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Kushida-Contreras BH, Gómez-Calva B, Mendoza-Ramírez B, Gaxiola-García MA. Autoimmune Autoinflammatory Syndrome Induced by Adjuvants (ASIA) After Injection of Foreign Materials for Cosmetic Purposes: Retrospective Analysis of 1027 Cases. Aesthetic Plast Surg 2024; 48:491-500. [PMID: 37775577 DOI: 10.1007/s00266-023-03670-y] [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: 06/29/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The injection of illicit, non-regulated foreign materials may trigger an autoimmune autoinflammatory syndrome induced by adjuvants (ASIA). METHODS A retrospective review of health records was performed to identify patients' epidemiological and clinical characteristics. The issues analyzed were age and gender of cases, occupation, the person who administered the substance, anatomical site, type and volume of the injected substance, time from injection to the onset of symptoms, chief complaint, measures taken to alleviate symptoms, local complications, systemic manifestations, and imaging method to aid in diagnosis. RESULTS More than 70% of patients were female and dedicated to household activities; the mean age was 44 years for females and 40.7 years for males. One-quarter of patients reported some comorbidity. The most commonly reported substance was mineral oil, whereas the most frequent anatomical site was the gluteal region with volumes around one liter. Signs and symptoms occurred almost exclusively at a local level, pain (40%) and swelling (18%) being the predominant manifestations with a peak incidence after three years. Treatment was mainly medical; surgery, primarily en bloc resection, was performed in 20% of patients. CONCLUSIONS A myriad of substances may induce autoimmune autoinflammatory syndrome induced by adjuvants (ASIA) when injected for cosmetic purposes. Since effective treatments are scarce, public policies should be enforced to alert the community and limit the consequences of this healthcare problem. 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)
| | - Brenda Gómez-Calva
- National Autonomous University of Mexico (Universidad Nacional Autónoma de México, UNAM), Mexico City, Mexico
| | - Bruno Mendoza-Ramírez
- National Autonomous University of Mexico (Universidad Nacional Autónoma de México, UNAM), Mexico City, Mexico
| | - Miguel Angel Gaxiola-García
- Plastic and Reconstructive Surgery Department, Mexico's Children's Hospital (Hospital Infantil de México "Federico Gómez"), Mexico City, Mexico.
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Kushida-Contreras BH, Gómez-Calva B, Gaxiola-García MA. Cosmetic Injection of Illicit Foreign Materials: Imaging Features and Patterns of Migration in 413 Cases. Aesthet Surg J 2024; 44:183-191. [PMID: 37863473 DOI: 10.1093/asj/sjad336] [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: 09/05/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The injection of illicit, nonregulated foreign materials is increasingly common and has negative consequences relative to the inflammatory process that ensues. OBJECTIVES The aim of this study was to identify anatomical and imaging characteristics after the cosmetic injection of illicit foreign materials. METHODS A retrospective review of clinical and imaging records was performed. The issues analyzed were the anatomical site, type of injected substance, imaging method for diagnosis, and patterns of migration. RESULTS Data on 413 patients were collected. Most patients were female, with a mean age of 44 years. The most commonly infiltrated region was the buttocks (n = 284; 53.58%) followed by the breast (n = 99; 18.67%). Magnetic resonance imaging was the most common method of diagnosis in those patients who had an imaging study (159 out of 168). The most frequent depth of foreign material detected by imaging was the muscular plane (n = 103; 61.30%). Migration was detected in 56.55% of patients who had an imaging study. Most infiltrated substances were unknown; biopolymers were the most commonly identified substances. Depending on the type of substance, migration rates varied from 13% to 29%; rate differences were not statistically significant (P = .712). Migration was more common when the depth of infiltration was in muscle (77.66%) than in subcutaneous tissue (23.4%); this difference was statistically significant (P < .0001). CONCLUSIONS Deep infiltration is related to greater migration rates, apparently regardless of the substance injected. LEVEL OF EVIDENCE: 3
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Clinical Management of Complications Following Filler Injection. Aesthetic Plast Surg 2022; 46:886-894. [PMID: 34816307 DOI: 10.1007/s00266-021-02650-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
AIM Dermal fillers have been progressively used for cosmetic procedures. Concurrently, the rates of filler complications have also increased. The aim of this study is to describe the clinical management and treatment we performed in patients with complications occurred after filler injection. METHODS From March 2000 to February 2020, 197 patients have been evaluated for complications due to filler injection. For each patient type of material, symptoms and signs were recorded. Ultrasound evaluation was used to obtain information about the type, amount and location of the injected material. Magnetic Resonance Imaging was performed in those patients who were candidate for surgery. Based on the clinical manifestations, we performed a targeted therapy. RESULTS The local and systemic medical therapy allowed us a complete remission of the clinical signs and symptoms in all patients presented with edema and erythema. We obtained optimal results with surgery, where a complete removal of the injected material was possible. In all the cases in which the complete removal of the infiltrated area could have led to functional impairments, we performed partial removal with poor outcomes. CONCLUSION We observed complex clinical manifestations in the patients subjected to permanent fillers. An accurate knowledge upon the effects of the materials on tissues, a specific instrumental evaluation and a targeted therapy are crucial. We suggest the use of absorbable fillers. Patient should be subjected to filler implant in authorized structures by an expert specialist with experience in filler injection and with a thorough knowledge of the anatomical structures. 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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Aesthetic Removal of Foreign Body Granulomas of Forehead Via Pretrichial Approach. J Craniofac Surg 2022; 33:1591-1595. [DOI: 10.1097/scs.0000000000008530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022] Open
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Choi J, Ko G, Kwon H, Ha Y, Kim S, Kyung H, Oh SH, Song SH. Minimally invasive removal of facial foreign body granulomas. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2022. [DOI: 10.14730/aaps.2021.00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Various materials, commonly called fillers, have been developed and are now used for cosmetic and reconstruction purposes. Indiscriminate injections of illegal and unknown substances have various side effects, among which foreign body granulomas are particularly difficult to treat. Surgical resection can be considered for small and well-defined foreign body granulomas, but complete resection is often impossible for wide facial granulomas, and postoperative deformities may occur. Therefore, this study presents cases where foreign bodies were evaluated using imaging studies and removed through minimally invasive procedures depending on their characteristics.Methods Thirty-five patients with chronic granulomas after illegal filler injections treated from 2012 to 2019 were enrolled. Clinically, these granulomas were classified into cystic and infiltrating groups according to the imaging study patterns. Patients in the cystic group underwent puncture and drainage, and those in the infiltrating group were first treated with intralesional laser treatment and then suctioned. If the results were insufficient, surgical removal combined with a lifting procedure was performed.Results All 35 patients were women, and their average age was 51 years. Surgery was successful in almost all cases, but four cases of insufficient removal and contour deformity were encountered during follow-up. Two patients underwent reoperation and two patients improved naturally.Conclusions In this study, we classified the characteristics of granulomas using preoperative imaging studies. Aesthetically favorable results were obtained using puncture and drainage and tumescent suction, along with, if necessary, surgical removal accompanied by a lifting procedure when removing facial foreign body granulomas.
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Alsufyani N, Aldosary R, Alrasheed R, Alsufyani M. Clinical and radiographic features of facial cosmetic materials: A systematic review. Imaging Sci Dent 2022; 52:155-164. [PMID: 35799966 PMCID: PMC9226230 DOI: 10.5624/isd.20210292] [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] [Received: 12/09/2021] [Revised: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to systematically screen the literature for studies reporting cosmetic material in the oral and maxillofacial complex to shed light on the types of cosmetic materials, their radiographic appearance, and possible complications. Materials and Methods Five electronic databases were reviewed for eligible studies. The general search terms were “cosmetic,” “filler,” “face,” and “radiograph.” Demographics, material types, clinical and radiographic presentation, and complications were recorded. Results Thirty-one studies with 53 cases met the inclusion criteria. The mean age was 52.6±15.4 years with a 4 : 3 female-to-male ratio. The most common material was calcium hydroxyapatite (CaHa) (n=14, 26.4%), found incidentally. The materials were generally located within the upper cheek and zygoma (n=35, 66.0%), radiographically well-defined (n=44, 83%), and had no effects on the surrounding structures (n=27, 50.9%). The internal structure was radiopaque (calcification, hyperdensity) for gold wires, CaHa, bone implants, and secondary calcification or ossification. Outdated cosmetic materials or non-conservative techniques were infiltrative, had effects on the surrounding structures, and presented with clinical signs, symptoms, or complications. Conclusion Conventional radiography, cone-beam computed tomography, and multi-detector computed tomography are useful to differentiate several cosmetic materials. Their magnetic resonance imaging appearance was highly variable. The infrequent inclusion of cosmetic materials in the differential diagnosis implies that medical and dental specialists may be unfamiliar with the radiographic appearance of these materials in the face.
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Affiliation(s)
- Noura Alsufyani
- Department of Oral and Maxillofacial Radiology, Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Medicine and Dentistry, School of Dentistry, University of Alberta, Canada
| | | | - Rasha Alrasheed
- Department of Oral Medicine and Pathology, Dental University Hospital, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alsufyani
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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López-Mendoza FJ, Moran-Romero M, Mouneu N. Outcomes and Complications of Surgical Removal of Foreign Body Granulomas Due to Illicit Polymer Injection for Cosmetic Purposes. Aesthet Surg J 2021; 41:NP1176-NP1187. [PMID: 33825814 DOI: 10.1093/asj/sjab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Subcutaneous injection of illicit polymers can result in a number of local complications, including injection-site deformity, granulomas, and skin changes. OBJECTIVES The aim of this study was to compare postoperative complications and symptom flare in patients undergoing surgical excision of foreign-body granulomas. METHODS We retrospectively examined data of patients who underwent surgical removal of foreign-body granulomas caused by polymer injection for cosmetic purposes. The granulomas were removed by ultrasonic-assisted liposuction or en bloc excision with primary closure, skin grafts, or free flaps during 2014 to 2020. Data collected included demographic and operative parameters. Postoperative complications, symptom flare, and time to flare were reported. The relations between type of surgery and complications, symptom flare, and time to flare were determined through statistical analysis. RESULTS The final cohort included 49 surgeries (42 primary and 7 secondary) in 35 patients. The overall complication rate was 28.9%, with no significant intergroup differences (30.8%, 20%, 66.7%, and 40%; P = 0.328). Wound dehiscence and skin burns were the main complications. An overall symptom flare of 35.1% in surgically treated areas over a mean period of 28.49 months was reported. Chi-squared test indicated statistical significance between type of surgery and symptom flare (P = 0.004) and between complications and flare (P = 0.013). Kaplan-Meier test for flare was statistically significant (P = 0.006) after comparison of the 4 groups. CONCLUSIONS The rate of postoperative complications was similar for each type of surgery. However, en bloc excision and reconstruction by either primary closure or free flap was associated with a significantly decreased rate of symptom flare and a longer symptom-free period. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Mario Moran-Romero
- Plastic and Reconstructive Surgery, Hospital General Dr Manuel Gea Gonzalez, Mexico City, Mexico
| | - Nicole Mouneu
- Department of Rheumatology, Hospital Angeles del Pedregal, Mexico City, Mexico
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Disease presentation and surgical treatment of patients with foreign-body granulomas and ASIA syndrome: case series. Arch Plast Surg 2021; 48:366-372. [PMID: 34352946 PMCID: PMC8342243 DOI: 10.5999/aps.2020.02152] [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: 10/25/2020] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Background The result of illicit polymer injection is chronic inflammation with foreign-body granuloma (FBG) formation. Treatment can be divided into medical and surgical. Some patients develop severe complications with need surgical treatment. This study aims to describe patients who underwent surgical removal of the FBGs and autoimmune/inflammatory syndrome induced by adjuvants (ASIA); additionally, we evaluated the quality of life after surgery. Methods In this retrospective single-center study, the authors examined data of patients who underwent surgical removal of FBG caused by illicit polymer injection for cosmetic purposes and confirmed ASIA from 2015 to 2020 by three different surgical approaches. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, treatment strategies, histopathology reports and quality of life. Results The cohort included 11 female patients with FBGs and ASIA. The most affected anatomical zones were the combination of gluteal region, thighs and legs (40%); and thighs with legs (20%). Main presentation was: skin hyperpigmentation (90.9%), skin induration (63.6%), chronic fatigue (63.6%), and ulcers (36.4%). Surgical modalities consisted of: ultrasonic-assisted liposuction in four patients (36.4%); open en bloc excision and primary closure in four patients (36.4%); and open en bloc excision and microsurgical reconstruction in three patients (27.2%). The postoperative quality of life visual analog scale score was 83.9. Conclusions ASIA treatment represents a challenge for the plastic surgeon. Adequate surgical treatment emphasizing, when possible, the total or near-total resection of the FBG must be performed to improve ASIA evolution.
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Agostini T, Perello R. Siliconomas of the lower limb: Tumour-like excision and reconstruction. Indian J Plast Surg 2019; 49:384-389. [PMID: 28216820 PMCID: PMC5288915 DOI: 10.4103/0970-0358.197228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Silicone oil injection can cause several complications including pain, cellulitis, abscesses, skin compromise, migration, embolism and multiorgan failure. Oil-infested tissue excision remains the solely treatment to prevent such complications. Objectives: The authors evaluate tumor-like excision of the oil-infested tissue as a treatment for patients experiencing silicone injections in the lower limbs, to both preserve aesthetic appearance and solve further risk of complication from silicone. Methods: Between January 2004 and January 2011 a total of 12 consecutive, nonrandomized female patients underwent surgical management of siliconoma of the lower limb. The mean age was 41-years, range from 22 to 61 years and all patients didn’t referred comorbidities. Eight siliconomas were located on the leg and 4 were on the thigh. The mean area of siliconoma was 35 cm2, range from 25 to 60 cm2. Each patient was evaluated by ultrasonography and EchocolorDoppler of the soft tissue and in order to achieve a “staging” of siliconoma. Results: Healing was uneventful in all cases. Three patients (25%) suffering hypertrophic scarring underwent further injection of corticosteroids to improve hypertrophic scars quality. Two patients (16.6%) required a further session of structural fat grafting to improve thigh's profile. All patients were satisfied with the cosmetic results and indispositions requiring medical therapy disappeared. Conclusions: Tumor-like excision and immediate reconstruction appears to be a safe and consistent surgical option that preserves aesthetic appearance for patients victims of illegal oil silicone injection of the lower limbs.
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Affiliation(s)
- Tommaso Agostini
- Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
| | - Raffaella Perello
- Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
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Novo RC, Salgado CJ, Yim E, Sinha V, Chim HW, Romanelli P. A staging system for gluteal foreign body reaction to injectables. J Plast Reconstr Aesthet Surg 2016; 69:e174-9. [PMID: 27325516 DOI: 10.1016/j.bjps.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Esthetic augmentation of the gluteal region can lead to complications including debilitating pain, infections, wounds, and scars. To our knowledge, a general consensus of staging and treatment guidelines for managing gluteal foreign body reaction to injectables has not yet been established. OBJECTIVE The objective of this study was to develop a reliable staging system that can be used to implement a treatment algorithm for gluteal foreign body reactions. METHODS A retrospective review of 40 patients treated for complications of gluteal injections between September 2010 and May 2014 was performed. Patient symptoms, imaging, and photographs were used to develop a staging system of disease. Institutional review board approval was obtained from the University of Miami Miller School of Medicine. Five independent observers reviewed the patients' documented symptoms and photographs. Using our staging system, the independent observers reviewed the patient cases at two separate time intervals. Intra- and interclass correlation coefficients (ICCs) were computed to assess the reliability for each of the observers. RESULTS Seven patients were classified as Stage I, fifteen as Stage IIa, nine as Stage IIb, and nine as Stage III. The mean patient age was 34 years (21-50). Analysis of the independent reviewer results revealed ICC for each rater to range from 0.96 to 0.98, demonstrating high indexes of intra-rater reliability. CONCLUSIONS Based on our statistical analysis, we found an excellent inter- and intra-observer reliability, indicating that the staging system is reproducible and reliable. A treatment strategy dependent on the stage can be implemented as a guideline to optimize functional and esthetic outcomes.
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Affiliation(s)
- Rebecca C Novo
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher J Salgado
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Elizabeth Yim
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Varsha Sinha
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harvey W Chim
- Division of Plastic Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paolo Romanelli
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Multimodal Imaging and Theranostic Application of Disease-Directed Agents. TOPICS IN MEDICINAL CHEMISTRY 2015. [DOI: 10.1007/7355_2015_91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Pseudocyst of the Neck After Facial Augmentation With Liquid Silicone Injection. J Craniofac Surg 2014; 25:e474-5. [DOI: 10.1097/scs.0000000000001125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Grippaudo FR, Di Girolamo M, Mattei M, Pucci E, Grippaudo C. Diagnosis and management of dermal filler complications in the perioral region. J COSMET LASER THER 2014; 16:246-52. [DOI: 10.3109/14764172.2014.946048] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Salgado CJ, Sinha VR, Desai U. Liposuction and lipofilling for treatment of symptomatic silicone toxicosis of the gluteal region. Aesthet Surg J 2014; 34:571-7. [PMID: 24676144 DOI: 10.1177/1090820x14527107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Silicone injection can cause numerous posttreatment complications-including debilitating pain, cellulitis, abscesses, overlying skin compromise, and siliconomas distorting overlying tissues-that can be difficult to manage. OBJECTIVES The authors evaluate liposuction as a treatment for patients experiencing complications from silicone injections to the gluteal region, to both preserve aesthetic appearance and minimize further risk of complication from these procedures. METHODS Eight patients (7 women and 1 man) who presented consecutively to us between 2010 and 2013 with complications from silicone injections to their gluteal region were enrolled in this study. Each patient was evaluated by computed tomography scan and a 0 to 6 visual analog scale for pain. Emergency room (ER) visits, previous hospital admissions, and cellulitis requiring antibiotics in the 12 months prior to treatment were recorded. Patients were treated with ultrasonic and standard liposuction followed by lipotransfer into the gluteal musculature. A Student t test was used for statistical comparison of pre- and postoperative values. RESULTS Average patient age was 36 years (range, 25-43 years). All patients initially presented with intense pain as assessed by a visual analog scale; by the 12th week postoperatively, the entire cohort experienced remission in pain. At 1 year postoperatively, no patients had infections (vs 75% preoperatively; P = .028), visited the ER (vs 50% preoperatively; P = .058), or were hospitalized (vs an average of 1.5 hospitalizations per patient preoperatively; P = .066). CONCLUSIONS Liposuction with immediate intramuscular fat transfer for buttock augmentation appears to be a safe surgical option that preserves aesthetic appearance for patients with gluteal silicone toxicosis.
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Affiliation(s)
- Christopher J Salgado
- DeWitt Daughtry Family Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, University of Miami Miller School of Medicine, Florida
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Carella S, Romanzi A, Ciotti M, Onesti MG. Skin ulcer: a long-term complication after massive liquid silicone oil infiltration. Aesthetic Plast Surg 2013; 37:1220-4. [PMID: 24045933 DOI: 10.1007/s00266-013-0212-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/27/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite scientific literature replete with stories of disastrous results and disfigurement, illicit subcutaneous injections of highly viscous fluids in massive quantities still are performed, often by unqualified persons. The authors present a devastating long-term outcome from a massive volume of silicone oil injected subcutaneously into the buttocks of a 48-year-old transsexual patient and its ulceration treated only through regular medications. METHODS The therapeutic protocol consisted of wound disinfection with iodopovidone, washing with saline solution, disinfection with sodium hypochlorite 0.05 %, and application of ointment containing Vibrio alginolyticus collagenase and hyaluronan. The follow-up evaluation was at 1 and 2 weeks and then at 1, 2, and 3 months. Weekly photographs were taken, and measurements of the lesion and evolution were estimated every 7 days. RESULTS After 3 months of regular medications, the authors succeeded in closing the ulcer, avoiding invasive therapeutic options. CONCLUSION In the presence of the cutaneous ulceration above a massively infiltrated area, if the removal of all the injected oil is surgically definitely impossible, other conservative procedures should be considered. Our experience demonstrated how it is possible to manage a so prickly a case with a noninvasive approach such as periodic medications. 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)
- Sara Carella
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy,
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Friedrich RE. Ultrasonographically supported removal of foreign bodies of the eye lid and parapharyngeal space in a 13-year-old boy subjected to shot injuries in early childhood. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2013; 2:Doc19. [PMID: 26504710 PMCID: PMC4582492 DOI: 10.3205/iprs000039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: B-scan ultrasonography is widely used in diagnostics of head and neck pathologies. Ultrasonography can be applied intraoperatively to identify foreign materials. Case report: This case report describes the ultrasonographic identification of foreign bodies of the eye lid and parapharyngeal space in an adolescent who was injured several years ago, obviously a victim of domestic violence. B-scan ultrasonography (small part transducer, emission frequency: 7.5 MHz) proved to be a reliable tool to locate the foreign bodies. Ultrasound imaging facilitated the decision-making of the surgical approach and thus reduced the surgical exploration time. Discussion: B-scan ultrasonography is a valuable tool in oral and maxillofacial surgery. The use of B-scan ultrasonography in the head neck region requires the capacity of the surgeon to fuse the ultrasonographic picture with the topography of the head and neck. The advantages and limitations of B-scan ultrasonography in the head and neck region concerning foreign body identification are briefly discussed.
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Affiliation(s)
- Reinhard E Friedrich
- Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Germany
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Grippaudo F, Tammaro A, Narcisi A, Paolini G, Longo B, Falesiedi F, Santanelli F. Conservative Surgical Approach for Reduction of Macrocheilitis Caused by Massive Injection of Liquid Silicone. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Cosmetic lip augmentation, regardless of the filling agent, is nowadays one of the most requested aesthetic procedures. Liquid silicone injections were used in the past, but after reports of severe late complications their use has been discontinued, ending with a permanent ban in most western countries. In this report we describe clinical presentation, diagnostic pathways and surgical reconstruction of six patients presenting with macrocheilia due to previous liquid silicone augmentation. Patients showed chronic inflammation of the lower third of the face, lip eversion, various degrees of asymmetry and functional impairment of the lips. All patients underwent preoperative soft tissue High Frequency Ultrasound (HFUS) and Magnetic Resonance Imaging (MRI) of the of the face to obtain evidence of the filler material and to ascertain its diffusion within the soft tissues of the perioral region. Conservative surgery was carried out to remove foreign material and to restore symmetric aesthetically pleasing lips. Histology confirmed the siliconoma diagnosis. HFUS and RMI allowed to clearly identify the silicone within the soft tissues. The conservative surgery restored the harmonious relationship between the lips, with an improvement in lip functionality at long term follow-up. Healing was complete and uneventful in all of the patients.
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Affiliation(s)
- F.R. Grippaudo
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A. Tammaro
- Dermatology Unit, NESMOS Department, Hospital S. Andrea, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A. Narcisi
- Dermatology Unit, NESMOS Department, Hospital S. Andrea, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - G. Paolini
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - B. Longo
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - F. Falesiedi
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - F. Santanelli
- Department of Plastic Surgery, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Ultrasound-assisted liposuction as a safe and effective method for the removal of siliconomas. Aesthetic Plast Surg 2012; 36:220-2. [PMID: 21701943 DOI: 10.1007/s00266-011-9778-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Callegari L, Leonardi A, Bini A, Sabato C, Nicotera P, Spano’ E, Mariani D, Genovese EA, Fugazzola C. Ultrasound-guided removal of foreign bodies: personal experience. Eur Radiol 2009; 19:1273-9. [DOI: 10.1007/s00330-008-1266-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 11/10/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
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Anastassov G, Schulhof S, Lumerman H. Complications after facial contour augmentation with injectable silicone. Diagnosis and treatment. Report of a severe case. Int J Oral Maxillofac Surg 2008; 37:955-60. [DOI: 10.1016/j.ijom.2008.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 11/08/2007] [Accepted: 04/24/2008] [Indexed: 10/22/2022]
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