 DOI: 10.1093/asj/sjae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024] Open
Abstract
Nonsurgical aesthetic procedures have been steadily growing in popularity among patients of all ages and ethnicities. At present, the literature remains devoid of guidelines on optimal practices in the delivery of aesthetic medical care to patients on immunosuppressant medications. The authors of this review sought to determine the physiologic responses of immunocompromised patients related to outcomes and potential complications following nonsurgical aesthetic procedures, and to suggest recommendations for optimal management of these patients. A comprehensive systematic review of the literature was performed to identify clinical studies of patients who had undergone nonsurgical aesthetic procedures while immunosuppressed. Forty-three articles reporting on 1690 immunosuppressed patients who underwent filler injection were evaluated, of which the majority (99%; 1682/1690) were HIV patients, while the remaining 8 were medically immunosuppressed. The complication rate of filler in this population was 28% (481/1690), with subcutaneous nodules the most frequently reported adverse event. A detailed synthesis of complications and a review of the inflammatory responses and impact of immunosuppressants and HIV infection on filler complications is presented. The authors concluded that patients on immunomodulatory medications may be at increased risk of filler granuloma relative to the general population, while patients on immunosuppressants may be at increased risk of infectious complications. Rudimentary guidelines for optimal preprocedural patient assessment, aseptic technique, injection technique, and antibacterial and antiviral prophylaxis are reviewed. Ongoing advancements in our understanding of the mechanisms underlying these inflammatory processes will undoubtedly optimize management in this patient population. LEVEL OF EVIDENCE: 3
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2
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Fakih-Gomez N, Kadouch J, Felice F, Haykal D, Muñoz-Gonzalez C. The Hybrid Filler Technique: A 5-Year Retrospective Analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04387-2. [PMID: 39327280 DOI: 10.1007/s00266-024-04387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND The combination of calcium hydroxylapatite (CaHA) and hyaluronic acid fillers (CPM-HA, cohesive polydensified matrix-based hyaluronic acid fillers, Belotero® range, Merz Pharmaceuticals GmbH, Frankfurt, Germany), known as hybrid fillers, has emerged as a popular approach in aesthetic medicine. Premixed CaHA with CPM-HA offers several advantages, including enhanced tissue elevation and reduced early volume loss after injection. OBJECTIVE The objective of the present study is to assess the safety of premixing CaHA and CPM-HA fillers for rejuvenation purposes or as an aesthetic harmonization treatment. METHODS This retrospective study presents the clinical experience of two expert injectors who consistently used premixed CaHA and CPM-HA fillers for aesthetic treatments between March 2018 and December 2023. The premixed hybrid formulation was standardized and administered following a published protocol. A total of 2112 patients were treated, with meticulous follow-up over a minimum of one year. RESULTS In the 2112 patients treated, only 5 minor adverse events (0.24%) were reported. The adverse events consisted of 4 non-inflammatory nodules of which 2 completely resolved with hyaluronidase, and 1 case of transient edema. Secondary findings consist of the treated areas, type of CPM-HA used and mixing ratios that were applied. CONCLUSION The results from the current retrospective study, with the largest published cohort so far, are consistent with prior publications and strongly support a good safety profile of the CaHA:CPM-HA hybrid blend. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Nabil Fakih-Gomez
- Department of Facial Plastic & Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, 00000, Lebanon.
| | - Jonathan Kadouch
- Practice for Aesthetic Dermatology, ReSculpt Clinic, Amsterdam, The Netherlands
| | - Fernando Felice
- Department of Facial Plastic Surgery of Medical &, Surgical Institute IMQ, Buenos Aires, Argentina
| | | | - Cristina Muñoz-Gonzalez
- Department of Facial Plastic & Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, 00000, Lebanon
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3
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Fakih-Gomez N, Verano-Garcia A, Porcar Plana CA, Muñoz-Gonzalez C, Kadouch J. Jawline Sharp Contouring With Hybrid Filler. Aesthetic Plast Surg 2024:10.1007/s00266-024-04226-4. [PMID: 39014233 DOI: 10.1007/s00266-024-04226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Having a well-defined jawline is a sign of youth and attractiveness among both men and women. Soft tissue fillers, such as calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) fillers, offer nonsurgical alternatives for rejuvenating the lower face and enhancing the jawline. The aim of this study was to investigate the use of a premixed combination of HA with cohesive polydensified matrix technology (CPM, Belotero Intense, CPM-I) and CaHA to create a sharply defined jawline. METHODS A total of 126 patients were enrolled in the study and treated with a premixed combination of CPM-I and CaHA using a retrograde fanning injection technique with cannulas. The injection volumes and product ratios were customized according to the patients' needs. RESULTS The cohort consisted of 75 females and 51 males. The average injected volume of premixed CaHA:CPM-I was 5.83 mL. In the majority of patients, a 1:1 syringe ratio of CaHA:CPM-I was applied (n = 81, 64.2%). No adverse events were reported during the 6-month follow-up period. CONCLUSION The hybrid filler approach investigated in this study shows promise for achieving well-defined, long-lasting jawline contours. 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 .
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Affiliation(s)
- Nabil Fakih-Gomez
- Department of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Main Street, Khaizaran, Lebanon.
| | - Alba Verano-Garcia
- Department of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Main Street, Khaizaran, Lebanon
| | | | - Cristina Muñoz-Gonzalez
- Department of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Main Street, Khaizaran, Lebanon
| | - Jonathan Kadouch
- Practice for Aesthetic Dermatology, ReSculpt Clinic, Amsterdam, Netherlands
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4
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Landau M, Klein J, Leizgold FR, Kroumpouzos G. Rare and novel complications of botulinum neurotoxin type A and dermal filler injections. Clin Dermatol 2024:S0738-081X(24)00107-X. [PMID: 38914174 DOI: 10.1016/j.clindermatol.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Botulinum neurotoxin type A (BoNTA) and filler injection procedures usually provide predicted outcomes with a low incidence of complications. Most of the complications after these procedures have been extensively discussed. In this study, we report on these injectables' less well-known, recently reported, and novel complications and attempt to clarify the underlying mechanisms. Counterfeit or mishandled BoNTA has been associated with botulism. BoNTA has been linked to uncommon complications, including morphea-like lesions, nontuberculous mycobacterial infections, vascular occlusion, and pseudoaneurysm of the superficial temporal artery. Unusual complications from filler injection include nonscarring alopecia, intraoral necrosis, nontuberculous mycobacterial infections, xanthelasma-like reactions, intracranial perforation, and pneumosinus dilatans. Post-BoNTA injection nodules and filler infection from bone destruction due to cocaine use are new complications. These complications pose a challenge for diagnosis and treatment. This publication aims to assist in promptly identifying and managing these rare and novel complications when necessary.
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Affiliation(s)
| | - Jerome Klein
- Jules Stein Eye Institute, UCLA Medical Center, Los Angeles, California, USA
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5
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Maci M, Fanelli C, Lorusso M, Ferrara D, Caroprese M, Laurenziello M, Tepedino M, Ciavarella D. Botulinum Toxin Type A and Hyaluronic Acid Dermal Fillers in Dentistry: A Systematic Review of Clinical Application and Indications. J Clin Med Res 2024; 16:273-283. [PMID: 39027812 PMCID: PMC11254312 DOI: 10.14740/jocmr5202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background Botulinum toxin type A (BoNT-A) and hyaluronic acid (HA) dermal fillers are increasingly utilized in dentistry for therapeutic and aesthetic purposes. However, a comprehensive synthesis of their clinical applications and indications in dentistry is lacking. This systematic review aimed to analyze the clinical application and indications of BoNT-A and HA dermal fillers in dentistry, providing insights into their efficacy, safety profiles, and limitations. Methods A systematic search was conducted in PubMed/MEDLINE databases to identify relevant studies published between 2018 and 2024. Medical Subject Headings (MeSH) terms and keywords related to BoNT-A, HA dermal fillers, dentistry, clinical applications, and indications were used. Study selection criteria included randomized controlled trials (RCTs) and non-RCTs involving human participants of any age group. Data extraction and synthesis followed established guidelines, focusing on study characteristics, participant demographics, intervention details, outcome measures, and key findings related to BoNT-A and HA dermal fillers' clinical application in dentistry. Results Systematic searches across electronic databases and grey literature identified 857 records, with an additional 73 from hand searches. After screening titles and abstracts, 542 records were excluded, leaving 374 full-text publications for evaluation. Ultimately, 12 RCTs and 13 non-RCTs were included. The systematic review encompassed diverse geographic locations: Brazil, Italy, Spain, Syria, India, Egypt, Korea, and the Netherlands, involving samples sizes ranging from 14 to 143 participants. The review synthesized findings on HA's efficacy in various areas, including bone repair, gingivitis management, temporomandibular joint disorders, postoperative swelling reduction, periodontal defect treatment, chin and check projection and lips augmentation. BoNT-A exhibited promising efficacy in managing orofacial pain conditions, gummy smile treatment and neuromodulation of the lower third muscles. Safety profiles varied among studies, with some reporting minimal adverse effects while others noted dose-related concerns. Conclusion BoNT-A and HA dermal fillers offer a wide array of clinical applications in dentistry, ranging from therapeutic interventions to aesthetic enhancements. Despite promising efficacy, careful consideration and monitoring of safety outcomes are essential when integrating these interventions into clinical practice. Further research addressing methodological limitations and safety concerns is warranted to optimize their utilization and improve patient care in dentistry.
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Affiliation(s)
- Marta Maci
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Carlotta Fanelli
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Donatella Ferrara
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Marino Caroprese
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy
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6
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Eichinger J, Casale J, Daniels P, Rice A. Trends in Medical Spa Statistics and Patient Safety. Dermatol Surg 2024; 50:216-217. [PMID: 37910652 DOI: 10.1097/dss.0000000000003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Justin Eichinger
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Jarett Casale
- Campbell University at Sampson Regional Medical Center, Clinton, North Carolina
| | - Phuong Daniels
- Campbell University at Sampson Regional Medical Center, Clinton, North Carolina
| | - Ashley Rice
- Campbell University at Sampson Regional Medical Center, Clinton, North Carolina
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7
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Rajanala S, Watchmaker JD, Dover JS. TikTok Sheds Light on Lasers: An Analysis of Laser, Light, and Energy-based Device Videos. Dermatol Surg 2023; 49:534-535. [PMID: 37052598 DOI: 10.1097/dss.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Susruthi Rajanala
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
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8
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Steenen SA, Bauland CG, de Lange J, van der Lei B. Complications After Botulinum Neurotoxin Type A and Dermal Filler Injections: Data From a Large Retrospective Cohort Study. Aesthet Surg J 2023; 43:NP56-NP63. [PMID: 35953448 PMCID: PMC9830985 DOI: 10.1093/asj/sjac228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Serge A Steenen
- Corresponding Author: Dr Serge A. Steenen, Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Center for Dentistry (ACTA), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands. E-mail: ; Instagram: @dr_steenen
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9
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Merkel EA, Worley B, Christensen RE, Harikumar V, Lu KQ, Evans ST, Anvery N, Dirr MA, Poon E, Alam M. In Vitro and Ex Vivo Investigation of Intralesional Sodium Thiosulfate as a Reversal Agent for Calcium Hydroxylapatite Soft Tissue Filler. J Invest Dermatol 2022; 142:3125-3127. [PMID: 35526562 PMCID: PMC9613503 DOI: 10.1016/j.jid.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Emily A Merkel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Brandon Worley
- Florida Dermatology and Skin Cancer Centers, Lake Wales, Florida, USA
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kurt Q Lu
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Spencer T Evans
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Otolaryngology - Head & Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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10
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Fakih-Gomez N, Kadouch J. Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler. Aesthetic Plast Surg 2022; 46:373-381. [PMID: 34341855 PMCID: PMC8831259 DOI: 10.1007/s00266-021-02479-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/05/2021] [Indexed: 12/04/2022]
Abstract
Background Limited data are available describing effectiveness of combining the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA). Methods The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA (CaHA:CPM-HA ) in the authors’ aesthetic practices. The midface and lower face were injected. Patients’ records were evaluated, and treatment results were scored using the Merz Aesthetics Scale for the jawline® (clinician rated, CR-MASJ). Adverse events were recorded. Results A total of 41 patients were included, all females with a mean age of 47.5 years (range 21–63 years). The mean CR-MASJ score improved from 2.12 at baseline to 0.68 at t = 3 months (SD = 0.69, 95% CI 1.28–1.60) and 1.27 at t = 12 months (SD = 0.74, 95% CI 0.43–0.74). 100% of the subjects had experienced a ≥1-point improvement in CR-MASJ score at t = 3 months, versus 85% at t = 12 months. No adverse events were reported. Conclusion The results of this study support the volumizing and lifting potential of the hybrid mix CaHA:CPM-HA for treatment of cheeks and jawline. 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.
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Affiliation(s)
- Nabil Fakih-Gomez
- Department of Facial Plastic & Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, Lebanon
| | - Jonathan Kadouch
- Practice for Aesthetic Dermatology, ReSculpt Clinic, Amsterdam, The Netherlands.
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11
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Abstract
The demand for minimally invasive cosmetic procedures is rising, and the public and other physicians deem dermatologists as top providers of these services. Given these expectations, dermatologic residency training must equip resident physician trainees to care for the growing population of patients with aesthetic concerns. As stands, formal hands-on cosmetic dermatology training in residency is lacking specific structure. Educational, cultural, time, and monetary barriers exist, among others, which restrict residents from attaining proficiency in cosmetic dermatology procedures prior to graduation. This may adversely impact patient safety and deter graduates from offering aesthetic procedures. The standardization of core residency competencies in minimally invasive cosmetic procedures is fundamental to guarantee patient safety and satisfaction while ensuring practitioner competence. The balance between these elements is essential for optimal patient care. We review and debate for modifying and strengthening the current curriculum requirements while presenting means to overcome barriers.
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Affiliation(s)
- Elizabeth J Kream
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Virginia A Jones
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA.
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12
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Kadouch J, Fakih-Gomez N. A Hybrid Filler: Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications. ACTA ACUST UNITED AC 2021. [DOI: 10.1177/07488068211016135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limited data are available describing the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) in combination. The aim of this study is to investigate the safety of premixing CaHA and HA fillers before injection. The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA in the authors’ aesthetic practices. Patients records were evaluated for adverse events at 1-3 month, 5-7 month and >12-month posttreatment follow-up visits. The retrospective chart review identified 134 patients who had been treated with premixed CaHA: HA, most of whom were female (95%). Most patients were treated for multiple facial areas. Injections were subcutaneous and performed with 25G 38- or 50-mm cannulas, using a fanning injection technique. Injection volumes and product ratios depended on the number of areas being treated and severity of the aesthetic defect. Only 2 adverse events were reported which comprised slight cases of overcorrection at 1-3 months, both of which resolved with hyaluronidase. No other adverse events were reported. This combined evaluation of the published literature and retrospective examination of case reports raised no concerns about the use of premixed CaHA and CPM-HA (Hybrid) fillers for the treatment of a range of facial aesthetic indications.
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13
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Arlette JP, Ashenhurst M, Hill V, Jiang K. Prevention and Management of Filler Induced Iatrogenic Stroke of the Eye. J Cutan Med Surg 2021; 25:543-552. [PMID: 33653128 DOI: 10.1177/1203475421999340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the past few decades, minimally-invasive esthetic treatments and the use of injectable Hyaluronic Acid Gels and other filling agents to treat facial esthetics have increased dramatically. Although extremely rare, a filler can cause ocular and orbital ischemia by retrograde flow from the ophthalmic artery when injected in any of the anastomosis of the face. Once filler reaches the central retinal artery, blindness is inevitable, and no treatment is effective. While the risk of blindness happening with any filler injection is rare, the life-altering irreversible consequence of a procedure that was anticipated to be simple and beautifying is a reality that each injector must be prepared for with every injection. The parameters associated with an iatrogenic stroke of the eye are the site of injection, the injection technique, patient characteristics, and the material injected. Understanding the interplay of each of these variables might help us reduce the possibility of blindness during the injection of a soft-tissue cosmetic filler. Here, we explore the causes of Hyaluronic Acid Gels Filler embolic phenomena, review the natural course of the process, and discuss appropriate immediate interventions. We also (1) propose an education plan for injectors and describe how to carry out a focused ophthalmologic examination and procedural activities for a referral to an ophthalmologist, (2) outline steps to prevent emboli during filler injection, and (3) how to manage and support a patient with a sudden loss of vision during or immediately after a Hyaluronic Acid Gels filler treatment.
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Affiliation(s)
- John P Arlette
- 70401 Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Michael Ashenhurst
- Department of Surgery, Division of Ophthalmology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Vivian Hill
- Department of Surgery, Division of Ophthalmology, University of Calgary, Alberta, Canada
| | - Kailun Jiang
- Department of Surgery, Division of Ophthalmology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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14
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Nayfeh T, Shah S, Malandris K, Amin M, Abd-Rabu R, Seisa MO, Saadi S, Rajjoub R, Firwana M, Prokop LJ, Murad MH. A Systematic Review Supporting the American Society for Dermatologic Surgery Guidelines on the Prevention and Treatment of Adverse Events of Injectable Fillers. Dermatol Surg 2021; 47:227-234. [PMID: 33565776 DOI: 10.1097/dss.0000000000002911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND As the use of injectable skin fillers increase in popularity, an increase in the reported adverse events is expected. OBJECTIVE This systematic review supports the development of American Society for Dermatologic Surgery practice guideline on the management of adverse events of skin fillers. METHODS AND MATERIALS Several databases for studies on risk factors or treatments of injection-related visual compromise (IRVC), skin necrosis, inflammatory events, and nodules were searched. Meta-analysis was conducted when feasible. RESULTS The review included 182 studies. However, IRVC was very rare (1-2/1,000,000 patients) but had poor prognosis with improvement in 19% of cases. Skin necrosis was more common (approximately 5/1,000) with better prognosis (up to 77% of cases showing improvement). Treatments of IRVC and skin necrosis primarily depend on hyaluronidase injections. Risk of skin necrosis, inflammatory events, and nodules may be lower with certain fillers, brands, injection techniques, and volume. Treatment of inflammatory events and nodules with antibiotics, corticosteroids, 5-FU, and hyaluronidase was associated with high response rate (75%-80%). Most of the studies were small and noncomparative, making the evidence certainty very low. CONCLUSION Practitioners must have adequate knowledge of anatomy, elicit history of skin filler use, and establish preemptive protocols that prepare the clinical practice to manage complications.
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Affiliation(s)
- Tarek Nayfeh
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Sahrish Shah
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Konstantinos Malandris
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mustapha Amin
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Rami Abd-Rabu
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mohamed O Seisa
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Samer Saadi
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Rami Rajjoub
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Firwana
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota
| | - Mohammad H Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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15
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Jones DH, Fitzgerald R, Cox SE, Butterwick K, Murad MH, Humphrey S, Carruthers J, Dayan SH, Donofrio L, Solish N, Yee GJ, Alam M. Preventing and Treating Adverse Events of Injectable Fillers: Evidence-Based Recommendations From the American Society for Dermatologic Surgery Multidisciplinary Task Force. Dermatol Surg 2021; 47:214-226. [PMID: 33543879 DOI: 10.1097/dss.0000000000002921] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Derek H Jones
- Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California
| | | | - Sue Ellen Cox
- Aesthetic Solutions, Assoc Clinical Faculty, UNC Department of Dermatology, Consulting Associate, Duke University Department Dermatology, Chapel Hill, North Carolina
| | | | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jean Carruthers
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Steven H Dayan
- Denova Research, Clinical Assistant Professor, University of Illinois, Chicago, Illinois
| | - Lisa Donofrio
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Nowell Solish
- Department of Dermatology, University of Toronto, Toronto, Canada
| | | | - Murad Alam
- Departments of Dermatology, Otolaryngology, and Surgery, Northwestern University, Chicago, Illinois
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16
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Fricton R, Poon E, Weil A, Alam M. Office practices that may improve the experience of the cosmetic dermatology patient. Arch Dermatol Res 2020; 314:307-310. [PMID: 33130963 DOI: 10.1007/s00403-020-02154-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Patients presenting for cosmetic dermatology procedures are often interested in lifestyle enhancement rather than treatment of an inflammatory or neoplastic disease or condition. In addition to good clinical outcomes, they may also particularly value the quality of the patient experience in the dermatology office. A list of beneficial practices that may improve patient experience was generated by interviewing staff members from several US practices, including clinic administrators, nurses, nurse managers, medical assistants, physician assistants, patient care coordinators, and dermatologists. Each was asked ten open-ended questions. The list of beneficial practices thereby obtained was ordered based on the number of participants who recommended each practice. Practices were further categorized into four categories: clinician improvement, administrative improvement, clinic improvement, and team improvement. For clinics providing cosmetic dermatology services, certain well-accepted beneficial practices may improve patient experience.
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Affiliation(s)
- Regina Fricton
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Emily Poon
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Alexandra Weil
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, IL, USA. .,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA. .,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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17
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Coughlin A, Gray ML, Westra WH, Teng MS, Rosenberg JD. Dermal Filler Presenting as Parotid Mass: A Case Report. Head Neck Pathol 2020; 15:638-641. [PMID: 32642936 PMCID: PMC8134640 DOI: 10.1007/s12105-020-01197-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/27/2020] [Indexed: 11/26/2022]
Abstract
Dermal filler injections are common cosmetic procedures and are growing in popularity. While frequently performed, dermal filler injections carry a risk of adverse events including vascular compromise and foreign body granulomas. Here, we discuss an unusual case of a patient with a history of dermal filler injections presenting with a parotid mass and an eyebrow mass requiring surgical resection. This case demonstrates the risk of delayed granuloma formation many years after dermal filler injection and highlights the importance of awareness and management of these potential long-term complications.
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Affiliation(s)
- Arielle Coughlin
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1189, New York, NY, 10029, USA
| | - Mingyang L Gray
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1189, New York, NY, 10029, USA.
| | - William H Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marita S Teng
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1189, New York, NY, 10029, USA
| | - Joshua D Rosenberg
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1189, New York, NY, 10029, USA
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18
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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.
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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
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19
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de Melo F, Carrijo A, Hong K, Trumbic B, Vercesi F, Waldorf HA, Zenker S. Minimally Invasive Aesthetic Treatment of the Face and Neck Using Combinations of a PCL-Based Collagen Stimulator, PLLA/PLGA Suspension Sutures, and Cross-Linked Hyaluronic Acid. Clin Cosmet Investig Dermatol 2020; 13:333-344. [PMID: 32440186 PMCID: PMC7211299 DOI: 10.2147/ccid.s248280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
Background Combinations of minimally invasive procedures (MIPs) are often used in aesthetic treatments and are increasingly considered as the new standard of care. Three agents with specific properties are available in this perspective: a polycaprolactone (PCL)-based collagen stimulator, a poly-L-lactic acid (PLLA)- and a poly-glycolic acid (PLGA)-based resorbable suspension suture with a 3D-cone technology, and a cross-linked hyaluronic acid (HA). Objective To develop the first practice guidelines on rejuvenation treatment of the face and the neck using combinations of these agents, whether associated or not with other widely used MIPs such as botulinum neurotoxins or energy-based devices. Methods A multi-disciplinary, multi-national board of plastic surgeons and dermatologists convened to develop guidelines using a predefined consensus method. The consensus was defined as ≥83% agreement rate between participants. Results Practice guidelines and algorithms, describing optimal procedure sequence and spacing, are proposed for the treatment of upper-, mid-, lower-face and neck, combining the PCL collagen stimulator, the PLLA/PLGA suspension sutures, and the cross-linked HA, whether associated or not with other MIPs. Conclusion These new guidelines provide general support to optimal management strategies. Individual treatment plans should be adapted according to the physician’s individual competence and the patient’s preferences.
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20
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Experiences With Medical Spas and Associated Complications: A Survey of Aesthetic Practitioners. Dermatol Surg 2020; 46:1543-1548. [DOI: 10.1097/dss.0000000000002344] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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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]
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22
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Nonphysician Practice of Cosmetic Dermatology: A Patient and Physician Perspective of Outcomes and Adverse Events. Dermatol Surg 2019; 45:588-597. [PMID: 30946699 DOI: 10.1097/dss.0000000000001829] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonphysicians are expanding practice into specialty medicine. There are limited studies on patient and physician perspectives as well as safety outcomes regarding the nonphysician practice of cosmetic procedures. OBJECTIVE To identify the patient (consumer) and physician perspective on preferences, adverse events, and outcomes following cosmetic dermatology procedures performed by physicians and nonphysicians. MATERIALS AND METHODS Internet-based surveys were administered to consumers of cosmetic procedures and physician members of the American Society for Dermatologic Surgery. Descriptive statistics and graphical methods were used to assess responses. Comparisons between groups were based on contingency chi-square analyses and Fisher exact tests. RESULTS Two thousand one hundred sixteen commenced the patient survey with 401 having had a cosmetic procedure performed. Fifty adverse events were reported. A higher number of burns and discoloration occurred in the nonphysician-treated group and took place more often in a spa setting. Individuals seeing nonphysicians cited motivating factors such as level of licensure (type) of nonphysician, a referral from a friend, price, and the location of the practitioner. Improper technique by the nonphysician was cited most as a reason for the adverse event. Both groups agree that more regulation should be placed on who can perform cosmetic procedures. Recall bias associated with survey data. CONCLUSION Patients treated by nonphysicians experienced more burns and discoloration compared with physicians, and they are encountering these nonphysicians outside a traditional medical office, which are important from a patient safety and regulatory standpoint. Motivating factors for patients seeking cosmetic procedures may also factor into the choice of provider. KEY POINTS Both patients and physicians think more regulation should be in place on who can perform cosmetic procedures. More adverse events such as burns and discolorations occurred with patients seeing nonphysicians compared with those seeing physicians. In addition, for those seeing nonphysicians, a majority of these encounters took place in spa settings. Patient safety is of utmost concern when it comes to elective cosmetic medical procedures. More adverse events and encounters occurring outside traditional medical settings when nonphysicians performed these procedures call into question the required training and oversight needed for such procedures.
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23
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Thoms K. Zukunft der Ästhetischen Dermatologie. J Dtsch Dermatol Ges 2019; 17:387-388. [DOI: 10.1111/ddg.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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In Vitro Analysis of the Degradation of Calcium Hydroxylapatite Dermal Filler: A Proof-of-Concept Study. Dermatol Surg 2018; 44 Suppl 1:S5-S9. [DOI: 10.1097/dss.0000000000001683] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Injection technique in neurotoxins and fillers: Indications, products, and outcomes. J Am Acad Dermatol 2018; 79:423-435. [DOI: 10.1016/j.jaad.2018.01.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Ezaldein HH, Scott JF, Yin ES, Ventura A, DeRuyter NP, Leffell DJ. Transparency and Dermatologic Device Approval by the US Food and Drug Administration. JAMA Dermatol 2018; 154:273-280. [PMID: 29365020 DOI: 10.1001/jamadermatol.2017.5757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The US Food and Drug Administration approves Class III medical devices via the premarket approval pathway, often requiring clinical data on safety and efficacy. Manufacturers can submit incremental device changes via supplemental applications, which are not subjected to such vetting measures and can cause understudied changes that lead to drift from a device's original design. Objectives To characterize the postapproval changes to Class III dermatologic devices and to evaluate inconsistencies in the use of the premarket approval pathway. Design, Setting, and Participants This study was a cross-sectional retrospective cohort analysis of a public US Food and Drug Administration database for premarket approval of devices. Included were dermatologic devices approved by the US Food and Drug Administration between January 1, 1980, and November 1, 2016, through the premarket pathway for device approval. Main Outcomes and Measures Original devices were identified, and their supplements were characterized chronologically, by review track, and by modification category. Results The 27 dermatologic devices studied consisted of 14 injectables, 11 photodynamic therapies, a dermal replacement matrix, and a diagnostic imaging instrument. Supplemental applications are increasingly used: the data-requiring panel-track pathway was the least common approach (2.8% [16 of 562 supplements]), while the 30-day track, which does not require clinical data, was most frequently used (42.5% [239 of 562 supplements]). Four devices (14.8%) underwent low-risk recalls (Class II or Class III), and 10 devices (37.0%) were voluntarily withdrawn. Conclusions and Relevance As manufacturers make increasing use of supplemental applications, minor device changes may occur without supporting clinical data, which could pose a safety risk to patients.
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Affiliation(s)
- Harib H Ezaldein
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, University of Washington, Seattle.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Emily S Yin
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Alessandra Ventura
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.,Dermatology Department, University of Rome Tor Vergata, Rome, Italy
| | | | - David J Leffell
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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27
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Lohman ME, Ghobadi CW, Xu S. Device Safety Implications of the Clinical Data Leading to US Food and Drug Administration Approval of Soft-Tissue Fillers. JAMA FACIAL PLAST SU 2017; 19:421-429. [DOI: 10.1001/jamafacial.2017.0082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary E. Lohman
- Department of Medicine, McGaw Medical Center, Northwestern University, Chicago, Illinois
| | - Comeron W. Ghobadi
- Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Shuai Xu
- Department of Dermatology, McGaw Medical Center, Northwestern University, Chicago, Illinois
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28
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Giordano CN, Matarasso SL, Ozog DM. Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies. J Am Acad Dermatol 2017; 76:1027-1042. [PMID: 28522039 DOI: 10.1016/j.jaad.2016.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022]
Abstract
The use of neuromodulators for therapeutic and cosmetic indications has proven to be remarkably safe. While aesthetic and functional adverse events are uncommon, each anatomic region has its own set of risks of which the physician and patient must be aware before treatment. The therapeutic usages of botulinum toxins now include multiple specialties and multiple indications. New aesthetic indications have also developed, and there has been an increased utilization of combination therapies to combat the effects of global aging. In the second article in this continuing medical education series, we review the prevention and treatment of adverse events, therapeutic and novel aesthetic indications, controversies, and a brief overview of combination therapies.
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Affiliation(s)
| | - Seth L Matarasso
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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29
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Paasch U, Schwandt A, Seeber N, Kautz G, Grunewald S, Haedersdal M. New lasers and light sources - old and new risks? J Dtsch Dermatol Ges 2017; 15:487-496. [DOI: 10.1111/ddg.13238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Uwe Paasch
- Department of Dermatology, Venereology and Allergology; University Hospital Leipzig and Medical Faculty; University of Leipzig; Germany
| | - Antje Schwandt
- Laser Medicine Center Rhein-Ruhr; Porschekanzel 3-5 45127 Essen Germany
| | | | - Gerd Kautz
- Dermatology Practice Peter/Seeber/Altheide; Wandsbeker Marktstr. 48-50 22041 Hamburg-Wandsbek Germany
| | - Sonja Grunewald
- Department of Dermatology, Venereology and Allergology; University Hospital Leipzig and Medical Faculty; University of Leipzig; Germany
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital; University of Copenhagen; Denmark
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30
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Paasch U, Schwandt A, Seeber N, Kautz G, Grunewald S, Haedersdal M. Neue Laser und Strahlquellen - alte und neue Risiken? J Dtsch Dermatol Ges 2017; 15:487-497. [DOI: 10.1111/ddg.13238_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig; Deutschland
| | - Antje Schwandt
- Laser Medizin Zentrum Rhein-Ruhr; Porschekanzel 3-5 45127 Essen Deutschland
| | | | - Gerd Kautz
- Hautarztpraxis Peter/Seeber/Altheide; Wandsbeker Marktstr. 48-50 22041 Hamburg-Wandsbek Deutschland
| | - Sonja Grunewald
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig; Deutschland
| | - Merete Haedersdal
- Dermatologische Abteilung, Bispebjerg Hospital; Universität Kopenhagen; Dänemark
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31
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Harrison J, Rhodes O. Hyaluronidase: Understanding Its Properties and Clinical Application for Cosmetic Injection Adverse Events. Plast Surg Nurs 2017; 37:109-111. [PMID: 28858168 DOI: 10.1097/psn.0000000000000193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The recent global consensus on the management of cosmetic aesthetic injectable complications from hyaluronic acid (HA) has increased the focus on the use of hyaluronidase more than ever before (M. Signorini et al., 2016). A comprehensive knowledge of facial anatomy, including structural positioning of facial arteries and veins, and an extensive knowledge of HA products available for injection procedures, combined with best practice protocols, will assist to prevent adverse events. Despite the growing number of patients using cosmetic fillers for facial restoration, the incidents incidence of adverse events remains low. Indeed, the avoidance of complications through safe and effective injection practice remains the key to preventing the need to use hyaluronidase.
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Affiliation(s)
- Jeanine Harrison
- Jeanine Harrison, BScN, MN, RN-EC, NP, is Nurse Practitioner, TH Medical Aesthetics, Thornhill, Ontario, Canada. Oriol Rhodes RN, BAS, MBA, is Registered Nurse, TH Medical Aesthetics, Thornhill, Ontario, Canada
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32
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Abstract
Any injectable filler may elicit moderate-to-severe adverse events, ranging from nodules to abscesses to vascular occlusion. Fortunately, severe adverse events are uncommon for the majority of fillers currently on the market. Because these are rare events, it is difficult to identify the relevant risk factors and to design the most efficacious treatment strategies. Poor aesthetic outcomes are far more common than severe adverse events. These in contrast should be easily avoidable by ensuring that colleagues receive proper training and follow best practices.
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33
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Rationalizing Outcome Measures in Dermatologic Surgery. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Kamouna B, Litov I, Bardarov E, Broshtilova V, Miteva L, Kazandjieva J. Granuloma formation after oil-soluble vitamin D injection for lip augmentation - case report. J Eur Acad Dermatol Venereol 2015; 30:1435-6. [PMID: 26302679 DOI: 10.1111/jdv.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B Kamouna
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - I Litov
- Hospital Europe, Europe Aesthetic centre, Sofia, Bulgaria
| | - E Bardarov
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - V Broshtilova
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - L Miteva
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - J Kazandjieva
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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