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de Oliveira Ciaramicolo N, Bisson GB, Piedade EDFDS, Osny FJ. Late Facial Edema After Lip Filling With Hyaluronic Acid: Possible Association With the Use of Ozempic. J Craniofac Surg 2024:00001665-990000000-01839. [PMID: 39190785 DOI: 10.1097/scs.0000000000010588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
In recent years there has been an extraordinary increase in the use of different filler materials as facial cosmetic treatments. The popularity of injectable tissue fillers among individuals who wish to restore volume and gain a more youthful appearance is because it is a minimally invasive esthetic procedure for soft tissue augmentation. However, although they are considered efficient and safe, they can trigger complications such as swelling, bruising, erythema, pain, infection, nodule formation, vascular occlusion, and pigmentary changes. The objective of this article was to present a case of a 46-year-old patient who presented with significant facial edema 3 months after lip and infraorbital filling with hyaluronic acid, resistant to medication, which appeared and worsened after starting to use Ozempic for weight loss. Therefore, we chose to perform an intralesional application of hyaluronidase 2.000utr, immediately observing the decrease in edema. After a week, the patient was completely recovered, with no signs of edema, no allergic reactions and feeling very well. The etiology of late inflammatory reactions is unclear and we believe that some medications may be capable of initiating these immune responses. Hyaluronidase is an effective treatment to reverse adverse reactions from hyaluronic acid injection, dissolving the peptide bond proteins within the hyaluronic acid, increasing the viscosity of the material and allowing it to be dispersed throughout the soft tissue.
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Affiliation(s)
- Nathaly de Oliveira Ciaramicolo
- Department of Oral Surgery, Stomatology, Oral Pathology and Oral Radiology, Bauru School Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Ferreira Junior Osny
- Department of Oral Surgery, Stomatology, Oral Pathology and Oral Radiology, Bauru School Dentistry, University of São Paulo, Bauru, Brazil
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de Melo MDGB, Azevedo LH, Ruiz LFN, Lobo MM, de Freitas PM. Photobiomodulation Therapy in the Management of Late Complications After Facial Filling. Cureus 2024; 16:e59513. [PMID: 38826871 PMCID: PMC11143946 DOI: 10.7759/cureus.59513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
The aim of the present study is to report a clinical case of a patient diagnosed with a late adverse reaction to the injection of filler material - persistent and intermittent delayed swelling (PIDS) - in which photobiomodulation therapy (PBMT) with low-power laser was used for edema reduction. This is an observational, descriptive, and retrospective work of a case report. The female patient, aged 73 years old, had undergone dermal filler six years before and complained of increased volume in the face region (glabellar region, labiomental sulcus, and nasolabial folds) and was submitted to ultrasound and anatomopathological analysis. PBMT using a low-power laser (660 nm and 808 nm, simultaneous irradiation, in contact, 2 J/point, 100 mW) proved to be effective for the non-invasive approach of late adverse reaction to dermal filler, such as PIDS, a common complication related to the use of dermal fillers.
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Affiliation(s)
| | | | | | | | - Patrícia M de Freitas
- Special Laboratory of Lasers in Dentistry, Department of Operative Dentistry, School of Dentistry, Universidade de São Paulo, São Paulo, BRA
- Faculty of Dentistry, Universidade de São Paulo, São Paulo, BRA
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3
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Landau M, Silikovich F, Fida M, Cartier H, Kroumpouzos G. Oral Methotrexate Treatment of Delayed-Onset Inflammatory Reactions to Dermal Fillers. Aesthet Surg J Open Forum 2024; 6:ojae011. [PMID: 38690015 PMCID: PMC11060488 DOI: 10.1093/asjof/ojae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background In aesthetic practice, delayed-onset (late) inflammatory reactions (DIRs) to dermal fillers are encountered. The treatment of DIRs can be challenging, with a response to established therapies, including oral antibiotics, intralesional and oral steroids, and hyaluronidase injection, occasionally reported as unsatisfactory. Objectives Evaluate the efficacy of low-dose oral methotrexate (MTX) therapy in treating recalcitrant DIRs. Methods We retrospectively reviewed cases of recalcitrant DIRs treated with oral MTX. Data collected included individuals' gender and age, medical history, filler type, facial area(s) injected, previous treatments attempted to dissolve the DIR, MTX treatment dosage and duration, and outcome. Adverse events were monitored throughout the treatment. Results Thirteen females with a mean age of 52.6 years (range, 31-67 years) who developed recalcitrant DIRs to dermal filler injection are included. Eight reactions were triggered by the injection of hyaluronic acid (HA) fillers, 4 by liquid injectable silicone (LIS), and 1 by polymethylmethacrylate (PMMA). The average starting dosage of MTX was 12.1 mg/week (range, 7.5-12.5 mg/week). Patients were treated for 2 to 3 months in most cases. The average follow-up post-MTX therapy was 11.8 months (range, 2-36 months). A complete response to MTX treatment was observed in 10 patients (6 HA and 4 LIS cases), partial response in 1 (HA case), and an unsatisfactory response in 2 (HA and PMMA cases). Treatment was well tolerated. Conclusions A short course of low-dose oral MTX is a possible treatment for DIRs that have not responded to established therapies. The promising results of this report require validation by powered studies. Level of Evidence 4
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Affiliation(s)
| | | | | | | | - George Kroumpouzos
- Corresponding Author: Dr George Kroumpouzos, 541 Main St, Suite 320, South Weymouth, MA 02190, USA. E-mail:
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Wang D, Huang X, Zhou Y, Gong M, Lu Y, Ni M. Cosmetic augmentation of lower-lid pretarsal roll with injection of autologous fat for Asians. J Plast Reconstr Aesthet Surg 2023; 87:46-53. [PMID: 37804647 DOI: 10.1016/j.bjps.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Autologous fat has the advantages of regeneration, rejuvenation, homology, and support. There are currently no reports indicating that injecting autologous fat enhances the fullness of the lower-lid pretarsal roll. OBJECTIVES In this retrospective, non-randomized study, the effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll were evaluated by comparison of preoperative and postoperative photographs and patient satisfaction during the follow-up. METHODS First, fat tissues were manually sucked with a 20-ml syringe connected to a 2.5-mm three-hole liposuction cannula. The treated fat tissues were transferred to a 10-ml syringe and centrifuged at 2000 rpm for 2 min, and then the fibrous tissues were manually removed. Finally, autologous fat was injected using a 1-ml syringe linked to a sharp needle. RESULTS Forty-seven patients who underwent surgery between 2018 and 2021 were retrospectively evaluated. Only three patients showed obvious asymmetry or uneven outlines after surgery and underwent a second fat injection. During recovery, bruising and minor contouring irregularities obviously improved after 1 or 2 weeks. Eight patients, who had severe bruising, were able to make a full recovery in more than 2 weeks. No patients experienced serious complications. All patients ultimately displayed pretarsal fullness in their lower eyelids and were satisfied with their outcomes. CONCLUSION The effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll are long-lasting, esthetic, and safe.
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Affiliation(s)
- Dong Wang
- Beijing Yimei Medical Cosmetology Plastic Clinic, No. 55, DongSanHuan North Road, Chaoyang District, Beijing 100020, China.
| | - Xing Huang
- Wuhan One and Only Medical Beauty Hospital, No. 158, Minzu Avenue Time Square, Wuhan 430070, China.
| | - Yinan Zhou
- Guangzhou Mei Lai Beauty Hospital, 222 Linhe West Heng Road, Linhe Street, Tianhe District, Guangzhou City, Guangdong Province 510630, China.
| | - Min Gong
- Beijing Yimei Medical Cosmetology Plastic Clinic, No. 55, DongSanHuan North Road, Chaoyang District, Beijing 100020, China.
| | - Yi Lu
- Beijing Yimei Medical Cosmetology Plastic Clinic, No. 55, DongSanHuan North Road, Chaoyang District, Beijing 100020, China.
| | - Ming Ni
- Beijing Yimei Medical Cosmetology Plastic Clinic, No. 55, DongSanHuan North Road, Chaoyang District, Beijing 100020, China.
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Milhomem AC, Gomes RS, Tomé FD, Dos Santos Arruda F, Franco PIR, da Costa EL, Pereira JX, Vinaud MC, de Souza Lino Júnior R. Polymethylmethacrylate Microspheres are Immunologically Inert in Mouse Tissues. Aesthetic Plast Surg 2023; 47:2813-2822. [PMID: 36607354 DOI: 10.1007/s00266-022-03243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
Nowadays, aesthetic concerns have gained attention, especially by patients looking for a less invasive alternative to minor facial corrections. Polymethylmethacrylate (PMMA) is widely used as a soft tissue filler; the demand for this polymer has increased, and along with it, there are some reports of adverse reactions. Such adverse reactions stem from consequences of immune and inflammatory reactions to PMMA. Some animal models have been used to unravel the causes of these reactions, among other factors involving the management of PMMA. The aim of this study was to determine the immunogenic profile of PMMA implantation in different anatomical planes of mice, over up to 360 experimental days. In this study, BALB/c mice were divided into 30 groups for immune evaluation of the interaction between the organism and the polymer; 2% PMMA was implanted subcutaneously, 10% intramuscularly and 30% in periosteal juxtaposition and followed during five experimental days (7, 30, 90, 180 and 360 days after implantation-DAI). Pro- and anti-inflammatory cytokines (IL-2, IL-4, IL-6, IFN-gamma, TNF, IL-17A, IL-10 and TGF-beta) were quantified in all experimental days. There was no statistical difference between the groups analyzed considering the evaluated parameters. Therefore, at all implanted depths, PMMA behaved inertly in a murine model.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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)
- Anália Cirqueira Milhomem
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil
| | - Rodrigo Saar Gomes
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil
| | - Fernanda Dias Tomé
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil
| | - Felipe Dos Santos Arruda
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil
| | - Pablo Igor Ribeiro Franco
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil
| | - Eduardo Luiz da Costa
- Bioplastia Brasil, Rua T-55, nº 938, sala 1009; Edifício EBM Walk Bueno - Setor Bueno, Goiânia, Goiás, Brazil
| | - Jonathas Xavier Pereira
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil
| | - Marina Clare Vinaud
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil
| | - Ruy de Souza Lino Júnior
- Department of Biosciences and Technology , Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Rua 235, s/n.º - Setor Leste Universitário, Goiânia, Goiás, Brazil.
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Berrino V, Berrino P. Lower Eyelid Complication After Blepharoplasty and COVID-19 Vaccination. Aesthetic Plast Surg 2023; 47:2573-2578. [PMID: 37580564 DOI: 10.1007/s00266-023-03532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Following COVID-19 mass vaccination campaign, new- and unknown-related reactions have emerged. CASE REPORT Four months after transcutaneous lower blepharoplasty and few days after the second dose of SARS-CoV-2 Pfizer mRNA vaccination, a 57-year-old man developed a bilateral palpebral ecchymosis. While the lesion healed spontaneously on the left side, the ecchymosis on the right lower lid did not regress. It presented swelling and hard consistency, clinically involving only skin layer. No alterations were revealed upon blood tests and instrumental evaluations. Histological examination showed lymphovascular hyperplasia on a probable reactive basis. The lesion was resistant to medical and surgical therapies. After 15 months, it regressed spontaneously. CONCLUSIONS In the reported case, an evident chronological relationship exists between surgical site and vaccine reaction, while other etiopathogenetic factors were excluded. This case represents a previously undescribed condition linking postvaccination reaction and long-term surgical outcome. 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 .
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Affiliation(s)
- Valeria Berrino
- Chirurgia Plastica Genova Srl, Via A.M. Maragliano 2, 16121, Genoa, Italy.
| | - Pietro Berrino
- Chirurgia Plastica Genova Srl, Via A.M. Maragliano 2, 16121, Genoa, Italy
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Oh S, Seo SB, Kim G, Batsukh S, Son KH, Byun K. Poly-D,L-Lactic Acid Stimulates Angiogenesis and Collagen Synthesis in Aged Animal Skin. Int J Mol Sci 2023; 24:ijms24097986. [PMID: 37175693 PMCID: PMC10178436 DOI: 10.3390/ijms24097986] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Angiogenesis promotes rejuvenation in multiple organs, including the skin. Heat shock protein 90 (HSP90), hypoxia-inducible factor-1 alpha (HIF-1α), and vascular endothelial growth factor (VEGF) are proangiogenic factors that stimulate the activities of phosphoinositide 3-kinase (PI3K), protein kinase B (AKT), and extracellular signal-regulated kinase 1/2 (ERK1/2). Poly-D,L-lactic acid (PDLLA), polynucleotide (PN), and calcium hydroxyapatite (CaHA) are dermal fillers that stimulate the synthesis of dermal collagen. However, it is not yet known whether these compounds promote angiogenesis, which leads to skin rejuvenation. Here, we evaluated whether PDLLA, PN, and CaHA stimulate angiogenesis and skin rejuvenation using H2O2-treated senescent macrophages and endothelial cells as an in vitro model for skin aging, and we used young and aged C57BL/6 mice as an in vivo model. Angiogenesis was evaluated via endothelial cell migration length, proliferation, and tube formation after conditioned media (CM) from senescent macrophages was treated with PDLLA, PN, or CaHA. Western blot showed decreased expression levels of HSP90, HIF-1α, and VEGF in senescent macrophages, but higher expression levels of these factors were found after treatment with PDLLA, PN, or CaHA. In addition, after exposure to CM from senescent macrophages treated with PDLLA, PN, or CaHA, senescent endothelial cells expressed higher levels of VEGF receptor 2 (VEGFR2), PI3K, phosphorylated AKT (pAKT), and phosphorylated ERK1/2 (pERK1/2) and demonstrated greater capacities for cell migration, cell proliferation, and tube formation. Based on the levels of 4-hydroxy-2-nonenal, the oxidative stress level was lower in the skin of aged mice injected with PDLLA, PN, or CaHA, while the tumor growth factor (TGF)-β1, TGF-β2, and TGF-β3 expression levels; the density of collagen fibers; and the skin elasticity were higher in the skin of aged mice injected with PDLLA, PN, or CaHA. These effects were greater in PDLLA than in PN or CaHA. In conclusion, our results are consistent with the hypothesis that PDLLA stimulates angiogenesis, leading to the rejuvenation of aged skin. Our study is the first to show that PDLLA, PN, or CaHA can result in angiogenesis in the aged skin, possibly by increasing the levels of HSP90, HIF-1α, and VEGF and increasing collagen synthesis.
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Affiliation(s)
- Seyeon Oh
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Republic of Korea
| | - Suk Bae Seo
- SeoAh Song Dermatologic Clinic, Seoul 05557, Republic of Korea
| | - Gunpoong Kim
- VAIM Co., Ltd., Okcheon 29055, Republic of Korea
| | - Sosorburam Batsukh
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Republic of Korea
- Department of Anatomy & Cell Biology, College of Medicine, Gachon University, Incheon 21936, Republic of Korea
| | - Kuk Hui Son
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University, Incheon 21565, Republic of Korea
| | - Kyunghee Byun
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Republic of Korea
- Department of Anatomy & Cell Biology, College of Medicine, Gachon University, Incheon 21936, Republic of Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health & Sciences and Technology (GAIHST), Gachon University, Incheon 21999, Republic of Korea
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Munhoz G, Cavallieri FA, de Almeida Balassiano LK, Tembra MF, Cunha JMT, Silveira ACO, Moreira MVR, Ramos-E-Silva M. Sterile abscess due to hyaluronic acid: A new diagnosis and a proposal for treatment-A series of eight cases. J Cosmet Dermatol 2022; 21:5562-5568. [PMID: 35638403 DOI: 10.1111/jocd.15135] [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: 01/28/2022] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND In recent years, fillers procedures with hyaluronic acid (HA) have grown significantly. Despite HA relative safety, the number of cases of complications after injections has grown, and in many of which, we are not aware of or have little control over. AIMS In this article, the authors describe a new adverse reaction after filling with HA injection, the sterile abscess. PATIENTS/METHODS We present eight patients with similar clinical, laboratory, and ultrasound characteristics for sterile abscess and report a new therapeutic modality for it. RESULTS All cases were treated with "Munhoz-Cavallieri Lavage Protocol" procedure with complete resolution. CONCLUSIONS "Munhoz-Cavallieri Lavage Protocol" serves as a guideline in diagnosis and management of sterile abscess.
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Affiliation(s)
- Gabriela Munhoz
- Clínica Gabriela Munhoz, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Aquino Cavallieri
- Cavallieri Clinic, Member of Brazilian College of Radiology and Diagnostic Imaging and of the National Commission of Ultrasound - Brazilian College of Radiology and Diagnostic Imaging Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria Fernanda Tembra
- Clínica Maria Fernanda Tembra, University Hospital and School of Medicine, Federal University of Rio de Janeiro, São Paulo, Brazil
| | - José Marcos T Cunha
- University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcos Vinicius Rust Moreira
- German Society of Infectology, Internal Medicine, Department of Antibiotic Stewardship Vivantes Hospitals, Berlin, Germany
| | - Marcia Ramos-E-Silva
- Centro Dermatológico Marcia Ramos-e-Silva, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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de Almeida Balassiano LK, Cavallieri FA, Munhoz G, Tembra MF, Ramos-E-Silva M. NOT SO "HAPPY BUMP": A complication due to hyaluronic acid. J Cosmet Dermatol 2022; 21:6308-6313. [PMID: 35869832 DOI: 10.1111/jocd.15266] [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: 05/03/2022] [Accepted: 07/12/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The use of hyaluronic acid (HA) as a dermal filler is considered safe. However, as new brands come to the market, reports of adverse events are becoming more and more common. OBJECTIVE To describe a particular type of adverse effect that, unlike the erythematous, indurated, and painful nodules described in the literature as "angry red bumps," is characterized by noninflammatory, stony-like nodules that appear in sites previously treated with HA. METHODS The report of four patients who presented this complication, and the occurrence of two HA syringes from the same batch that had hardened the product inside at the time of filling. CONCLUSION The authors propose the nomenclature "happy bump" to group adverse reactions to HA that translate into noninflammatory nodules, with a stony consistency, appearing up to 4 weeks (recent) or after one month (late) in sites previously treated with AH.
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Affiliation(s)
- Laila Klotz de Almeida Balassiano
- Sector of Dermatology and Post Graduation Program in Medical Clinics (Area: Dermatology) - University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda A Cavallieri
- Cavallieri Clinic, Member of the Brazilian College of Radiology and Diagnostic Imaging and the National Commission of Ultrasound - Brazilian College of Radiology and Diagnostic Imaging, Rio de Janeiro, Brazil
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10
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Imen MT. Delayed infectious reactions of dermal filler injections in the face: Causes and management. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 124:101334. [PMID: 36400392 DOI: 10.1016/j.jormas.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Nowadays, dermal filler injections in the face, are widespread. However, late complications are rarely reported and misunderstood. Moreover, they could be potentially severe, particularly cellulitis which is life-threatening. Reactivation of the biofilm and the hypersensitivity reaction are the main etiopathogenic factors of such unpredictable infections and granuloma reactions. Through four cases of foreign-body cellulitis, this article aims to explain the causality of filler material, and trigger conditions while emphasizes the prompt and adequate solution. MATERIAL AND METHODS This work is a retrospective study and chart review which was granted an exemption by the author's institutional review board (IRB). Four women ranging from 27 to 55 years old, presented with onset symptoms of cellulitis of the face and inflammatory swelling of the lip. The hyaluronic acid filler was injected a long date prior. Trigger conditions caused the hatching of such complications which were solved with medical treatment without any filler dissolution or removal. RESULTS Improvement of the symptoms was remarkable within the three and fifth days of antibiotic therapy. There was no abscess formation or, recurrence for more than one-year follow-up. CONCLUSION The screening for dermal filler deposits must be considered for any inflammatory reaction of the face. Their causality should be discussed as well as the infectious and/or immunologic etiology, ensuring prompt and adequate medical treatment. Thus abscess formation could then not happen, and the resolution of the inflammatory reaction will be obtained. The extraction of filler material or the use of hyaluronidase should not be mandatory and will be done on a case-by-case basis.
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11
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Johnson L. A lower lip swelling of recent onset. J Am Dent Assoc 2022; 154:432-435. [PMID: 35863974 DOI: 10.1016/j.adaj.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/20/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
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12
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Wang Y, Borthwell RM, Hori K, Clarkson S, Blumstein G, Park H, Hart CM, Hamad CD, Francis KP, Bernthal NM, Phillips KS. In vitro and in vivo methods to study bacterial colonization of hydrogel dermal fillers. J Biomed Mater Res B Appl Biomater 2022; 110:1932-1941. [PMID: 35352867 PMCID: PMC10371418 DOI: 10.1002/jbm.b.35050] [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: 11/03/2021] [Revised: 12/27/2021] [Accepted: 02/09/2022] [Indexed: 11/11/2022]
Abstract
Preclinical in vitro and in vivo methods to study bacterial interactions with dermal fillers and infection pathogenesis are lacking. In this work, first in vitro methods to assess protein biofouling and effective pore size of commercial dermal fillers, including degradable hyaluronic acid (HA)-based fillers and other semi-degradable or permanent fillers (non-HA), were developed. The results were then related to Staphylococcus aureus (S. aureus) adhesion rates in vitro. HA fillers had less protein sorption than non-HA fillers and overall had smaller effective pore sizes. The properties correlated with levels of bacterial adhesion, where the control glass surface had the most rapid increase in bacterial cell adhesion, with a slope of 0.29 cm-2 min-1 , three unique non-HA fillers had intermediate adhesion with slopes of 0.11 and 0.06 cm-2 min-1 , and three unique HA fillers had the least adhesion with slopes of 0.02, 0.02, and 0.01 cm-2 min-1 . S. aureus had greater motility on the HA fillers than on non-HA fillers. Next, a mouse model for dermal filler biofilm and infection was developed. Mice were inoculated with a controlled amount of bioluminescent bacteria (Xen36 S. aureus) and polyacrylamide hydrogels of different stiffness were injected. In vivo bioluminescence was monitored longitudinally for 35 days to ensure that lasting colonization was established. The inoculum was optimized to achieve adequate bioluminescent signal, and bacterial bioburden over time and inter-animal variability in bioburden were determined. These in vitro and in vivo approaches can be used for future studies of antimicrobial interventions for dermal fillers.
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Affiliation(s)
- Yi Wang
- Division of Biology, Chemistry and Materials Science, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Office of Medical Products and Tobacco, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rachel M Borthwell
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Kellyn Hori
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Samuel Clarkson
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Gideon Blumstein
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Howard Park
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Christopher M Hart
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Christopher D Hamad
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Kevin P Francis
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - K Scott Phillips
- Division of Biology, Chemistry and Materials Science, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Office of Medical Products and Tobacco, United States Food and Drug Administration, Silver Spring, Maryland, USA
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Bachour Y, Bekkenk MW, Rustemeyer T, Kadouch JA. Late inflammatory reactions (LIRs) in patients with soft tissue fillers after SARS-CoV-2 infection and vaccination: A systematic review of the literature. J Cosmet Dermatol 2022; 21:1361-1368. [PMID: 35150192 PMCID: PMC9115339 DOI: 10.1111/jocd.14840] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/31/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Soft tissue fillers are used for cosmetic and reconstructive purposes, and soft tissue filler procedures are among the most common nonsurgical procedures in the USA. Although soft tissue filler procedures are relatively quick and safe, adverse events such as late inflammatory reactions have been reported with every filler product. Infections and vaccinations have been proposed as potential triggers for late inflammatory reactions (LIRs), and it is therefore not surprising that these adverse events have been reported after SARS-CoV-2 infection and vaccination. Therefore, this review aims to give a detailed overview of these cases. MATERIALS AND METHODS A literature search was undertaken on LIRs in patients with a history of soft tissue filler use after SARS-CoV-2 infection or vaccination. This systematic review was reported according to the PRISMA guidelines. We searched the electronic database PubMed from January 2020-August 2021. Data on patient characteristics, filler characteristics, clinical findings and treatment options were included. RESULTS This review included 7 articles with a total of 19 patients with LIRs after SARS-CoV-2 infection or vaccination. Three patients with postinfection LIRs and 16 patients with postvaccination LIRs were reported. These LIRS mainly occurred in females who had HA injections for cosmetic purposes. Three patients with postinfection LIRs had symptoms of facial swelling and/or lip angioedema in a matter of weeks. Sixteen patients reported reactions after SARS-CoV-2 vaccination (13 following Moderna vaccination and 3 after Pfizer vaccination, after both the first and second doses) from 13 hours up to three weeks. These patients presented with similar clinical symptoms as patients with postinfection LIRs. All patients were treated in a conservative manner. DISCUSSION This review shows a relationship between LIRs and SARS-CoV-2 infection and vaccination. In the case of vaccination, these adverse events have been reported only after Moderna and Pfizer vaccinations. The reported adverse events are generally minor and self-limiting, and we encourage patients with soft tissue fillers to participate in vaccination programs.
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Affiliation(s)
- Y Bachour
- Public Health Service (GGD) Amsterdam, The Netherlands
| | - M W Bekkenk
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J A Kadouch
- Department of Dermatology, ReSculpt Clinic, Amsterdam, The Netherlands
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Invited Discussion on: The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature. Aesthetic Plast Surg 2021; 45:1760-1761. [PMID: 34142194 DOI: 10.1007/s00266-021-02373-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
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