Prevention and Management of Serious Complications After Facial Fat Grafting

Facial vascular visualization enhancement based on optical detection technology

OBJECTIVE

This study aims to develop a facial vascular enhancement imaging system and analyze vascular distribution in the facial region to assess its potential in preventing unintended intravascular injections during cosmetic facial filling procedures.

METHODS

A facial vascular enhancement imaging system based on optical detection technology was designed, and volunteers were recruited. The system was utilized to detect and analyze vascular distribution in various anatomical regions of the faces. The vascular visualization-enhanced (VVE) images generated by the system were compared with visible light images to validate the vascular visualization capability of the system. Additionally, the reliability of vascular visualization was assessed by comparing the observed vascular patterns in the VVE images with those in near-infrared light images.

RESULTS

Thirty volunteers were recruited. The VVE images produced by the system demonstrated a significant capacity to identify vascular morphology and yielded a higher vessel count compared to visible light images, particularly in the frontal, orbital, perioral, mental, temporal, cheek, and parotid masseter regions (P < .05). The temporal region exhibited the highest vascular density, followed by the cheek region and then the frontal region. Reliability analysis of vascular visualization enhancement indicated that the system's imaging of facial vasculature not only demonstrated reliability but also enhanced physicians' visual perception.

CONCLUSION

Blood vessel distribution varies across facial regions. The facial vascular enhancement imaging system facilitates real-time and clear visualization of facial vasculature, offering immediate visual feedback to surgeons. This innovation holds promise for enhancing the safety and effectiveness of facial filling procedures.

Surgical Lip Remodeling Following Permanent Filler Injection: A Scoping Review

ABSTRACT

Over the years, several techniques have been introduced to obtain permanent lip enhancement, such as the use of silicone lip implants or the off-label use of permanent fillers. Although some reports indicate that permanent lip filler is safe, many others describe early- and late-onset complications. The main issue with permanent lip fillers is the lack of a standard technique to correct undesirable results. The aim of this scoping review was to list and evaluate the surgical pathways described in literature to correct lip deformity resulted from the injection of permanent fillers. The methods and the inclusion criteria of this work were specified in advance and documented in a protocol, according to the PRISMA 2009 checklist. The research was carried out on electronic databases PubMed, Cochrane Library, and Scopus databases identifying articles from March 1991 to December 2020 and conducted up to December 23rd, 2020. Articles language was limited to English. The selection process identified 3 retrospective studies eligible for inclusion. 73 patients and a total of 111 lips (72 upper and 39 lower) were considered. Two early complications were identified, 1 suture dehiscence and 1 total lip mucosa necrosis. Surgical lip remodeling following permanent filler injection seems to be an effective approach although the surgical pathway needs to be customized per each patient. Complication rate seems to be coherent to lip surgery performed with reconstructive purposes. To confirm these data case-control studies with much wider cohorts are needed to reach statistical significance.

Personal Strategy to Avoid Fat Embolism During Fat Grafting: Brisk Withdrawal of Cannula While Injection

INTRODUCTION

Complications of fat grafting by means of injection may lead to unwanted passage of substrate into vessel lumens resulting in catastrophic complications. Likewise, a similar trend of complications is observed with non-autologous fillers regardless of an almost generalized use of blunt cannulas, the latter being implicated in the majority of serious vascular complications of hyaluronic acid injection. This report is the product of investigation to review all cases that underwent an original technique of fat injection: "The smart fat injection" during the cannula's brisk withdrawal technique. The aim of this research was to document the safety of this technique by searching if fat embolism had occurred and if yes, its incidence in this group of fat injection surgeries.

METHOD

This retrospective review included 3039 patients who underwent the smart fat injection at the facial or corporeal level between 2001 and 2019. The study focused on the search for complications linked to fat yet also cruorical embolism, as the latter may resemble the clinical symptoms of fat embolism.

RESULTS

The assessment of the 3039 patients who underwent the smart fat injection during cannula's brisk withdrawal, resulted in none presenting clinically detectable fat or a cruorical embolism.

CONCLUSION

This report documents the safety of the smart fat injection developed over a period of 22 years. It further explains the rationale of the technique for avoiding fat embolism while simultaneously enhancing fat take. This technique should not be implemented without appropriate in vitro training.

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 Table of Contents or online Instructions to Authors www.springer.com/00266 .