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Phelps PO, Ibrahim NA, Holds JB, Massry GG. Infraorbital Injections of Polymethylmethacrylate Microspheres: Treatments for Delayed Granulomatous Inflammation. Facial Plast Surg Aesthet Med 2024. [PMID: 38656207 DOI: 10.1089/fpsam.2024.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- Paul O Phelps
- Chicago Oculofacial Plastic Surgery, Chicago, Illinois, USA
- Chicago Medical School, Chicago, Illinois, USA
- Division of Ophthalmology, Department of Surgery, Cook County Health, Chicago, Illinois, USA
| | - Nora A Ibrahim
- Burt and Will Plastic Surgery and Dermatology, Plainfield, Illinois, USA
| | - John B Holds
- Ophthalmic Plastic and Cosmetic Surgery, Inc., St. Louis, Missouri, USA
- Department of Ophthalmology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Guy G Massry
- Beverly Hills Ophthalmic Plastic Surgery, Beverly Hills, California, USA
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Lin G, Yihao X, Zhang X, You J, Wang H, Zheng R, Tian L, Guo J, Song Z, Fan F. Tunneled Paranasal Augmentation Using Diced Autologous Costal Cartilage in Asian Rhinoplasty: A Comparative Study. Facial Plast Surg 2024. [PMID: 38547925 DOI: 10.1055/a-2296-3105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2024] Open
Abstract
Due to the prevalence of anterior maxilla dysplasia in Asian population, paranasal concavity is a common accompaniment to low nose, but its impact on facial harmonization is often underestimated. A retrospective comparative study was conducted on patients diagnosed as low nose with paranasal concavity between June 2017 and June 2021, with a total of 56 patients followed up successfully. The control and observation groups were established according to whether the paranasal augmentation was performed. Demographic data were collected. Cosmetic enhancement was quantitatively evaluated by sagittal planimetry, establishing related anatomical landmarks and measuring columella base prominence (CBP) and alar base prominence (ABP). Subjective evaluation concluded the patient-reported satisfaction (FACE-Q-Rhinoplasty Module and Facial Appearance Module) and the third-party physician assessment (Global Aesthetic Improvement Scale, GAIS).Significant improvements in CBP and ABP were reported both in the control and the observation group (p < 0.01). In postoperative intergroup comparisons, the observation group was superior to the control group regarding ABP values (2.5 ± 0.75 degrees, p < 0.01), FACE-Q-Facial scores (7.49 ± 3.70, p < 0.05), and GAIS scores (p < 0.05). However, no statistical difference was found in CBP values and FACE-Q-Rhinoplasty scores. Paranasal augmentation-related complications included asymmetry of alar bases (6.9%) and facial or intraoral foreign body sensation (34.5%). This study affirmed that paranasal augmentation using diced costal cartilage in rhinoplasty is a safe procedure effective in remedying paranasal concavity and improving facial satisfaction. LEVEL OF EVIDENCE:: IV.
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Affiliation(s)
- Guangxian Lin
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Xu Yihao
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Xulong Zhang
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Jianjun You
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Huan Wang
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Ruobing Zheng
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Le Tian
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Junsheng Guo
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Zhen Song
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
| | - Fei Fan
- Nasal Reconstruction Centre, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, Shijingshan District, China
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Barraza-Vergara LF, Carmona-Sarabia L, Torres-García W, Domenech-García M, Mendez-Vega J, Torres-Lugo M. In vitro assessment of inflammatory skin potential of poly(methyl methacrylate) at non-cytotoxic concentrations. J Biomed Mater Res A 2023; 111:1822-1832. [PMID: 37589190 DOI: 10.1002/jbm.a.37591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
Poly(methyl methacrylate) (PMMA) is considered an attractive substrate material for fabricating wearable skin sensors such as fitness bands and microfluidic devices. Despite its widespread use, inflammatory and allergic responses have been attributed to the use of this material. Therefore, the main objective of this study was to obtain a comprehensive understanding of potential biological effects triggered by PMMA at non-cytotoxic concentrations using in vitro models of NIH3T3 fibroblasts and reconstructed human epidermis (RhE). It was hypothesized that concentrations that do not reduce cell viability are sufficient to activate pathways of inflammatory processes in the skin. The study included cytotoxicity, cell metabolism, cytokine quantification, histopathological, and gene expression analyses. The NIH3T3 cell line was used as a testbed for screening cell toxicity levels associated with the concentration of PMMA with different molecular weights (MWs) (i.e., MW ~5,000 and ~15,000 g/mol). The lower MW of PMMA had a half-maximal inhibitory concentration (IC50 ) value of 5.7 mg/cm2 , indicating greater detrimental effects than the higher MW (IC50 = 14.0 mg/cm2 ). Non-cytotoxic concentrations of 3.0 mg/cm2 for MW ~15,000 g/mol and 0.9 mg/cm2 for MW ~5,000 g/mol) induced negative metabolic changes in NIH3T3 cells. Cell viability was severely reduced to 7% after the exposure to degradation by-products generated after thermal and photodegradation degradation of PMMA. PMMA at non-cytotoxic concentrations still induced overexpression of pro-inflammatory cytokines, chemokines, and growth factors (IL1B, CXCL10, CCL5, IL1R1, IL7, IL17A, VEGFA, FGF2, IFNG, IL15) on the RhE model. The inflammatory response was also supported by histopathological and gene expression analyses of PMMA-treated RhE, indicating tissue damage and gene overexpression. Results suggested that non-cytotoxic concentrations of PMMA (3.0 to 5.6 mg/cm2 for MW ~15,000 g/mol and 0.9 to 2.1 mg/cm2 for MW ~5,000 g/mol) were sufficient to negatively alter NIH3T3 cells metabolism and activate inflammatory events in the RhE skin.
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Affiliation(s)
- Luisa F Barraza-Vergara
- Department of Chemical Engineering, University of Puerto Rico at Mayagüez, Mayaguez, Puerto Rico, USA
| | - Lesly Carmona-Sarabia
- Department of Chemistry, University of Puerto Rico at Río Piedras, San Juan, Puerto Rico, USA
| | - Wandaliz Torres-García
- Department of Industrial Engineering, University of Puerto Rico at Mayagüez, Mayaguez, Puerto Rico, USA
| | - Maribella Domenech-García
- Department of Chemical Engineering, University of Puerto Rico at Mayagüez, Mayaguez, Puerto Rico, USA
| | - Janet Mendez-Vega
- Department of Chemical Engineering, University of Puerto Rico at Mayagüez, Mayaguez, Puerto Rico, USA
| | - Madeline Torres-Lugo
- Department of Chemical Engineering, University of Puerto Rico at Mayagüez, Mayaguez, Puerto Rico, USA
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Rosendy G, Cavalcante IL, Barros CCDS, López-Labady J, González N, Pérez-Alfonzo R, González MG, Freire CH, de Arruda JAA, de Andrade BAB, Villarroel-Dorrego M. Adverse Reactions Associated with Dermal Fillers in the Oral and Maxillofacial Region: A Venezuelan Experience. Head Neck Pathol 2023; 17:631-637. [PMID: 37247174 PMCID: PMC10513972 DOI: 10.1007/s12105-023-01563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population. METHODS A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented. RESULTS A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively. CONCLUSION Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology.
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Affiliation(s)
- Gabriela Rosendy
- Master's Program in Stomatologic Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Israel Leal Cavalcante
- Department of Dentistry, University of Fortaleza, Fortaleza, Brazil
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP 21.941-902, Brazil
| | - Caio César da Silva Barros
- Postgraduate Program in Dental Sciences, Department of Dentistry, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Jeaneth López-Labady
- Master's Program in Stomatologic Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Nieves González
- Dermatology Service, Instituto de Biomedicina, Hospital Dr. José María Vargas, Caracas, Venezuela
| | - Ricardo Pérez-Alfonzo
- Dermatology Service, Instituto de Biomedicina, Hospital Dr. José María Vargas, Caracas, Venezuela
| | - Maria Gabriela González
- Dermatology Service, Instituto de Biomedicina, Hospital Dr. José María Vargas, Caracas, Venezuela
| | - Clara Herrera Freire
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP 21.941-902, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP 21.941-902, Brazil.
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Durkin AJ, Catena D, Woltjen N, Boyle K, Polling M, Weng J, Chim JH. Surgical Management of Polymethylmethacrylate-Collagen Gel Complications in the Lower Eyelid: A Case Series. Ann Plast Surg 2023; 90:12-18. [PMID: 36534095 DOI: 10.1097/sap.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND As nonsurgical rejuvenation with fillers continues to grow in popularity, patients are increasingly interested in more durable results. Polymethylmethacrylate (PMMA)-collagen gel is unique among fillers in that the PMMA microspheres are not completely absorbed and phagocytosed by the body. This durability coupled with the biophysical properties of PMMA makes it a poor choice for periorbital rejuvenation, an unforgiving and highly complex anatomic area. METHODS Between 2011 and 2018, 14 patients with PMMA granulomas in various facial areas self-referred to the senior author's practice. Of these patients, 11 were managed nonsurgically; however, all 3 patients who presented with granulomas in the infraorbital area required surgery to remove the filler and restore a natural aesthetic. RESULTS The 3 patients with significant swelling and PMMA filler nodules in the infraorbital area with unacceptable cosmetic appearance were females between the ages of 50 and 55 years. Nonsurgical protocols were unsuccessful, and surgical removal was required. All subjects have been followed for a minimum of 2 years with no immediate- or long-term postoperative complications secondary to PMMA removal. Patients remain satisfied with the outcome of the surgery. CONCLUSIONS Despite the evidence that the periorbital area is prone to adverse events when injected with particulate fillers, misguided enthusiasm for PMMA-collagen gel as a durable treatment continues to lead to unnecessary and severe complications in patients. The case studies presented here highlight that this product should not be introduced into the periorbital area. We also describe a surgical treatment approach for its removal if complications arise.
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Affiliation(s)
| | | | | | | | | | - John Weng
- Florida State University College of Medicine, Tallahassee
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Palmieri IP, Raichi M. Clinical commentary about foreign body complications over 20 years after polymethyl-methacrylate face implants and control of late sequelae with Polynucleotides Highly Purified Technology (PN-HPT ® ). J Cosmet Dermatol 2022; 21:5537-5542. [PMID: 35405040 DOI: 10.1111/jocd.14950] [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: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Mainly in the past, foreign body complications, including granuloma, were pretty frequent after semi-permanent polymethyl-methacrylate (PMMA) implants. RESULTS The authors describe a twenty-year history of recurring post-PMMA complications interspersed by long uneventful years, with acute edematous side effects evolving into unpleasant skin dystrophia with persistent cutis laxa. The case report also discusses a simple clinical algorithm to discriminate among foreign body complications with particular attention to granulomas. CONCLUSIONS The authors conclude by discussing the benefits of the anti-dystrophic treatment with natural-origin remodeling PN-HPT® (Polynucleotides Highly Purified Technology).
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Affiliation(s)
- Isabella Pia Palmieri
- Master Diploma in Surgery and Aesthetics, University of Padua Medical School, Padua, Italy.,Master Diploma in Aesthetic Medicine, University of Naples Medical School, Naples, Italy
| | - Mauro Raichi
- Clinical Pharmacology and Toxicology Consultant in Aesthetic Medicine, Milan, Italy
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Windle B. Case Report of Idiopathic Masseteric Hypoplasia Treated With Polymethyl Methacrylate-Collagen Gel. Aesthet Surg J Open Forum 2021; 4:ojab040. [PMID: 35072067 PMCID: PMC8781771 DOI: 10.1093/asjof/ojab040] [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] Open
Abstract
Congenital hypoplasia of the masseter muscle is a rare condition most commonly associated with craniofacial or poly-malformation syndromes, with a small number of reported idiopathic cases. The condition is most commonly managed by orthodonture and later surgical intervention; however, surgery is not an option for all patients. Nonsurgical approaches to correcting asymmetry may be considered for patients for whom the functional impact of hypoplasia has been largely managed and the patient's concern is primarily aesthetic. In this case study, the patient presented for a consultation seeking a nonsurgical solution for marked facial asymmetry. The patient underwent physical examination and magnetic resonance imaging to confirm diagnosis of congenital masseter muscle hypoplasia. To treat the asymmetry, a total of 9.6 cc of polymethyl methacrylate (PMMA)-collagen gel (Bellafill; Suneva Medical, Inc., San Diego, CA) was injected along the border of the mandible from the gonial angle out to the area of the mental foramen and slightly above over the course of 6 months (2 visits spaced 3 months apart) to provide long-term, nonsurgical correction. The patient was very satisfied with the results, highlighting the potential for PMMA-collagen gel to be used in clinical situations in which durable, nonsurgical correction of lower-face asymmetry is needed. LEVEL OF EVIDENCE 5
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Affiliation(s)
- Brian Windle
- Corresponding Author: Dr Brian Windle, 1700 116th Ave NE #100, Bellevue, WA 98004, USA. E-mail:
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Matías-Sánchez M, Oviedo-Ramírez MI, Díaz-Manzano JA. Polymethylmethacrylate Granuloma After Septoplasty. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:329-331. [PMID: 34535224 DOI: 10.1016/j.otoeng.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Manuel Matías-Sánchez
- Servicio de Otorrinolaringología, Hospital General Universitario de Elda, Elda, Alicante, Spain.
| | | | - José Antonio Díaz-Manzano
- Servicio de Otorrinolaringología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Granuloma de polimetilmetacrilato tras septoplastia. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Efficacy and Safety of Lyophilized Articular Cartilage Matrix as an Injectable Facial Filler. Aesthetic Plast Surg 2021; 45:1266-1272. [PMID: 33216175 DOI: 10.1007/s00266-020-02017-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of an injectable lyophilized articular cartilage matrix (LACM) which is in the form of cartilage powder that may increase the convenience of use and become unaffected by donor site morbidity as a potential filler. METHODS The safety test was conducted using 20 rabbits with an intravascular embolization model. Commonly used commercial hyaluronic acid (HA), acellular dermal matrix (ADM), polymethyl methacrylate (PMMA), and polylactic acid (PLA) products were selected for comparison of efficacy and adverse effect of LACM. The efficacy test was performed using 30 mice subcutaneous buttock-injection model. Gross assessments of the changes in size of injected materials and histological examinations were conducted. RESULTS Regarding the safety test, in one rabbit in the HA group, complete blurring occurred in the left eye, and necrosis of the posterior auricular artery was observed in one rabbit in the ADM group. In the ADM, severe ecchymosis around the injection sites was observed, and the bruises lasted longer than in the other groups. The LACM exhibited faster bruise resolution. Comparing the changes in size between weeks 4 and 12 in the mouse model, no significant changes in size were observed in the LACM (p = 0.359), HA (p = 0.421), and ADM (p = 0.097), but a significant change was observed in the PMMA (p = 0.001). In the histological examination, LACM exhibited well-demarcated margins with good biocompatibility. CONCLUSION The LACM shows potential as a facial filler according to the in vivo safety and efficacy tests LEVEL OF EVIDENCE V: 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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Restoring Facial Contour and Harmony Using Biphasic Calcium Phosphate Bioceramics. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3516. [PMID: 33854862 PMCID: PMC8032359 DOI: 10.1097/gox.0000000000003516] [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: 08/09/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Abstract
Background: The restoration of facial contour is one of the pillars for the treatment of facial disharmonies and deformities. Fat transplantation and fillers have been widely used to improve the positioning of soft tissues, which are, however, directly related to the conditions and positioning of the underlying bone tissue. Recontouring of the latter has been performed using osteotomies and several types of bone grafts or biomaterials, as inlay or onlay grafts/implants. Here, biphasic calcium phosphate bioceramics were applied in a series of cases, their long-term results are shown, and their advantages, discussed. Methods: A retrospective analysis of 20 patients, who were subjected to facial recontour with onlay implants of biphasic calcium phosphate bioceramics, is reported. Patients were seeking to improve facial harmony due to congenital deformities, trauma, tumor resection or signs of aging, and were followed for up to 16 years. Clinical data, radiographic images, and information regarding pain and other findings were retrieved from medical records. Results: Six patients were men and 14 were women. Their ages ranged from 19 to 64 years. Bioceramics were implanted under the periosteum through external or intraoral incisions. Some patients underwent combined procedures, such as rhinoplasties or facial lifting. None of the patients presented exacerbated inflammation or pain. One of them had infection in the intraoral incision, which was resolved with medication. Conclusion: All patients had improved facial contours following the use of bio-ceramics to augment bone tissue and presented stable results at long-term evaluation.
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The use of periocular fillers in aesthetic medicine. J Plast Reconstr Aesthet Surg 2021; 74:1602-1609. [PMID: 33546985 DOI: 10.1016/j.bjps.2020.12.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/08/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2022]
Abstract
The periocular area is the first to display signs of ageing. Dermal fillers are an increasingly popular, minimally invasive method for facial rejuvenation. The eye is anatomically delicate and complex. Therefore, special consideration must be taken if dermal fillers are employed. This article examines the literature to assess the efficacy and safety of dermal fillers around the eye as well as the management of complications secondary to dermal filler use, such as oedema, granuloma formation, filler migration, xanthelasma, skin necrosis and visual loss. Hyaluronic acid (HA) is the most popular and commonly employed dermal filler for periocular use. It is effective, with good observer improvement and patient satisfaction (p<0.0001). Ninety percent of adverse events are mild in nature and self-resolve within 1 month. Malar oedema is a delayed complication unique to the periocular area, occurring in 11% of patients. This can be managed with use of hyaluronidase if a HA filler has been employed. Other complications, such as granuloma formation, filler migration and xanthelasma, have also been reported with variable management outcomes. Vascular adverse events include skin necrosis and visual loss. No Level 1 evidence exists for the management of visual loss. Two cases of visual restoration have been identified in the literature; however, this is rare.
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Paulucci BP. PMMA Safety for Facial Filling: Review of Rates of Granuloma Occurrence and Treatment Methods. Aesthetic Plast Surg 2020; 44:148-159. [PMID: 31637504 DOI: 10.1007/s00266-019-01522-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022]
Abstract
PMMA is composed of microspheres suspended in bovine collagen. Once injected in a dermal area, the carrier is absorbed, giving place to collagen that gives volume and maintains the spheres in the place. This process may give origin to exacerbate foreign body reaction and granuloma. The frequency of such complication is not clear. The primary objective was to review and compare the frequencies of granuloma between the published studies. The secondary aim was to compare the therapies and efficacies. The series of cases in which PMMA was used as facial filler were reviewed, and the rate of granulomas was compared; the case report studies describing those complications were also reviewed, and the therapies and outcomes were quantified. The data showed general frequency of PMMA-related complications of 4.9% and granulomas 1.9%; the incidence of granuloma was 1/2075 patients-year, and the time to development ranged from 6 to 180 months. The most used therapies were steroid, surgery or both, with satisfactory results. In conclusion, considering the actual risks and benefits of PMMA, we may affirm that it is a safe filler; doctors and patients must be conscious of potential risks when deciding for its use. 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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Abstract
Potential complications related to dermal fillers depend on the type of the fillers and the site of their application. The classification of dermal filler complications can be divided into early and late, and into minor and major events. According to their mechanism, they can be divided into non-ischaemic and ischaemic complications. The aim of this study is to present possible complications related to dermal fillers, to explain their aetiology and to propose preventive management and treatment. Non-ischaemic complications can be technique-dependent and include the reactions at the site of the injection, contour irregularities, and inflammatory and infectious reactions. They are usually resolved as a matter of course after 2-7 days. Arterial or venous occlusion leads to ischemia, with subsequent necrosis of the skin and/or vision loss.
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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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Injection technique in neurotoxins and fillers: Indications, products, and outcomes. J Am Acad Dermatol 2018; 79:423-435. [DOI: 10.1016/j.jaad.2018.01.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mild Complications or Unusual Persistence of Porcine Collagen and Hyaluronic Acid Gel Following Periocular Filler Injections. Ophthalmic Plast Reconstr Surg 2018; 34:e143-e146. [DOI: 10.1097/iop.0000000000001029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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