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Piccolo D, Mutlag MH, Pieri L, Pennati BM, Conforti C, Bonan P. Novel Management of Granuloma Formation Secondary to Dermal Filler with Intralesional 1444 nm Nd:YAG Laser Technique. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1406. [PMID: 37629696 PMCID: PMC10456612 DOI: 10.3390/medicina59081406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Background: Dermal fillers for soft tissue for the treatment of face sagging, volume loss, and wrinkles have become popular among patients of all ages and ethnicities, and their use is becoming increasingly widespread. Aim: the goal of this study was to evaluate the effectiveness and safety of a micro-pulsed, 1444 nm Nd:YAG laser on dermal filler complications, in particular on granuloma management. Methods: A subcutaneous, 1444 nm Nd:YAG laser was used on five female patients (range age 52-68 years) with hyaluronic filler granulomas located on the face (two on the cheek area and three on the lips); three patients had self-injected the filler, buying it online. Before and after the therapy, the patients received a skin ultrasound to determine the form and location of the granulomas and to determine if there had been a full or partial resolution. During this study, all possible adverse effects at the treatment site were monitored. The 5-point Global Aesthetic Improvement Scale (GAIS) (0 point-no change; 1 point-25%, mild improvement; 2 points-50%, moderate improvement; 3 points-75%, good improvement; 4 points-100%, excellent improvement) was recorded at a 3-month follow-up. Results: good results were obtained in the treatment of filler granulomas with the intralesional 1444 nm laser, even if just a single treatment was performed (one intervention was effective for curing granulomas up to 5 mm in diameter). Three patients were satisfied with excellent improvement, and two patients experienced good improvement. The results are functional and aesthetically satisfying, as shown by photographic assessment. At the last follow-up, the granuloma had reduced or completely disappeared in all cases, and no infections, burns, scarring or fibrosis, episodes of severe bleeding, or other serious adverse effects had been reported. All subjects tolerated the post-treatment period well. Conclusions: Our findings showed that granuloma treatment with an intralesional 1444 nm Nd:YAG laser is a minimally invasive, easy, fast, efficient, and low-risk procedure.
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Affiliation(s)
- Domenico Piccolo
- Skin Center-Dermo Aesthetic Laser Centers, 67051 Avezzano, Italy;
| | | | - Laura Pieri
- Clinical Research and Practice Department, El.En. Group, 50041 Calenzano, Italy;
| | | | - Claudio Conforti
- Dermatology Clinic, University of Trieste, Piazza dell’Ospitale 1, 34125 Trieste, Italy;
| | - Paolo Bonan
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, 50019 Florence, Italy;
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Ginter A, Lee T, Woodward J. How Much Does Filler Apparatus Influence Ease of Injection (and Hence, Potential Safety)? Ophthalmic Plast Reconstr Surg 2023; 39:76-80. [PMID: 35829648 DOI: 10.1097/iop.0000000000002247] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To document the relative contributions of intrinsic filler fluid dynamics versus delivery systems for ease of injection-specifically, to measure extrusion force variability across different syringes and needles (with the characterization of intrinsic rheological fluid properties vs. delivery apparatus contributions to ease of injection). METHODS Six different fillers were tested: Belotero balance (Bel), Juvederm Voluma XC (Vol), Revanesse Versa (Rev), Restylane Lyft (Res), Radiesse (Rad), and Teosyal RHA3 (RHA). Extrusion force was measured in Newtons (N) for each by testing using the provided injection apparatus (needle + syringe), and also by standardizing all fillers to the same syringe and then varying needle sizes (30-ga, 27-ga, 25-ga/1.5-inch, 25-ga/2-inch, and 22-ga). Five trials were conducted for each scenario, with comparison via t -test (2-tailed, unpaired, assuming unequal variance). RESULTS The following results were noted: (1) in order of least to highest extrusion force in box-provided syringe + needle at 0.2 ml volume, the following were noted: Vol < RHA = Bel (27-ga) < Bel (30-ga) < Rev < Res = Rad; (2) for each filler (except for Vol which was similar), the box-provided syringe involved greater extrusion force than the standardized syringe used in this study (each 1-cc, p < 0.05); (3) for 27-ga and 30-ga needles, after standardization of delivery syringe at 0.2 ml volume, a significant difference was noted (proportional to increasing resistance): Bel = Vol = RHA3 < Res < Rev < Rad (for needles of 30-ga [ p < 0.05] and 27-ga [ p < 0.01]); (4) for testing cannulas after standardization of syringes no reproducible order was noted with increasing resistance when using 25-ga/1.5-inch long, 25-ga/2-inch, and 22g/2-inch cannulae; and (5) confirming expectation (validating study technique), the extrusion force was significantly higher for smaller needles and longer needles. CONCLUSIONS The delivery apparatus appeared to be the most influential contributor to filler injection extrusion force, with significant changes in ease of injection correlated to the filler's intrinsic rheological properties, such as viscosity (when standardized to the same syringe for needles tested). Knowledge of such data could influence the injector's ability to maximize patients' safety and clinical results.
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Affiliation(s)
- Anna Ginter
- Duke University, Duke Eye Center, Durham, North Carolina
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Patient Comfort, Safety, and Effectiveness of Resilient Hyaluronic Acid Fillers Formulated With Different Local Anesthetics. Dermatol Surg 2022; 48:1065-1070. [PMID: 36129233 PMCID: PMC9521576 DOI: 10.1097/dss.0000000000003541] [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: 12/01/2022]
Abstract
Supplemental Digital Content is Available in the Text. Maximizing patient comfort during hyaluronic acid gel injection is a common concern that is usually addressed by selecting fillers with lidocaine.
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Comparative Preclinical Study of Lidocaine and Mepivacaine in Resilient Hyaluronic Acid Fillers. Pharmaceutics 2022; 14:pharmaceutics14081553. [PMID: 35893810 PMCID: PMC9329866 DOI: 10.3390/pharmaceutics14081553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Hyaluronic acid-based filler injections are now well-established aesthetic procedures for the correction of skin tissue defects and volume loss. Filler injections are becoming increasingly popular, with a growing number of injections performed each year. Although classified as a minimally invasive procedure, the introduction of a needle or a canula may remain painful for the patient. A major improvement was achieved with the incorporation of local anesthetics into the formulation for pain relief. Methods: In this study, two well-known anesthetics, lidocaine and mepivacaine, were systematically compared to assess their influence on filler mechanical and biological features. The impact of each anesthetic was monitored in terms of gel rheological properties, stability, durability, and degradation. The release profiles of each anesthetic were also recorded. Finally, the pharmacokinetics of each anesthetic in rats were assessed. Results: For all the rheological and biological experiments performed, lidocaine and mepivacaine influences were comparable. The addition of either anesthetic into a soft-tissue filler showed no significant modifications of the stability, durability, and degradability of the gel, with similar release profiles and pharmacokinetics at an equivalent concentration. Conclusions: Substituting lidocaine with mepivacaine does not impact the properties of the gels, and thus both can be equally incorporated as anesthetics in soft-tissue fillers.
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Abdelmohsen MA. Injectable fillers: imaging features and related complications. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Injectable fillers are currently widely used in the clinical practice; there are many indications for injectable fillers including facial and gluteal rejuvenation, management of post-traumatic facial disfiguring, and pathological volumetric loss secondary to certain disease medications like human immune deficiency virus (HIV) medications.
Radiologists should be familiar with the specific imaging features of the injectable fillers, characteristic anatomical locations, and possible complications to avoid diagnostic pitfalls especially when incidentally discovered while imaging of other pathological process like neoplastic work up or granulomatous lesions follow-up.
Results
The study included 48 patients (45 females and 3 males): 44 patients with facial injectable fillers and four patients with pelvic injectable fillers.
Of the 48 patients, 37 patients showed unremarkable fillers features with normal morphological features and anatomical distribution, and eleven patients showed complications: six patients showed one complication, and five patients showed more than one complications.
Dedicated fillers imaging study was done in 22 patients, while in the other 26 patients, imaging was done for other reasons, and fillers were notified and documented.
Magnetic resonance imaging (MRI) was done for 46 patients; two patients were subjected to combine ultra-sonographic and CT examinations with no clinical indication for MRI study assessment.
Conclusion
Magnetic resonance imaging (MRI) is an effective tool for evaluation of facial and gluteal region fillers with delineation of their imaging features and related potential complications.
Differentiation between fillers and neoplastic or granulomatous lesions could be accurately done with MRI.
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Liu C, Sun J. A porcine acellular dermal matrix induces human fibroblasts to secrete hyaluronic acid by activating JAK2/STAT3 signalling. RSC Adv 2020; 10:18959-18969. [PMID: 35518338 PMCID: PMC9053941 DOI: 10.1039/c9ra03736e] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 04/26/2020] [Indexed: 11/21/2022] Open
Abstract
Human facial skin undergoes continuous ageing over a lifespan. At present, facial skin rejuvenation is mainly achieved by injecting filling materials. However, conventional materials lack long-term beneficial effects and can only rejuvenate the skin temporarily by physical filling. To overcome this shortcoming, this study developed a porcine acellular dermal matrix with a porous three-dimensional scaffold structure and containing natural growth factors (3D-GF-PADM). The average size of the 3D-GF-PADM particles was 33.415 μm, and the dynamic viscosity and elastic modulus were within ranges suitable for clinical applications. Our study revealed that the 3D-GF-PADM exhibited an extremely low α-gal epitope number (3.15 ± 0.84 × 1011/mg) and DNA content, and no immunotoxicity, but contained abundant TGF-β1, VEGF and other growth factors. More importantly, this 3D-GF-PADM actively induced the synthesis of hyaluronic acid by fibroblasts of the host skin. Study at the molecular level further demonstrated that the 3D-GF-PADM activated the JAK2/STAT3 pathway, resulting in the upregulation of HAS2 expression, which led to an increase in hyaluronic acid synthesis. Our study developed a novel 3D-GF-PADM that can actively induce hyaluronic acid synthesis, which may be used clinically as a skin filling material to achieve long-term skin rejuvenation. By activating the JAK2/STAT3 pathway, 3D-GF-PADM induces the production of hyaluronic acid in human fibroblasts.![]()
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Affiliation(s)
- Chao Liu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Biomaterials Research and Testing Center Shanghai 200023 China +86-21-63034903
| | - Jiao Sun
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Biomaterials Research and Testing Center Shanghai 200023 China +86-21-63034903
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Kim JH, Kwon TR, Lee SE, Jang YN, Han HS, Mun SK, Kim BJ. Comparative Evaluation of the Effectiveness of Novel Hyaluronic Acid-Polynucleotide Complex Dermal Filler. Sci Rep 2020; 10:5127. [PMID: 32198443 PMCID: PMC7083941 DOI: 10.1038/s41598-020-61952-w] [Citation(s) in RCA: 6] [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: 11/06/2019] [Accepted: 02/18/2020] [Indexed: 11/08/2022] Open
Abstract
HA (Hyaluronic acid) filler, the most commonly used dermal filler, causes several side effects. HA-PN (Hyaluronic acid-Polynucleotide), a new composite filler, has excellent biocompatibility and induces tissue regeneration. In this study, we compare the efficacies and safety profiles of these fillers. The characteristics of HA and HA-PN fillers were compared using scanning electron microscopy and rheometry. No morphological difference was noted between the fillers. However, the latter had higher viscosity and elasticity values. The HA-PN filler induced higher cell migration than the HA filler in a wound healing assay. It was also found to stimulate better collagen synthesis in human and mouse fibroblasts. The HA and HA-PN fillers were injected into SKH1 hairless mice to determine changes in their volume for up to 24 weeks. Increased cell migration and collagen synthesis were observed in mice injected with the HA-PN complex filler. Although the safety and durability of the HA and HA-PN fillers were similar, the latter induced a lower transient receptor potential vanilloid 4 expression and caused less stimulation upon injection. In conclusion, HA-PN complex fillers can stimulate fibroblast growth and facilitate volume growth and skin regeneration.
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Affiliation(s)
- Jong Hwan Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae-Rin Kwon
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Eun Lee
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
| | - Yoo Na Jang
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
| | - Hye Sung Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
| | - Seog Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea.
- Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea.
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Zader J, Kunz M, Simon JC, Treudler R. [Complicated syphilis therapy by permanent fillers]. DER HAUTARZT 2019; 70:127-130. [PMID: 30402684 DOI: 10.1007/s00105-018-4296-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The number of patients suffering from a sexually transmitted disease (STD) in Germany is rising steadily. Mostly MSM (men who have sex with men) are affected. We report the case of an HIV-positive patient with syphilis, in whom the implantation of permanent fillers into the buttocks and thighs, for cosmetic purposes, prevented standard therapy of syphilis by intramuscular penicillin administration. According to current guidelines intravenous ceftriaxone (2 g once daily) was administered instead.
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Affiliation(s)
- Jeannine Zader
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
| | - Manfred Kunz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
| | - Jan C Simon
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
| | - Regina Treudler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland
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Goldman A, Wollina U. Intralesional Neodymium YAG laser to Treat Complications of Polymethylmethacrylate. Open Access Maced J Med Sci 2018; 6:1636-1641. [PMID: 30337979 PMCID: PMC6182523 DOI: 10.3889/oamjms.2018.348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/23/2018] [Accepted: 09/08/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dermal fillers are widely used for facial and body contouring. Polymethylmethacrylate (PMMA) is a permanent biphasic filler for soft tissue augmentation. In case of unwanted side effects, drug therapy and surgical excision have been commonly used with mixed results. AIM We report on a series of patients with adverse events to PMMA and an innovative minor invasive procedure to reduce disfigurement by nodules and lumps. METHODS We employed a subdermal, intralesional 1,064 nm neodymium-doped yttrium aluminium garnet (Nd: YAG) laser in combination with suction using a blunt liposuction cannula of 2.0-2.5 mm of diameter. RESULTS For 12 years, a total of 81 consecutive subjects (79 females and 2 males) were treated. The average age of the patients was 43.7 years (range 26 to 76 years). Granulomas and lumps could be removed in a minor invasive procedure with tumescent anaesthesia. In a minority of cases, the procedure had to be repeated. The results were impressive and not adverse events related to intralesional laser therapy were observed, 86.4% of patients were satisfied. CONCLUSION The procedure should be used before or in combination with classical surgery to remove PMMA in case of adverse tissue reactions to PMMA.
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Affiliation(s)
- Alberto Goldman
- Clinica Goldman and Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Uwe Wollina
- Städtisches Klinikum Dresden, Academic Teaching Hospital Dresden, Department of Dermatology and Allergology, Dresden, Germany
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Alam M, Tung R. Injection technique in neurotoxins and fillers: Planning and basic technique. J Am Acad Dermatol 2018; 79:407-419. [DOI: 10.1016/j.jaad.2018.01.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stander BA, van Vollenstee FA, Kallmeyer K, Potgieter M, Joubert A, Swanepoel A, Kotze L, Moolman S, Pepper MS. An in vitro and in vivo study on the properties of hollow polycaprolactone cell-delivery particles. PLoS One 2018; 13:e0198248. [PMID: 29969443 PMCID: PMC6029779 DOI: 10.1371/journal.pone.0198248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/16/2018] [Indexed: 12/11/2022] Open
Abstract
The field of dermal fillers is evolving rapidly and numerous products are currently on the market. Biodegradable polymers such as polycaprolactone (PCL) have been found to be compatible with several body tissues, and this makes them an ideal material for dermal filling purposes. Hollow PCL spheres were developed by the Council for Scientific and Industrial Research (CSIR) to serve both as an anchor point and a "tissue harbour" for cells. Particles were tested for cytotoxicity and cell adherence using mouse embryo fibroblasts (MEF). MEFs adhered to the particles and no significant toxic effects were observed based on morphology, cell growth, cell viability and cell cycle analysis, suggesting that the particles are suitable candidates for cell delivery systems in an in vivo setting. The objective of providing a "tissue harbour" was however not realized, as cells did not preferentially migrate into the ported particles. In vivo studies were conducted in BALB/c mice into whom particles were introduced at the level of the hypodermis. Mice injected with PCL particles (ported and non-ported; with or without MEFs) showed evidence of local inflammation and increased adipogenesis at the site of injection, as well as a systemic inflammatory response. These effects were also observed in mice that received apparently inert (polystyrene) particles. Ported PCL particles can therefore act as a cell delivery system and through their ability to induce adipogenesis, may also serve as a dermal bulking agent.
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Affiliation(s)
- Barend Andre Stander
- Department of Physiology, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Fiona A. van Vollenstee
- Institute for Cellular and Molecular Medicine, Department of Immunology, and SAMRC Extramural Unit for Stem Cell Research and Therapy, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Karlien Kallmeyer
- Institute for Cellular and Molecular Medicine, Department of Immunology, and SAMRC Extramural Unit for Stem Cell Research and Therapy, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Marnie Potgieter
- Institute for Cellular and Molecular Medicine, Department of Immunology, and SAMRC Extramural Unit for Stem Cell Research and Therapy, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Annie Joubert
- Department of Physiology, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Andri Swanepoel
- Polymers and Composites Competency Area, Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Lara Kotze
- Polymers and Composites Competency Area, Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Sean Moolman
- Polymers and Composites Competency Area, Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Michael S. Pepper
- Institute for Cellular and Molecular Medicine, Department of Immunology, and SAMRC Extramural Unit for Stem Cell Research and Therapy, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
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Tal S, Maresky HS, Bryan T, Ziv E, Klein D, Persitz A, Heller L. MRI in detecting facial cosmetic injectable fillers. Head Face Med 2016; 12:27. [PMID: 27595744 PMCID: PMC5011976 DOI: 10.1186/s13005-016-0124-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Despite being considered a non-invasive procedure, injections can cause adverse outcomes including infections, overfilling, asymmetry, foreign body granulomas, and reactions that lead to scarring. Complications may be associated with the procedure itself, the physician’s technique, and/or the type of agent injected. In these instances, it is important to be able locate and identify the substance used. This study investigated the viability of using MRI to correctly identify injected substances, their symmetry of distribution, and related complications. Methods Fourteen patients with suspected injectable filler complications were identified by our institution’s plastic surgery service. All subjects were scanned with MRI, using highly specific face-oriented sequences at high resolution with small field of view and thin slices across the axial and coronal planes by T1 Dixon non-contrast, T2 Dixon, and T1 Dixon after gadolinium injection. Two independent and blinded radiologists evaluated the images and reported (1) the likely injected substance, (2) symmetry, and (3) complications. These radiological results were compared against clinical data provided by the plastic surgery service. Results Ten patients (83 %) presented objective injectable complications: 4 had abscess, 4 granulomata, and 2 had allergic reactions to the injected substance. The Fleiss Kappa for inter-rater agreement on substances was 0.80. Asymmetry was identified in six patients (50 %) with a Kappa between radiology evaluators of 1. MRI characteristics of these common fillers are summarized in table form. Conclusions Given the growing awareness among referring physicians of the value of dedicated facial MRI, utilization of this imaging technique may lead to discovery of the injected substance’s true identity, evaluation of symmetry and/or complications.
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Affiliation(s)
- Sigal Tal
- Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,Department of Medical Imaging, Sackler Faculty of Medicine, Tel Aviv Universiy, Zeriffin, 70300, Israel
| | - Hillel S Maresky
- Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. .,Department of Medical Imaging, Sackler Faculty of Medicine, Tel Aviv Universiy, Zeriffin, 70300, Israel.
| | - Theodore Bryan
- Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ella Ziv
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Klein
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Persitz
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Heller
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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What Are Your Patients Reading Online About Soft-tissue Fillers? An Analysis of Internet Information. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e824. [PMID: 27536503 PMCID: PMC4977152 DOI: 10.1097/gox.0000000000000840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/08/2016] [Indexed: 11/26/2022]
Abstract
Background: Soft-tissue fillers are increasingly being used for noninvasive facial rejuvenation. They generally offer minimal downtime and reliable results. However, significant complications are reported and patients need to be aware of these as part of informed consent. The Internet serves as a vital resource to inform patients of the risks and benefits of this procedure. Methods: Three independent reviewers performed a structured analysis of 65 Websites providing information on soft-tissue fillers. Validated instruments were used to analyze each site across multiple domains, including readability, accessibility, reliability, usability, quality, and accuracy. Associations between the endpoints and Website characteristics were assessed using linear regression and proportional odds modeling. Results: The majority of Websites were physician private practice sites (36.9%) and authored by board-certified plastic surgeons or dermatologists (35.4%) or nonphysicians (27.7%). Sites had a mean Flesch-Kincaid grade level of 11.9 ± 2.6, which is well above the recommended average of 6 to 7 grade level. Physician private practice sites had the lowest scores across all domains with a notable lack of information on complications. Conversely, Websites of professional societies focused in plastic surgery and dermatology, as well as academic centers scored highest overall. Conclusions: As the use of soft-tissue fillers is rising, patients should be guided toward appropriate sources of information such as Websites sponsored by professional societies. Medical professionals should be aware that patients may be accessing poor information online and strive to improve the overall quality of information available on soft-tissue fillers.
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Kruglikov IL, Wollina U. Soft tissue fillers as non-specific modulators of adipogenesis: change of the paradigm? Exp Dermatol 2015; 24:912-5. [PMID: 26309229 DOI: 10.1111/exd.12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 12/15/2022]
Abstract
Dermal filler injection is a cornerstone of facial rejuvenation procedures. Based on available data in animal and human studies, we suppose that the activation and proliferation of adipose-derived stem cells and expansion of mature adipocytes play a crucial role in long-term effects of volumizing, tissue tightening and beautification.
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Affiliation(s)
| | - Uwe Wollina
- Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Abstract
Acne is a common inflammatory disease. Scarring is an unwanted end point of acne. Both atrophic and hypertrophic scar types occur. Soft-tissue augmentation aims to improve atrophic scars. In this review, we will focus on the use of dermal fillers for acne scar improvement. Therefore, various filler types are characterized, and available data on their use in acne scar improvement are analyzed.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital, Dresden-Friedrichstadt, Dresden, Germany
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Wollina U. Facial rejuvenation starts in the midface: three-dimensional volumetric facial rejuvenation has beneficial effects on nontreated neighboring esthetic units. J Cosmet Dermatol 2015; 15:82-8. [DOI: 10.1111/jocd.12175] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology; Academic Teaching Hospital Dresden-Friedrichstadt; Dresden Germany
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18
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Wollina U. Midfacial rejuvenation by hyaluronic acid fillers and subcutaneous adipose tissue – A new concept. Med Hypotheses 2015; 84:327-30. [DOI: 10.1016/j.mehy.2015.01.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/27/2022]
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Hizal E, Buyuklu F, Ozdemir BH, Erbek SS. Long-term inflammatory response to liquid injectable silicone, cartilage, and silicone sheet. Laryngoscope 2014; 124:E425-30. [DOI: 10.1002/lary.24800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/22/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Evren Hizal
- Department of Otorhinolaryngology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
| | - Fuat Buyuklu
- Department of Otorhinolaryngology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
| | - B. Handan Ozdemir
- Department of Pathology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
| | - Selim S. Erbek
- Department of Otorhinolaryngology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
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Portaliou DM, Liao SD, Shields RA, Lee WW. Review of laser and light therapy in the treatment of oculofacial pathology. World J Ophthalmol 2014; 4:14-20. [DOI: 10.5318/wjo.v4.i2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/13/2014] [Accepted: 03/12/2014] [Indexed: 02/06/2023] Open
Abstract
Demand for non-invasive techniques to treat oculofacial pathology has allowed for the growth and development of several new laser and light therapy modalities. These modalities include the use of intense pulsed light (IPL) and photodynamic therapy (PDT), light-emitting diode devices, as well as ablative and non-ablative lasers. Therapeutic applications in the periorbital area may involve the treatment of vascular lesions, telangiectasias, dyspigmentation, photodamage, hypertrichosis, rhytids, and scars. Laser and light-based technology offers patients treatment options that range from conservative to aggressive, allowing for choices between subtle results with little downtime or dramatic results with longer downtime. Advantages of laser treatments, as compared to traditional medical and surgical treatments, include a longer lasting effect than some of the conservative therapies and the ability to serve as a happy medium between non-invasive topical medicine and invasive surgical techniques. For patients seeking non-invasive alternatives, these modalities confer a major advantage over incisional surgery. Understanding appropriate usage, side effects, and outcomes is before treating functional and cosmetic issues. Here we present a review of current treatment modalities, their use, side effects, and outcomes.
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