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Baranska-Rybak W, Lajo-Plaza JV, Walker L, Alizadeh N. Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation on Etiology, Prevention and Management. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01202-3. [PMID: 38907876 DOI: 10.1007/s13555-024-01202-3] [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: 04/22/2024] [Accepted: 05/31/2024] [Indexed: 06/24/2024] Open
Abstract
Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24 h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactions. Hyaluronidase is not recommended as a first-line treatment for infections, which require drainage, bacterial culture, and antibiotic treatment. However, the board emphasizes the need for individualized evaluation and treatment in all cases.
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Affiliation(s)
- Wioletta Baranska-Rybak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Ul. Smoluchowskiego 17, 80-214, Gdańsk, Poland.
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Park SJ, Yoo KH. One-Year Safety Evaluation of New Hyaluronic Acid Fillers (YYS Series): A Prospective, Multicenter, Observational Study. Dermatol Surg 2024:00042728-990000000-00752. [PMID: 38595129 DOI: 10.1097/dss.0000000000004190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND With the continuous increasing availability of new filler products, each hyaluronic acid filler brand has distinctive pharmacokinetics, which may be associated with different complications. Therefore, the long-term safety of new generations of fillers should be evaluated. OBJECTIVE This prospective, multicenter, observational, postmarketing study (ClinicalTrials.gov identifier: NCT04738019) aimed to investigate the incidence of delayed-onset nodules and adverse reactions after the injection of new hyaluronic acid fillers (YYS series) into the facial skin. METHODS Subjects scheduled to receive an injection YYS series filler were followed up for 52 weeks. The authors aimed to determine the incidence of a self-reported delayed-onset nodule-a visible or palpable nodule or mass at the injection site that was detected beyond the 14th day following the injection-during the 1-year follow-up period. RESULTS Among the 1,022 subjects who received an injection of the YYS series, the incidences of delayed-onset nodules were 0% for YYS 360, YYS 540, and YYS 720. A 0.21% incidence (1 delayed hypersensitivity reaction) of a delayed-onset adverse reaction was noted for YYS 720, although none were reported for YYS 360 and YYS 540. CONCLUSION In this study, a notably low frequency of adverse reactions associated with the YYS series was observed.
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Affiliation(s)
- Su Jung Park
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Kwang Ho Yoo
- Department of Dermatology, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Republic of Korea
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3
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Wilde CL, Jiang K, Lee S, Ezra DG. The Posthyaluronidase Syndrome: Dosing Strategies for Hyaluronidase in the Dissolving of Facial Filler and Independent Predictors of Poor Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5765. [PMID: 38655103 PMCID: PMC11037726 DOI: 10.1097/gox.0000000000005765] [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: 01/25/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024]
Abstract
Background Hyaluronic acid dermal fillers are used extensively in periocular aesthetic medicine, and the incidence of filler-related complications is increasing. This study aimed to investigate the optimal dosing strategy for hyaluronidase and to identify predictors of poor outcomes. Methods We performed a retrospective review of 157 orbits of 90 patients treated with hyaluronidase over a 4-year period. Demographic data, indication, and details of hyaluronidase treatment and outcomes were recorded. Results The primary indication for dissolving filler was swelling in 52%, lumpiness in 20%, and before surgical blepharoplasty in 17%. The most frequently used hyaluronidase concentration was 150 U per mL in 66%, followed by 75 U per mL in 31%, 37.5 U per mL in 3%, and 100 U per mL in 1%. Outcomes were characterized as follows: 59% with a satisfactory result; 24% as insufficient treatment requiring further hyaluronidase; and 18% complaining of facial changes such as hollowing, indicating a post hyaluronidase syndrome. There was no statistical difference in outcomes between the 75 and 150 U per mL dosage groups (P = 0.625). A significant correlation was identified between posthyaluronidase syndrome and duration of filler in situ (P = 0.00019) and volume of filler (P = 0.000017). Conclusions The posthyaluronidase syndrome may be related to previous filler volume and duration, rather than the concentration or dose of hyaluronidase used. All patients should be informed about the risks of adverse effects after hyaluronidase treatment; patients with longer histories of filler use and higher total volumes should be advised of the increased risk.
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Affiliation(s)
- Caroline L. Wilde
- From Moorfields Eye Hospital NHS Trust, London, United Kingdom
- The Ezra Clinic, London, United Kingdom
| | - Kailun Jiang
- From Moorfields Eye Hospital NHS Trust, London, United Kingdom
| | - Sieun Lee
- Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Daniel G. Ezra
- From Moorfields Eye Hospital NHS Trust, London, United Kingdom
- The Ezra Clinic, London, United Kingdom
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Zaccaria G, Dotti A, Benanti E, Vigliarolo C, Vaienti L. A treatment algorithm for hyaluronic acid filler related complications of the face. J Plast Reconstr Aesthet Surg 2024; 91:207-217. [PMID: 38422922 DOI: 10.1016/j.bjps.2024.02.010] [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: 08/09/2023] [Revised: 12/28/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Throughout the last decade, a notable increase in HA-filler-related complications have been observed, owing to the increase in demand for filler injections and availability of multiple products. OBJECTIVES The aim is to provide practical advice on the best way to prevent and treat HA-filler-related complications. METHODS Thirty patients who experienced visible and/or symptomatic complications localized within the facial area were treated according to our algorithm. Patients with inflammatory lesions underwent antibiotic and anti-inflammatory therapy, followed by hyaluronidase injections. Patients with abscesses were treated with antibiotics, incision, and drainage. Each patient completed the dermatology-specific quality of life questionnaire (DLQI) at the first and last examinations. RESULTS Among the 29 patients who received antibiotic therapy, 3 healed without further treatment. However, 18 received hyaluronidase injections, 9 underwent incision and drainage, and 5 presented with fistulas and developed retracted scars. Moreover, 80% of the patients were completely healed, 13% significantly improved, and 3% did not show any improvement. The DLQI scores analysis showed a notable impact of patients' diseases on their quality of life, mainly in the terms of personal relationships and symptoms, with minor impacts on intimate relationships, ability to work, and study. We demonstrated that our algorithm resulted in a significant improvement in the overall quality of life at the last follow-up (p < 0.001). CONCLUSIONS The use of filler injections requires caution and specific training because they can lead to serious complications. If these complications are recognized promptly, healing can be optimized. Our treatment algorithm demonstrated high rate of healing and significant improvement in the patients' quality of life.
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Affiliation(s)
- Giovanna Zaccaria
- Plastic and Reconstructive Surgery Department, Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy.
| | - Alessandro Dotti
- Plastic, Reconstructive and Aesthetic Surgery Graduate School, Università degli Studi di Milano, Milan, Italy
| | - Elisa Benanti
- Plastic and Reconstructive Surgery Department, Istituto Clinico Città Studi, Milan, Italy
| | - Camilla Vigliarolo
- Plastic, Reconstructive and Aesthetic Surgery Graduate School, Università degli Studi di Milano, Milan, Italy
| | - Luca Vaienti
- Plastic and Reconstructive Surgery Department, Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy; Head of Plastic and Reconstructive Surgery Department, Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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Zhang YL, Sun ZS, Hong WJ, Chen Y, Zhou YF, Luo SK. Biofilm formation is a risk factor for late and delayed complications of filler injection. Front Microbiol 2024; 14:1297948. [PMID: 38260874 PMCID: PMC10800873 DOI: 10.3389/fmicb.2023.1297948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Biofilm formation is a major cause of delayed-graft complications. Similarly to implants, dermal fillers carry the risk of biofilm formation, which can lead to the development of nodules, chronic inflammatory reactions, abscesses and other complications. In this study, we investigated the late or delayed complications associated with biofilm formation on dermal fillers. Methods In this retrospective analysis, we analyzed all cases of complications caused by filler injections at a single center between January 2017 and December 2022, the majority of which comprised nodule formation and chronic persistent inflammatory reactions. The risk of biofilm formation with fillers was summarized and analyzed based on the results of bacterial culture and pathological examination. Results Sixty-one patients were enrolled, including 42 cases of nodule formation, 15 of chronic inflammatory reactions, and 4 of active infection. Bacterial culture of the tissue samples obtained from seven patients after surgical treatment were positive, and comprised four cases of Staphylococcus aureus, one case of Staphylococcus epidermidis, one case of Staphylococcus saprophyticus and one case of Mycobacterium abscessus. The corresponding histopathological results indicated extensive mononuclear lymphocyte infiltration, with a giant cell reaction in the fibrous connective tissue. Conclusion The results of this study suggest that biofilm formation is a significant risk factor for late and delayed complications following filler injection, and is caused by the contamination of resident bacteria and recessive infection at the injection site.
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Affiliation(s)
- You-liang Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Zhong-sheng Sun
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Wei-jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Yin Chen
- Department of Health Management, Guangdong Second Provincial Genera Hospital, Guangzhou, Guangdong, China
| | - Yang-fan Zhou
- Department of Pathology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Sheng-kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
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Lee W, Shah-Desai S, Rho NK, Cho J. Etiology of Delayed Inflammatory Reaction Induced by Hyaluronic Acid Filler. Arch Plast Surg 2024; 51:20-26. [PMID: 38425859 PMCID: PMC10901605 DOI: 10.1055/a-2184-6554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/26/2023] [Indexed: 03/02/2024] Open
Abstract
The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient's immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient's immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.
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Affiliation(s)
- Won Lee
- Yonsei E1 Plastic Surgery Clinic, Scientific Faculty of the Minimal Invasive Plastic Surgery Association, Dongan-ro, Dongan-gu, Anyang, Republic of Korea
| | | | - Nark-Kyoung Rho
- Department of Dermatology, Sungkyunkwan University School of Medicine, Gyeonggi-do, Republic of Korea. Leaders Aesthetic Laser & Cosmetic Surgery Center, Seoul, Republic of Korea
| | - Jeongmok Cho
- Etonne Plastic Surgery Clinic, Scientific Faculty of the Milimal Invasive Plastic Surgery Association, Seoul, Republic of Korea
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Hooper PB, Dover JS, Arndt KA, Rohrer TE. Letter on "Hyaluronic Acid Fillers, Needle Contamination by Fastidious Microorganisms, and Risk of Complications". Dermatol Surg 2023; 49:717-718. [PMID: 37249546 DOI: 10.1097/dss.0000000000003823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
| | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Kenneth A Arndt
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Salame N, Brody HJ. Highly Purified Microdroplet Liquid Injectable Silicone for the Treatment of Acne Scars in Lighter and Darker Skin Types: A Retrospective Review. Dermatol Surg 2023; 49:363-367. [PMID: 36799864 DOI: 10.1097/dss.0000000000003712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Treatment of acne scarring in darker skin types is fraught with challenges. Highly purified liquid injectable silicone (LIS) is effective in the treatment of acne scars, although its use in darker skin types has yet to be evaluated. OBJECTIVE Retrospective evaluation of the safety and efficacy of highly purified LIS for the treatment of acne scars in lighter and darker skin types. MATERIALS AND METHODS A retrospective chart review of patients who received highly purified LIS for acne scars between July 2010 and March 2021. RESULTS Two hundred six total treatments in 96 patients, 32.29% ( n = 31) of whom were Fitzpatrick skin type IV ( n = 20, 20.83%) and V ( n = 11, 11.46%), with depressed and both broad-based and shallow acne scarring were reviewed. Mean age was 50.77 years (SD 16.77), and 83% were female. Complications such as granuloma formation, migration, extrusion of silicone, hyperpigmentation, hematoma, or infection were not observed. The average follow-up time was 6.31 years (SD 3.02). CONCLUSION Highly purified LIS is a safe and effective permanent treatment for acne scars in all skin types. Injection of highly purified LIS using small volume microdroplet technique at 6- to 8-week intervals did not yield any complications, including in patients with darker skin types.
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Affiliation(s)
- Nicole Salame
- Both authors are affiliated with the Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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9
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Li Z, Zhao P, Xu Q, Bi J, Huo R. Delayed Inflammatory Reactions After Hyaluronic Acid Filling of Neck Lines: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:99-102. [PMID: 36686608 PMCID: PMC9849916 DOI: 10.2147/ccid.s394141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
The incidence of adverse events after hyaluronic acid filling is gradually increasing. In addition to acute reactions in the early postoperative period, there have been some cases of delayed inflammatory reactions. However, such events are rarely reported in Asia, which may be due to atypical symptoms, long intervals, and misidentification of the product quality. Herein, we present a case in which erythema of the neck appeared three weeks after hyaluronic acid injection into the neck lines and a delayed inflammatory reaction was diagnosed. Watchful waiting was performed, and the erythema subsided spontaneously after two weeks. This case suggests that in patients with a history of hyaluronic acid injections who develop allergic and inflammatory reactions after an interval, it is important to consider whether the reaction is a delayed inflammatory reaction, and if aggressive intervention is necessary.
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Affiliation(s)
- Zhiyu Li
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Pu Zhao
- Department of Plastic Surgery, Liaocheng Hospital of Traditional Chinese Medicine, Liaocheng, People’s Republic of China
| | - Qing Xu
- Department of Plastic and Aesthetic Surgery, Maternity and Child Health Care of Zaozhuang, Zaozhuang, People’s Republic of China
| | - Jianhai Bi
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People’s Republic of China,Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, People’s Republic of China,Correspondence: Jianhai Bi; Ran Huo, Email ;
| | - Ran Huo
- Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People’s Republic of China,Department of Plastic and Aesthetic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China,Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
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Munhoz G, Cavallieri FA, de Almeida Balassiano LK, Tembra MF, Cunha JMT, Silveira ACO, Moreira MVR, Ramos-E-Silva M. Sterile abscess due to hyaluronic acid: A new diagnosis and a proposal for treatment-A series of eight cases. J Cosmet Dermatol 2022; 21:5562-5568. [PMID: 35638403 DOI: 10.1111/jocd.15135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND In recent years, fillers procedures with hyaluronic acid (HA) have grown significantly. Despite HA relative safety, the number of cases of complications after injections has grown, and in many of which, we are not aware of or have little control over. AIMS In this article, the authors describe a new adverse reaction after filling with HA injection, the sterile abscess. PATIENTS/METHODS We present eight patients with similar clinical, laboratory, and ultrasound characteristics for sterile abscess and report a new therapeutic modality for it. RESULTS All cases were treated with "Munhoz-Cavallieri Lavage Protocol" procedure with complete resolution. CONCLUSIONS "Munhoz-Cavallieri Lavage Protocol" serves as a guideline in diagnosis and management of sterile abscess.
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Affiliation(s)
- Gabriela Munhoz
- Clínica Gabriela Munhoz, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Aquino Cavallieri
- Cavallieri Clinic, Member of Brazilian College of Radiology and Diagnostic Imaging and of the National Commission of Ultrasound - Brazilian College of Radiology and Diagnostic Imaging Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria Fernanda Tembra
- Clínica Maria Fernanda Tembra, University Hospital and School of Medicine, Federal University of Rio de Janeiro, São Paulo, Brazil
| | - José Marcos T Cunha
- University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcos Vinicius Rust Moreira
- German Society of Infectology, Internal Medicine, Department of Antibiotic Stewardship Vivantes Hospitals, Berlin, Germany
| | - Marcia Ramos-E-Silva
- Centro Dermatológico Marcia Ramos-e-Silva, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
BACKGROUND Delayed-onset reactions are increasingly relevant given the growing use of hyaluronic acid dermal fillers. There is poor understanding of the phenomenon's etiology and incidence. OBJECTIVE To highlight differences between the dermal filler products with an emphasis on delayed-onset reaction incidence, pathogenesis, prevention, and treatment. METHODS A literature review was performed for delayed-onset reactions following hyaluronic acid dermal filler injection using PubMeb and Embase. Articles were included based on relevance, quality, and the predetermined definition of "delayed-onset reaction" (>30 days post injection). A total of 28 studies were included in the data analysis. RESULTS A total of 13,136 subjects from 28 studies treated with 15 filler types were included in the analysis. VYC-15L dermal filler injections carried the highest risk of delayed reaction with a mean incidence of 3.83% ( n = 46/1,202), followed by VYC-20L (0.92%) and VYC-17.5L (0.88%). The mean incidence of delayed reactions among all filler types was 1.13%. CONCLUSION Incidence of delayed reaction to hyaluronic fillers ranges from 0% to 3.83% (mean = 1.13%) and varies by filler type. The exact etiology of these delayed reactions remains disputed. Future studies should report reaction description, precise timeline, and posttreatment immunologic history to better delineate the incidence of delayed-onset hypersensitivity reactions.
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Affiliation(s)
- Ryan E Kokoska
- All authors are affiliated with the Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
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12
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Treatment of Delayed-onset Inflammatory Reactions to Hyaluronic Acid Filler: An Algorithmic Approach. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4362. [PMID: 35747256 PMCID: PMC9208893 DOI: 10.1097/gox.0000000000004362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/11/2022] [Indexed: 02/08/2023]
Abstract
Hyaluronic acid fillers are one of the most widely used and versatile fillers worldwide. Although traditionally regarded as immunologically inert, many currently available products have been substantially modified to improve longevity and to optimize properties for specific indications. Such modifications, either alone or in combination with other factors (such as the immune status of the patient, immune-triggering events, and bacterial contamination), may lead to the development of late-onset inflammatory nodules in some patients. This article discusses the clinical presentation of late-onset adverse inflammatory reactions to hyaluronic acid injections, describes their likely triggers, and presents the author's treatment algorithm for successful resolution.
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Zaccaria G, Cassuto D, Baccarani A, Lusetti IL, Santis GD. Filler-induced complications of the lips: 10 years experience with intralesional laser treatment and refinements. J Plast Reconstr Aesthet Surg 2021; 75:1215-1223. [PMID: 34930702 DOI: 10.1016/j.bjps.2021.11.042] [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: 06/27/2020] [Revised: 05/09/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of minimally invasive cosmetic procedures has steadily increased every year. In the last decade, the rates of filler injection reactions have also increased. This study presents our experience in the management and treatment of permanent filler complications to the lips. Undoubtedly, in these adverse reactions, the lips are the hallmark that most stigmatizes an unnatural look of the face. METHODS One hundred and eighty-one patients (168 female and 13 male) with permanent filler complications to the lips were treated from September of 2009 to September of 2019 at the University Hospital of Modena. One hundred and thirty-five patients underwent intralesional laser treatment (ILT). Forty-six patients underwent a stab incision and drainage and 10 of these patients had solid and calcified nodules and therefore underwent a combined technique. Thirty-three patients underwent further cosmetic procedures. RESULTS In 95% of patients there was a clinical improvement of which complete resolution in 38.7% and partial improvement in 34.2% of cases. Nine patients stopped the treatment because they were not satisfied. No patient was considered to have worsened after the treatment. Thirty-three patients underwent further treatments. CONCLUSIONS A systematic combined approach between antibiotic therapy and treatments (ILT and a stab incision) represents the best therapeutic approach in dealing with permanent fillers complications to the lips. This treatment modality allows both the removal of the foreign material and the inflammatory reaction with low morbidity and little cosmetic disfigurement. Further cosmetic procedures may be applied to improve aesthetic appearance once most of the non-resorbable substance has been removed.
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Affiliation(s)
- Giovanna Zaccaria
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy.
| | - Daniel Cassuto
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
| | - Alessio Baccarani
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
| | - Irene Laura Lusetti
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
| | - Giorgio De Santis
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
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14
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Ryu HJ, Kim BY, Ryu SI, Kim NY, Ko JY, Ro YS, Kim IH, Kim JE. "New classification of late and delayed complications after dermal filler: Localized or Generalized?". J COSMET LASER THER 2021; 22:244-252. [PMID: 33957852 DOI: 10.1080/14764172.2021.1922703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: As filler injections have become very common procedures worldwide, the number of complications has increased. However, there is a lack of systematized studies and precise classification of late and delayed complications. This study aimed to suggest new and reliable classifications and to characterize the clinical manifestations of late and delayed complications after filler injections.Methods: This retrospective study analyzed patients and suggested a new classification of delayed adverse effects related to filler injection. Several demographic and clinical findings were analyzed. Patients were classified into two types according to their clinical presentation: Type I (Localized) or Type II (Generalized).Results: Twenty-five patients were evaluated during a clinically active adverse event suspected to be related to fillers. The most common injected filler substance was hyaluronic acid (HA, 68.8%). 76% of the patients were classified with Localized complications. In the Generalized complications group, systemic symptoms were more common (p=0.002), the treatment response was poor (p=0.010), and fewer patients showed complete remission (p=0.007) than in the Localized complications group.Conclusions: We propose a simple new classification method for late and delayed complications after dermal filler: Localized and Generalized. We expect that this new classification could help provide appropriate treatment and predict patient prognosis.
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Affiliation(s)
- Hwa Jung Ryu
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Bo Young Kim
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Sook In Ryu
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Na Young Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Il-Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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15
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Nagendran ST, Ali MJ, Dogru M, Malhotra R. Complications and Adverse Effects of Periocular Aesthetic Treatments. Surv Ophthalmol 2021; 67:741-757. [PMID: 33933438 DOI: 10.1016/j.survophthal.2021.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
The popularity and variety of temporary and permanent periocular aesthetic treatments has increased over the past decade. Patients frequently present to eye clinics with ocular complications and side effects following these treatments, their severity ranging from ocular irritation from dry eyes to visual loss from vascular occlusion. A careful, thorough history is essential, as many patients may not associate aesthetic procedures with ocular complications, and some may be embarrassed to disclose this information. All ophthalmologists should understand the potential ocular sequelae of these treatments and be able to initiate treatment in sight-threatening cases. Wesummarises the current literature on ophthalmic complications of the most common periocular aesthetic treatments.
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Affiliation(s)
- Sonali T Nagendran
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, United Kingdom
| | - Mohammad Javed Ali
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, United Kingdom.
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16
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Jones DH, Fitzgerald R, Cox SE, Butterwick K, Murad MH, Humphrey S, Carruthers J, Dayan SH, Donofrio L, Solish N, Yee GJ, Alam M. Preventing and Treating Adverse Events of Injectable Fillers: Evidence-Based Recommendations From the American Society for Dermatologic Surgery Multidisciplinary Task Force. Dermatol Surg 2021; 47:214-226. [PMID: 33543879 DOI: 10.1097/dss.0000000000002921] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Derek H Jones
- Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California
| | | | - Sue Ellen Cox
- Aesthetic Solutions, Assoc Clinical Faculty, UNC Department of Dermatology, Consulting Associate, Duke University Department Dermatology, Chapel Hill, North Carolina
| | | | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jean Carruthers
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Steven H Dayan
- Denova Research, Clinical Assistant Professor, University of Illinois, Chicago, Illinois
| | - Lisa Donofrio
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Nowell Solish
- Department of Dermatology, University of Toronto, Toronto, Canada
| | | | - Murad Alam
- Departments of Dermatology, Otolaryngology, and Surgery, Northwestern University, Chicago, Illinois
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17
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Fernandes L, Fortes BN, Lincopan N, Ishida K. Caspofungin and Polymyxin B Reduce the Cell Viability and Total Biomass of Mixed Biofilms of Carbapenem-Resistant Pseudomonas aeruginosa and Candida spp. Front Microbiol 2020; 11:573263. [PMID: 33391197 PMCID: PMC7772422 DOI: 10.3389/fmicb.2020.573263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Pseudomonas aeruginosa and Candida spp. are biofilm-forming pathogens commonly found colonizing medical devices, being mainly associated with pneumonia and bloodstream infections. The coinfection by these pathogens presents higher mortality rates when compared to those caused by a single microbial species. This study aimed to evaluate the antibiofilm activity of echinocandins and polymyxin B (PMB) against polymicrobial biofilms of carbapenem-resistant (CR) Pseudomonas aeruginosa and Candida spp. (C. albicans, C. parapsilosis, C. tropicalis, and C. glabrata). In addition, we tested the antimicrobial effect on their planktonic and monomicrobial biofilm counterparties. Interestingly, beyond inhibition of planktonic [minimum inhibitory concentration (MIC) = 0.5 μg/ml] and biofilm [minimum biofilm inhibitory concentration (MBIC)50 ≤ 2–8 μg/ml] growth of P. aeruginosa, PMB was also effective against planktonic cells of C. tropicalis (MIC = 2 μg/ml), and polymicrobial biofilms of CR P. aeruginosa with C. tropicalis (MBIC50 ≤ 2 μg/ml), C. parapsilosis (MBIC50 = 4–16 μg/ml), C. glabrata (MBIC50 = 8–16 μg/ml), or C. albicans (MBIC50 = 8–64 μg/ml). On the other hand, while micafungin (MFG) showed highest inhibitory activity against planktonic (MIC ≤ 0.008–0.5 μg/ml) and biofilm (MBIC50 ≤ 2–16 μg/ml) growth of Candida spp.; caspofungin (CAS) displays inhibitory activity against planktonic cells (MIC = 0.03–0.25 μg/ml) and monomicrobial biofilms (MBIC50 ≤ 2–64 μg/ml) of Candida spp., and notably on planktonic and monomicrobial biofilms of CR P. aeruginosa (MIC or MBIC50 ≥ 64 μg/ml). Particularly, for mixed biofilms, while CAS reduced significantly viable cell counts of CR P. aeruginosa and Candida spp. at ≥32 and ≥ 2 μg/ml, respectively; PMB was effective in reducing viable cells of CR P. aeruginosa at ≥2 μg/ml and Candida spp. at ≥8 μg/ml. Similar reduction of viable cells was observed for CAS (32–64 μg/ml) combined with PMB (2 μg/ml). These findings highlight the potential of PMB and CAS for the treatment of polymicrobial infections caused by Candida spp. and critical priority CR P. aeruginosa.
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Affiliation(s)
- Luciana Fernandes
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Bruna Nakanishi Fortes
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Nilton Lincopan
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Kelly Ishida
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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18
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Establishing a Standardized Facial Cosmetic Preinjection Safety Tool: The ACIST. Plast Surg Nurs 2020; 40:211-221. [PMID: 33259423 DOI: 10.1097/psn.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the past 20 years, the American population has seen an increased demand for nonsurgical minimally invasive facial rejuvenation solutions for the aging process. This widespread and increased demand for cosmetic injections brings a greater propensity for complications and adverse events. Choosing suitable patients for dermal filler is essential, as is concrete knowledge of the factors related to adverse events; however, there was no standardized tool to facilitate this process. The Joint Commission's Universal Safety checklist tools have been integrated into hospital surgical operating rooms and ambulatory outpatient settings across America and internationally and have successfully reduced errors in patient safety and outcomes. This article establishes the importance of integrating the Assessment Cosmetic Injection Safety Tool (ACIST), a standardized preinjection safety tool, into the cosmetic practice to decrease the incidence of adverse events associated with dermal filler and to achieve optimal patient satisfaction and outcomes. The ACIST was designed from the scientific literature, piloted at an urban cosmetic practice in the southern United States, finalized on the basis of feedback from participating staff members at the pilot study center, and disseminated to cosmetic nurse injectors.
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19
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20
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Goodman GJ, Liew S, Callan P, Hart S. Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australas J Dermatol 2020; 61:217-225. [PMID: 32201935 PMCID: PMC7497045 DOI: 10.1111/ajd.13273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
Facial aesthetic treatment with injectable neuromodulators and hyaluronic acid fillers is well established, with favourable safety profiles and consistent outcomes. As with any medical treatment, adverse events and complications may occur. Adverse events associated with these products are typically transient and mild to moderate in severity. Serious adverse events, such as infection and intravascular occlusion, are rare. Proper patient selection, consent and counselling, preparation and impeccable injection technique are important risk reduction strategies. Both clinicians and patients must be alert to the signs and symptoms of complications so that appropriate treatment can be started promptly. In this article, the authors review the current literature and provide their consensus recommendations for minimising adverse outcomes when treating patients with botulinum toxin or hyaluronic acid fillers.
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Affiliation(s)
| | - Steven Liew
- Shape ClinicDarlinghurstNew South WalesAustralia
| | | | - Sarah Hart
- Skin InstituteRemuera, AucklandNew Zealand
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21
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Goodman GJ, Al‐Niaimi F, McDonald C, Ciconte A, Porter C. Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers. J Cosmet Dermatol 2020; 19:1846-1850. [DOI: 10.1111/jocd.13531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Greg J. Goodman
- Monash University Carlton Vic. Australia
- Skin Health Institute Carlton Vic. Australia
- University College of London London UK
| | - Firas Al‐Niaimi
- Guy’s Hospital London London UK
- 152 Harley Street Clinic London UK
- Department of Dermatology Aalborg University Hospital Aalborg Denmark
| | - Cara McDonald
- St Vincent’s Hospital Fitzroy Fitzroy Vic. Australia
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22
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Artzi O, Cohen JL, Dover JS, Suwanchinda A, Pavicic T, Landau M, Goodman GJ, Ghannam S, Al Niaimi F, van Loghem JAJ, Goldie K, Sattler S, Cassuto D, Lim TS, Wanitphakdeedecha R, Verner I, Fischer TC, Bucay V, Sprecher E, Shalmon D. Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm. Clin Cosmet Investig Dermatol 2020; 13:371-378. [PMID: 32547150 PMCID: PMC7244356 DOI: 10.2147/ccid.s247171] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/18/2020] [Indexed: 12/28/2022]
Abstract
Background and Objectives There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose. Materials and Methods A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists. Results Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement. Conclusion A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.
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Affiliation(s)
- Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joel L Cohen
- AboutSkin Dermatology and AboutSkin Research, , Greenwood Village and Lone Tree, CO, USA
| | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, MA, USA.,Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Dermatology, Brown Medical School, Rhode Island, USA
| | - Atchima Suwanchinda
- Department of Dermatology, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand.,Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tatjana Pavicic
- Private Practice for Dermatology and Aesthetics Dr. Tatjana Pavicic, Munich 80539, Germany
| | | | | | - Sahar Ghannam
- Associate Prof. of Dermatology, Alexandria University, Alexandria, Egypt
| | | | | | - Kate Goldie
- Medical Director European Medical Aesthetics Ltd, London W1G 8QN, UK
| | | | | | | | | | - Ines Verner
- Verner Clinic, Tel Aviv, Israel.,Department of Dermatology, University of Rome, Guglielmo Marconi, Italy
| | - Tanja C Fischer
- Skin and Laser Center, Potsdam, Germany.,School of Medicine, University of Frankfurt, Germany
| | - Vivian Bucay
- Bucay Center for Dermatology and Aesthetics, UTHSC, San Antonio, TX, USA
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Shalmon
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Shalmon D, Cohen JL, Landau M, Verner I, Sprecher E, Artzi O. Management Patterns of Delayed Inflammatory Reactions to Hyaluronic Acid Dermal Fillers: An Online Survey in Israel. Clin Cosmet Investig Dermatol 2020; 13:345-349. [PMID: 32440187 PMCID: PMC7216297 DOI: 10.2147/ccid.s247315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Over the past few decades, soft tissue augmentation is ever-increasing, specifically hyaluronic acid (HA)-based filler injections. As the number of these procedures have risen, so have the adverse reactions. Delayed-type inflammatory reactions (DIRs) secondary to tissue fillers are typically classified according to the time of appearance post-procedure and have various presentations including nodules, abscesses, edema, and discoloration. Currently, the treatment of these complications varies among physicians. OBJECTIVE The aim of this study was to assess the knowledge and experience of practitioners in Israel who inject HA-based tissue fillers with respect to the management of late-onset procedural complications. MATERIALS AND METHODS A survey regarding management and treatment of late-onset inflammatory reactions was sent to 1120 physicians and dentists in Israel who practice tissue filler injections. RESULTS Three hundred thirty-four out of the 1120 practitioners replied to the questionnaire. The majority of respondents were dentists (group A) comprising 31% of all respondents. Group B accounted for 31% of injectors and consisted of dermatologists (19%) and plastic surgeons (12%), and group C (38%) accounted for all other practitioners; 48.2% of all injectors indicated that they have not previously encountered a DIR, whereas 11.4% responded that they have encountered more than 5 DIRs. In order to assess treatment management, we presented the injectors with a simulatory case of a woman with a late-onset complication. Most injectors referred the patient to the emergency department. When asked to establish a treatment plan, the majority of practitioners prescribed short-term oral steroids, ie, prednisone (35.3%). A limited number of patients were treated with intra-lesional hyaluronidase (31.4%) injection as only 34% of injectors kept hyaluronidase at their clinic. CONCLUSION The varied approach regarding the management of delayed type reactions to HA-based filler injections, reflected in our study, illustrates the existing ambivalence in the current literature regarding the management and therapy of late-onset complications.
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Affiliation(s)
- Dana Shalmon
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Joel L Cohen
- AboutSkin Dermatology and AboutSkin Research, Greenwood and Lone Tree, CO, USA
| | | | - Ines Verner
- Verner Clinic Tel Aviv, University of Rome “Guglielmo Marconi”, Israel, Italy
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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24
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Broly M, Marie J, Picard C, Demoures A, Raimbault C, Beylot‐Barry M, Cogrel O. Management of granulomatous foreign body reaction to fillers with methotrexate. J Eur Acad Dermatol Venereol 2020; 34:817-820. [DOI: 10.1111/jdv.16027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- M. Broly
- Department of Dermatology Centre Hospitalier Universitaire de Bordeaux Hôpital Saint‐André Bordeaux France
| | - J. Marie
- Department of Dermatology Centre Hospitalier de Périgueux Périgueux France
| | - C. Picard
- Department of Dermatology Centre Hospitalier France‐Etats‐Unis Hôpital de Saint‐Lô Saint‐ Lô France
| | - A. Demoures
- Department of Pathology Centre Hospitalier de Périgueux Périgueux France
| | | | - M. Beylot‐Barry
- Department of Dermatology Centre Hospitalier Universitaire de Bordeaux Hôpital Saint‐André Bordeaux France
| | - O. Cogrel
- Department of Dermatology Centre Hospitalier Universitaire de Bordeaux Hôpital Saint‐André Bordeaux France
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25
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Christen MO, Vercesi F. Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics. Clin Cosmet Investig Dermatol 2020; 13:31-48. [PMID: 32161484 PMCID: PMC7065466 DOI: 10.2147/ccid.s229054] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022]
Abstract
Compared to other domains, tissue engineering and esthetics have dramatically expanded in recent years, leading to both major biomedical advances and futuristic perspectives. The two share a common approach based on biomaterials, especially polymers. This paper illustrates this with the example of polycaprolactone (PCL), a polymer synthesized in the early 1930s, and one of its most recent applications, a PCL-based collagen stimulator, a filler used in esthetics. PCL is biocompatible and biodegradable. Its specific physicochemical and mechanical properties, viscoelasticity and ease of shaping led to the production of PCL-based products with various shapes and durations dependent on its biodegradation kinetics. PCL has been safely used in the biomedical field for more than 70 years, from sutures to tissue and organ replacement by 3D printing. The PCL-based collagen stimulator is composed of PCL microspheres suspended in a carboxymethyl-cellulose gel carrier providing immediate and sustained volumizing effects when injected; the morphology, the biocompatibility of the PCL microspheres embedded with the collagen fibers produced all contribute to the creation of a unique 3D scaffold for a sustained effect. Its safety has been investigated in clinical studies and vigilance surveys. Recently published experts' recommendations on injection modalities and techniques should help further optimize treatment outcome and safety. This paper also integrates reviews and recommendations on the prevention and management of adverse events related to dermal and subdermal fillers including the PCL-based collagen stimulator. In addition, in terms of efficacy and safety, this product benefits from its daily clinical use in esthetics worldwide and continuous extensive fundamental and clinical research, both on it and the PCL polymer. Forthcoming data from further investigations will reinforce knowledge of the product and procedures in the field.
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26
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Abstract
In the past 20 years, the American population has seen an increased demand for nonsurgical minimally invasive facial rejuvenation solutions for the aging process. This widespread and increased demand for cosmetic injections brings a greater propensity for complications and adverse events. Choosing suitable patients for dermal filler is essential, as is concrete knowledge of the factors related to adverse events; however, there was no standardized tool to facilitate this process. The Joint Commission's Universal Safety checklist tools have been integrated into hospital surgical operating rooms and ambulatory outpatient settings across America and internationally and have successfully reduced errors in patient safety and outcomes. This article establishes the importance of integrating the Assessment Cosmetic Injection Safety Tool (ACIST), a standardized preinjection safety tool, into the cosmetic practice to decrease the incidence of adverse events associated with dermal filler and to achieve optimal patient satisfaction and outcomes. The ACIST was designed from the scientific literature, piloted at an urban cosmetic practice in the southern United States, finalized on the basis of feedback from participating staff members at the pilot study center, and disseminated to cosmetic nurse injectors.
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27
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Capodiferro S, Sportelli P, Limongelli L, Dell’Olio F, Tempesta A, Favia G, Maiorano E. Delayed sclerosing granulomatous reaction to dermal filler injection of poly-hydroxyethyl-methacrylate suspended in hyaluronic acid: Histochemical and confocal laser scanning microscopical analysis. Clin Case Rep 2019; 7:2215-2219. [PMID: 31788282 PMCID: PMC6878211 DOI: 10.1002/ccr3.2478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 11/14/2022] Open
Abstract
Re-absorbable dermal fillers of poly-hydroxyethyl-methacrylate suspended in hyaluronic acid are considered overall safe and well tolerable because of biocompatibility; nevertheless, rarely, late, or early adverse reactions may occur.
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Affiliation(s)
- Saverio Capodiferro
- Department of Interdisciplinary MedicineUniversity of Bari Aldo MoroBariItaly
| | - Pasquale Sportelli
- Department of Interdisciplinary MedicineUniversity of Bari Aldo MoroBariItaly
| | - Luisa Limongelli
- Department of Interdisciplinary MedicineUniversity of Bari Aldo MoroBariItaly
| | - Fabio Dell’Olio
- Department of Interdisciplinary MedicineUniversity of Bari Aldo MoroBariItaly
| | - Angela Tempesta
- Department of Interdisciplinary MedicineUniversity of Bari Aldo MoroBariItaly
| | - Gianfranco Favia
- Department of Interdisciplinary MedicineUniversity of Bari Aldo MoroBariItaly
| | - Eugenio Maiorano
- Department of Emergency and Organ TransplantationUniversity of Bari Aldo MoroBariItaly
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28
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Ten-Year and Beyond Follow-up After Treatment With Highly Purified Liquid-Injectable Silicone for HIV-Associated Facial Lipoatrophy: A Report of 164 Patients. Dermatol Surg 2019; 45:941-948. [PMID: 30893157 DOI: 10.1097/dss.0000000000001889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Highly purified liquid-injectable silicone (LIS) has been established as a permanent agent for off-label correction of HIV-associated facial lipoatrophy (HIV-FLA). However, controversy exists about long-term safety. OBJECTIVE To establish the safety and efficacy at 10 years or greater of LIS for HIV-FLA. METHODS Patients from 3 practices with 10-year or greater in-person office follow-up were analyzed to determine the number of LIS treatments and total volume required to achieve optimal correction. The nature of any treated adverse events was noted. RESULTS One hundred sixty-four patients had 10-year or greater in-office follow-up. All subjects maintained long-term correction with an average of 9 treatments, average of 1.56 mL per treatment, and an average total of 14.1 mL. Two patients had severe adverse events manifesting as temporary facial edema. Four patients experienced mild-to-moderate excess fibroplasia presenting as perceived overcorrection, and 6 patients had nondisfiguring subcutaneous firmness. All adverse events were successfully treatable, mostly with intralesional 5-fluorouracil and triamcinolone. CONCLUSION Liquid-injectable silicone is an effective long-term treatment option for HIV-FLA. When injected in small quantities with the microdroplet serial puncture technique at monthly or greater intervals, optimal correction appears durable for more than 10 years. Adverse events consisted mostly of excess fibroplasia and were treatable.
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29
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Shin JY, Chae MH, Lee JY, Yoon TY, Kim MK. A Case of Sterile Abscess Induced by Hyaluronic Acid Filler Injection. Ann Dermatol 2019; 31:S41-S43. [PMID: 33911692 PMCID: PMC7997081 DOI: 10.5021/ad.2019.31.s.s41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/15/2019] [Accepted: 02/16/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jee Yon Shin
- Department of Dermatology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Myeong Heon Chae
- Department of Dermatology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Ji Yeoun Lee
- Department of Dermatology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Tae Young Yoon
- Department of Dermatology, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Mi Kyeong Kim
- Department of Internal Medicine, School of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
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30
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Heydenrych I, Kapoor KM, De Boulle K, Goodman G, Swift A, Kumar N, Rahman E. A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures and algorithms for management. Clin Cosmet Investig Dermatol 2018; 11:603-611. [PMID: 30538521 PMCID: PMC6257077 DOI: 10.2147/ccid.s180904] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The recent rapid growth in dermal filler use, in conjunction with inadequate product and injector control, has heralded a concerning increase in filler complications. The 10-point plan has been developed to minimize complications through careful preconsideration of causative factors, categorized as patient, product, and procedure related. Patient-related factors include history, which involves a preprocedural consultation with careful elucidation of skin conditions, systemic disease, medications, and previous cosmetic procedures. Other exclusion criteria include autoimmune diseases and multiple allergies. The temporal proximity of dental or routine medical procedures is discouraged. Insightful patient assessment, with the consideration of ethnicity, gender, and generational needs, is of paramount importance. Specified informed consent is vital due to the concerning increase in vascular complications, which carry the risk for skin compromise and loss of vision. Informed consent should be signed for both adverse events and their treatment. Product-related factors include reversibility, which is a powerful advantage when using hyaluronic acid (HA) products. Complications from nonreversible or minimally degradable products, especially when layered over vital structures, are more difficult to control. Product characteristics such as HA concentration and proprietary cross-linking should be understood in the context of ideal depth, placement, and expected duration. Product layering over late or minimally degradable fillers is discouraged, while layering of HA of over the same brand, or even across brands, seems to be feasible. Procedural factors such as photographic documentation, procedural planning, aseptic technique, and anatomical and technical knowledge are of pivotal importance. A final section is dedicated to algorithms and protocols for the management and treatment of complications such as hypersensitivity, vascular events, infection, and late-onset nodules. The 10-point plan is a systematic, effective strategy aimed at reducing the risk of dermal filler complications.
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Affiliation(s)
- Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Century City, Cape Town, South Africa, .,Division of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa,
| | - Krishan M Kapoor
- Department of Plastic Surgery, Fortis Hospital, Mohali, India.,AntiClock Clinic, Chandigarh, India
| | | | - Greg Goodman
- Department of Primary Heath Care, Monash University, Clayton, Victoria, Australia.,Skin and Cancer Foundation Inc, Clayton, Victoria, Australia
| | - Arthur Swift
- Westmount Institute of Plastic Surgery, Montreal, Canada
| | - Narendra Kumar
- Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK
| | - Eqram Rahman
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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