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Li Y, Zheng Q, Lin J, Su X, Zhuang J, Wei Q, Hu J. Mild Allergic Reactions after Botulinum Toxin Injection: A Case Series and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5845. [PMID: 38798928 PMCID: PMC11124596 DOI: 10.1097/gox.0000000000005845] [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: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 05/29/2024]
Abstract
Background Botulinum toxin type A (BTA) is becoming more and more prevalent as an injection agent in cosmetic surgery. However, there is an increasing amount of cases reporting unexpected adverse reactions related to BTA injection. BTA can invoke many kinds of hypersensitive reactions, some of which can be delayed-type or even fatal; hence, it is of crucial importance to pay close attention to atypical and early symptoms that may indicate the presence of BTA allergy in patients. Methods In this study, we reported three cases of mild and unexpected BTA-related hypersensitive reaction with a symptom of nonpruritic erythema on the chest that happened after BTA treatment of upper facial wrinkles and proposed several suggestions based on our practical experience and literature review. Results Two patients' symptoms were alleviated spontaneously, and one patient's were alleviated after taking oral corticosteroid. According to our literature review, we believe that these incidences indicate a kind of unreported allergic reaction relevant to botulinum toxin. Conclusions We suggest clinicians consider warily patients' subsequent BTA injection schedule if any suspicious reaction occurs after treatment. We suggest that patients who experience nonpruritic erythema after botulinum toxin injection should suspend subsequent injection plans for at least 3 months to prevent more severe consequences.
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Affiliation(s)
- Yingzi Li
- From the Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qiaoyuan Zheng
- College of Clinical Medicine, Fudan University, Shanghai, People’s Republic of China
| | - Jinhao Lin
- Xinjiang Second Medical Collage, Karamay, People’s Republic of China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Zhuang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qingqian Wei
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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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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3
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Zargaran D, Zargaran A, Terranova T, Khaledi H, Robinson A, Davies J, Weyrich T, Mosahebi A. Profiling UK injectable aesthetic practitioners: A national cohort analysis. J Plast Reconstr Aesthet Surg 2023; 86:150-154. [PMID: 37717299 DOI: 10.1016/j.bjps.2023.06.057] [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: 03/02/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The United Kingdom (UK) injectables market has been growing rapidly with a lack of robust regulation and to date, no information regarding the profile of practitioners has been published. AIM We aim to provide a descriptive and qualitative analysis of the advertised practitioners in the United Kingdom. METHODS We performed a systematic search using the internet search engine Google to perform a qualitative descriptive analysis of aesthetic practitioners in the UK. For each contiguous country in the UK: England, Scotland, and Wales, five searches were performed. The list of practitioners was then cross-referenced with professional regulatory bodies, with extraction of registration number, date of registration and presence or absence from the Specialist Register or General Practitioner Register. RESULTS 3000 websites were visited and evaluated. 1224 independent clinics with 4405 practitioners were identified. 738 were identified as those in business support functions and the remaining 3667 practitioners were undertaking injectable practice. The profile of professions were doctors 32%, nurses 13%, dentists 24% and dental nurses 8%. Of the 1163 doctors identified 481 were on the specialist register (41%) and 219 were on the GP register (19%). 27 specialties were represented in this cohort analysis. Plastic Surgery formed the majority of those who were on the specialist register at 37%, followed by Dermatology at 18%. CONCLUSION This paper is the first to describe the range of practitioners, their professional backgrounds and experience who perform non-surgical aesthetic interventions. The range of backgrounds may have an impact on the potential risks to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.
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Affiliation(s)
- David Zargaran
- Department of Plastic Surgery, University College London, London, UK.
| | | | - Tom Terranova
- QUAD A - American Association for the Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF), IL, USA
| | - Helia Khaledi
- Department of Plastic Surgery, University College London, London, UK
| | | | - Julie Davies
- UCL Global Business School for Health, University College London, London, UK
| | - Tim Weyrich
- Department of Computer Science, University College London, London, UK; Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Germany
| | - Afshin Mosahebi
- Department of Plastic Surgery, University College London, London, UK
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4
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Cohen JL, Goodman GJ, De Almeida AT, Jones D, Carruthers J, Grimes PE, de Maio M, Swift A, Solish N, Fagien S, Carruthers A, Sangha S. Decades of beauty: Achieving aesthetic goals throughout the lifespan. J Cosmet Dermatol 2023; 22:2889-2901. [PMID: 37632289 DOI: 10.1111/jocd.15968] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Several elements, including age, influence judgments of beauty and attractiveness. Aging is affected by intrinsic factors (e.g., genetics, race/ethnicity, anatomical variations) and extrinsic factors (e.g., lifestyle, environment). AIMS To provide a general overview of minimally invasive injectable procedures for facial beautification and rejuvenation to meet the aesthetic goals of patients across their lifespan, organized by decade. METHODS This case study review describes aesthetic considerations of females in their third to sixth decade of life (i.e., 20-60 years of age or beyond). Each case study reports the treatments, specifically botulinum toxin type A and soft tissue fillers, used to address aesthetic concerns. RESULTS Signs of aging, as well as aesthetic goals and motivations, vary by age groups, cultures, and races/ethnicities. However, there are overarching themes that are associated with each decade of life, such as changes in overall facial shape and specific facial regions, which can be used as a starting point for aesthetic treatment planning. Appropriate patient selection, thorough aesthetic evaluation, product knowledge, and injection technique, as well as good physician-patient communication, are essential for optimal treatment outcomes. CONCLUSIONS Nonsurgical facial injectable treatments can successfully enhance and rejuvenate facial features across different age ranges. A comprehensive understanding of facial aging and the aesthetic considerations of patients by the decade contributes to optimal treatment planning and maintenance.
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Affiliation(s)
- Joel L Cohen
- AboutSkin Dermatology and DermSurgery, Greenwood Village, Colorado, USA
| | - Greg J Goodman
- Adjunct Professor of Dermatology, Monash University, Clayton, Victoria, Australia
| | - Ada Trindade De Almeida
- Medical Director and Cosmetic Dermatologic Surgeon, Clinica de Dermatologia, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Derek Jones
- Skin Care and Laser Physicians of Beverly Hills, Los Angeles, California, USA
| | - Jean Carruthers
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Pearl E Grimes
- Vitiligo & Pigmentation Institute, Los Angeles, California, USA
| | | | - Arthur Swift
- Westmount Institute of Plastic Surgery, Montreal, Quebec, Canada
| | | | - Steven Fagien
- Aesthetic Eyelid Plastic Surgery, Boca Raton, Florida, USA
| | | | - Sara Sangha
- Allergan Aesthetics, an AbbVie Company, Irvine, California, USA
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Abstract
Dermal filler and botulinum toxin injections are among the most performed non-invasive procedures for rejuvenation and contouring, internationally. Although most dermal fillers and approved botulinum toxins are well tolerated with a high safety profile, adverse events and/or complications can happen. Injection-related sequelae and side effects are usually rare, mild, transient, and self-limiting in nature. However, devastating and life-changing complications, such as intravascular occlusion, skin necrosis, permanent visual impairment, and stroke, have been reported. Risk reduction measures include an in-depth knowledge of anatomy, physiology, and pharmacology, correct patient selection, correct identification of clinical indications, and, fundamentally, the importance of appropriate skill and training. In this paper, some of the complications are discussed and advice on how to minimise adverse events and complications from these injectables is provided.
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Affiliation(s)
- Souphiyeh Samizadeh
- Souphiyeh Samizadeh BDS, BSc, MJDF RCS (Eng.), PGCert (Clinical Education), MSc (Aesthetic Medicine), FHEA Visiting Clinical Teacher, King's College London, London, UK; Honorary Clinical Lecturer, University College London, London, UK; Founder and Director, Great British Academy of Aesthetic Medicine, London, UK
- Koenraad De Boulle MD Consultant Dermatologist and Director Aalst Dermatology Clinic, Aalst Belgium Associate Professor, University College London, London, UK
| | - Koenraad De Boulle
- Souphiyeh Samizadeh BDS, BSc, MJDF RCS (Eng.), PGCert (Clinical Education), MSc (Aesthetic Medicine), FHEA Visiting Clinical Teacher, King's College London, London, UK; Honorary Clinical Lecturer, University College London, London, UK; Founder and Director, Great British Academy of Aesthetic Medicine, London, UK
- Koenraad De Boulle MD Consultant Dermatologist and Director Aalst Dermatology Clinic, Aalst Belgium Associate Professor, University College London, London, UK
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6
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Hu X, Guo K, Li J, Wang X, Liu H, Yu Q, Kuang G, Li G, Huang J, Li H, Lin Z, Xiong N. Postoperative ecchymoma of eyelid after botulinum toxin injection for hemifacial spasm: a case report. Front Neurol 2023; 14:1171303. [PMID: 37545723 PMCID: PMC10398381 DOI: 10.3389/fneur.2023.1171303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Hemifacial spasm (HFS) is a rare movement disorder characterized by involuntary muscle contractions on one side of the face. Compared to the high therapeutic effect, adverse effects of botulinum toxin treatment for HFS occurred rarely. However, managing HFS patients who are also taking antithrombotic drugs poses a challenge. Here, we present a case of postoperative ecchymoma of the eyelid following a botulinum toxin injection in a patient receiving daily vinpocetine and aspirin antiplatelet therapy. This case highlights the importance of considering the potential risks and formulating a treatment plan that maximizes benefit while minimizing complications in HFS patients undergoing botulinum toxin injections and taking antithrombotic medications. To the best of our knowledge, this is the first reported case of postoperative ecchymoma of the eyelid following a botulinum toxin injection. Further research and additional case reports are needed to better understand the management strategies for this patient population.
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Affiliation(s)
- Xinyu Hu
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kexin Guo
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingwen Li
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xinyi Wang
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hanshu Liu
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Qinwei Yu
- Department of Cardiology, Wuhan Red Cross Hospital, Wuhan, China
| | - Guiying Kuang
- Department of Neurology, Wuhan Red Cross Hospital, Wuhan, China
| | - Gang Li
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jinsha Huang
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hongge Li
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhicheng Lin
- Laboratory of Psychiatric Neurogenomics, McLean Hospital, Harvard Medical School, Belmont, MA, United States
| | - Nian Xiong
- Department of Neurology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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7
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David M, Braccini F, Garcia P, Loreto F, Benadiba L, Gorj M, Grand-Vincent A, Rumyantseva Mathey E, Deutsch JJ, Ehlinger A, Cartier H, Nadra K, Fanian F. Long-Term Efficacy and Tolerability of a Medium G' HA Filler with Tri-Hyal Technology on the Rejuvenation of the Mobile Facial Zone. Clin Cosmet Investig Dermatol 2023; 16:1795-1805. [PMID: 37465030 PMCID: PMC10351526 DOI: 10.2147/ccid.s395353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023]
Abstract
Purpose Injectable hyaluronic acid-based fillers are commonly used for the correction of skin contour irregularities and to smooth skin depressions formed by volume loss during the aging process. These fillers are particularly efficient to restore perioral skin depressions/wrinkles or to correct topographical anomalies. The European directives require a continuous evaluation of the performance of these medical devices, particularly for CE marked products. Methods An 18-month prospective randomized single-blind study for the efficacy and safety of ART FILLER Universal (AFU) was performed on the lips, the nasolabial folds, and the marionettes lines. The evaluations were performed on 153 subjects enrolled in this study. The efficacy, the longevity, and the safety were evaluated for the injected areas via area specific clinical scoring after a single injection with the filler and with no re-touch. Results We showed here that filler injection induced potent improvements of volume restoration after a single injection on all the treated areas. These beneficial properties of the filler were significant 3 weeks after injection and during the whole study period. Moreover, injections of the filler were well tolerated by the subjects. The recorded adverse events are routinely seen with HA fillers for face volume corrections, and most of these local reactions resolved within 14 days. Conclusion AFU was well tolerated and showed a continuous efficacy for at least 18 months, in exploratory analyses.
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8
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Carruthers A, Carruthers J, De Boulle K, Lowe N, Lee E, Brin MF. Treatment of crow's feet lines and forehead lines with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore) 2023; 102:e32496. [PMID: 37499083 PMCID: PMC10374187 DOI: 10.1097/md.0000000000032496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Extrinsic and age-related intrinsic factors contribute to the development of facial lines, including lateral canthal lines (called crow's feet lines [CFL]) and horizontal forehead lines (FHL). OnabotulinumtoxinA is a highly effective treatment for facial lines that inhibits acetylcholine release at the neuromuscular junction. This temporary chemical denervation leads to localized muscle relaxation and subsequent wrinkle reduction. Early studies of onabotulinumtoxinA treatment for facial neuronal disorders such as dystonia documented improvements in FHL and CFL. After the neurotoxin was approved for treating frown lines (glabellar lines [GL]), individuals requested treatment for other rhytids, and physicians continued assessing use in new areas. Once onabotulinumtoxinA was in clinical trial development, its efficacy and safety for CFL and FHL were successively evaluated as required by the US Food and Drug Administration and by key global health authorities, including those in the European Union, Japan, and China. Allergan, collaborating with leading physicians, established clinical programs that included novel safety and efficacy measures to meet regulatory requirements. Global, phase 3, randomized, controlled studies of CFL and FHL met rigorous primary endpoints. Some countries mandated clinical trial data beyond US and European regulations, and Allergan conducted 11 studies in total, fulfilling diverse regulatory and study population data requirements. Adverse events associated with local spread, including brow and eyelid ptosis, diplopia, headache, and eyelid sensory disorder, were infrequent and well tolerated. Consequently, onabotulinumtoxinA treatment of upper facial lines is now established globally as a highly effective, minimally invasive treatment for patients to achieve a natural appearance and look younger.
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Affiliation(s)
| | | | | | - Nicholas Lowe
- University of California, Los Angeles, CA, USA
- Cranley Clinic, London, UK
| | - Elisabeth Lee
- Allergan Aesthetics, an AbbVie Company, Irvine, CA, USA
| | - Mitchell F Brin
- Allergan/AbbVie, Irvine, CA, USA
- University of California, Irvine, CA, USA
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9
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Monstrey SJ, Govaers K, Lejuste P, Lepelletier D, de Oliveira PR. Evaluation of the role of povidone‑iodine in the prevention of surgical site infections. Surg Open Sci 2023; 13:9-17. [PMID: 37034245 PMCID: PMC10074992 DOI: 10.1016/j.sopen.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Background The occurrence of surgical site infections (SSIs) is associated with increased risk of mortality, development of other infections, and the need for reintervention, posing a significant health burden. The aim of this review was to examine the current data and guidelines around the use of antiseptic povidone‑iodine (PVP-I) for the prevention of SSIs at each stage of surgical intervention. Methods A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Results Scientific evidence demonstrates that PVP-I can be used at every stage of surgical intervention: preoperative, intraoperative, and postoperative. PVP-I is one of the most widely used antiseptics on healthy skin and mucous membranes for preoperative surgical site preparation and is associated with a low SSI rate. For intraoperative irrigation, aqueous PVP-I is the recommended agent and has been demonstrated to decrease SSIs in a range of surgical settings, and for postoperative wound healing, there is a growing body of evidence to support the use of PVP-I. Conclusions There is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation. The use of a single agent (PVP-I) at each stage of surgical intervention could potentially provide advantages, including economic benefits, over agents that can only be used at discrete stages of the surgical procedure. Key message Evidence supports the use of PVP-I at all stages of surgical intervention, from preoperative measures (including skin preparation, preoperative washing, and nasal decolonization) to intraoperative irrigation, through to postoperative wound management. However, there is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation.
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10
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Braccini F, Fanian F, Garcia P, Delmar H, Loreto F, Benadiba L, Nadra K, Kestemont P. Comparative clinical study for the efficacy and safety of two different hyaluronic acid-based fillers with Tri-Hyal versus Vycross technology: A long-term prospective randomized clinical trial. J Cosmet Dermatol 2023; 22:473-485. [PMID: 35770300 PMCID: PMC10084174 DOI: 10.1111/jocd.15200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyaluronic acid-based fillers have an immediate volumizing effect for the treatment of dermal contour deformities and to smooth dermal depressions formed by the loss of volume. A previous study on 2016-2018 has shown the efficacy and safety of the HA-based filler ART FILLER® Volume on the midface only, but not in a comparative manner. METHODS In this context, an 18 months prospective randomized single-blind study of the non-inferiority of ART FILLER® Volume versus the reference product Juvéderm Voluma® was performed on the midface, temple, and jawline, and non-comparative study on the chin. The efficacy and the longevity were evaluated for the selected face areas via dedicated clinical scoring systems after a single filler injection without any re-touch or re-injection. The short- and long-term adverse effects were also recorded. RESULTS The observations confirmed the non-inferiority of ART FILLER® Volume versus the reference product on the different injected areas. For both fillers, the beneficial effects on volumes restoration were maintained 18 months post-injection; however, these effects were diminished among the time. Furthermore, injections of Art Filler® Volume were well tolerated by the subjects and showed less acute side effects compared with the reference product that may be explained by a lower induction of inflammation.
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11
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Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions. Molecules 2022; 27:molecules27175398. [PMID: 36080164 PMCID: PMC9458226 DOI: 10.3390/molecules27175398] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023] Open
Abstract
Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.
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12
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Alsufyani N, Aldosary R, Alrasheed R, Alsufyani M. Clinical and radiographic features of facial cosmetic materials: A systematic review. Imaging Sci Dent 2022; 52:155-164. [PMID: 35799966 PMCID: PMC9226230 DOI: 10.5624/isd.20210292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/15/2022] [Accepted: 01/15/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to systematically screen the literature for studies reporting cosmetic material in the oral and maxillofacial complex to shed light on the types of cosmetic materials, their radiographic appearance, and possible complications. Materials and Methods Five electronic databases were reviewed for eligible studies. The general search terms were “cosmetic,” “filler,” “face,” and “radiograph.” Demographics, material types, clinical and radiographic presentation, and complications were recorded. Results Thirty-one studies with 53 cases met the inclusion criteria. The mean age was 52.6±15.4 years with a 4 : 3 female-to-male ratio. The most common material was calcium hydroxyapatite (CaHa) (n=14, 26.4%), found incidentally. The materials were generally located within the upper cheek and zygoma (n=35, 66.0%), radiographically well-defined (n=44, 83%), and had no effects on the surrounding structures (n=27, 50.9%). The internal structure was radiopaque (calcification, hyperdensity) for gold wires, CaHa, bone implants, and secondary calcification or ossification. Outdated cosmetic materials or non-conservative techniques were infiltrative, had effects on the surrounding structures, and presented with clinical signs, symptoms, or complications. Conclusion Conventional radiography, cone-beam computed tomography, and multi-detector computed tomography are useful to differentiate several cosmetic materials. Their magnetic resonance imaging appearance was highly variable. The infrequent inclusion of cosmetic materials in the differential diagnosis implies that medical and dental specialists may be unfamiliar with the radiographic appearance of these materials in the face.
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Affiliation(s)
- Noura Alsufyani
- Department of Oral and Maxillofacial Radiology, Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Medicine and Dentistry, School of Dentistry, University of Alberta, Canada
| | | | - Rasha Alrasheed
- Department of Oral Medicine and Pathology, Dental University Hospital, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alsufyani
- Department of Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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Bhojani-Lynch T, Deckers A, Ohanes O, Poupard K, Maffert P. A Prospective, Observational Registry Study to Evaluate Effectiveness and Safety of Hyaluronic Acid-Based Dermal Fillers in Routine Practice: Interim Analysis Results with One Year of Subject Follow-Up. Clin Cosmet Investig Dermatol 2021; 14:1685-1695. [PMID: 34815685 PMCID: PMC8605794 DOI: 10.2147/ccid.s329415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/26/2021] [Indexed: 01/09/2023]
Abstract
Background Monitoring the effectiveness, safety and emerging uses of hyaluronic acid (HA) fillers in their wide range of indications requires a holistic approach. Purpose To propose an observational study design aiming to gather real-world evidence (RWE) and continuously evaluate the performance and safety of marketed devices in routine practice. Materials and Methods A prospective, observational registry was initiated at six European sites. Investigators enrolled any subject receiving at least one injection with a target study device (TEOSYAL Deep Lines [HADL] and/or Global Action [HAGA]). They followed their routine practice regarding injection technique, volume, and subject follow-up. Effectiveness was evaluated at 3 months using the global aesthetic improvement scale (GAIS). Safety was assessed based on common treatment reactions (CTR) and adverse events (AE). Results High quantity of RWE was collected following the initiation of this registry. In the first 158 subjects enrolled, 1220 injections were performed in more than 25 indications, including 679 with the target devices and 271 with devices of the same filler line. The primary objective was achieved, with 93.9% of treatments providing improvement at Month 3 according to the PI and subject. Post-injection CTR were mild to moderate and short-lived, and there was no clinically significant AE. More than 76% of treatments still provided some visible effect at month 12. Conclusion Based on RWE, HADL and HAGL are effective and safe in their respective indications mostly distributed in the midface, perioral region, and lower face. Observational registries are a valuable asset in the context of post-market clinical follow-up.
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Affiliation(s)
| | - Anne Deckers
- Centre Médical Esthétique Eureka, Dalhem, Belgium
| | - Ohan Ohanes
- Swiss Care Cosmetic & Laser Clinic, London, UK
| | - Kevin Poupard
- Clinical Development Department, Teoxane S.A., Geneva, Switzerland
| | - Pauline Maffert
- Clinical Development Department, Teoxane S.A., Geneva, Switzerland
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14
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Heydenrych I, De Boulle K, Kapoor KM, Bertossi D. The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments. Clin Cosmet Investig Dermatol 2021; 14:779-814. [PMID: 34276222 PMCID: PMC8279269 DOI: 10.2147/ccid.s315711] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.
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Affiliation(s)
- Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Century City, Cape Town, South Africa
| | | | | | - Dario Bertossi
- Maxillofacial Department, University of Verona, Verona, Italy
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15
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Philipp-Dormston WG. [Responsible application of hyaluronic acid fillers in aesthetic medicine : Prevention, diagnosis and therapy of adverse events and complications]. Hautarzt 2021; 72:408-420. [PMID: 33877378 DOI: 10.1007/s00105-021-04802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Injection treatments with hyaluronic acid-based fillers are a standard procedure in aesthetic medicine. Performed by an experienced and thoughtful physician, they lead to effective and natural treatment results. It is paramount to know and avoid adverse events and complications or to identify and treat them in a timely manner. They are classified and treated according to their cause, time of onset and severity.
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Affiliation(s)
- Wolfgang G Philipp-Dormston
- Hautzentrum Köln, Schillingsrotter Str. 39-41, 50996, Köln, Deutschland. .,Faculty of Health, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 45, 58455, Witten, Deutschland.
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16
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Kapoor KM, Murthy R, Hart SLA, Cattin TA, Nola PF, Rossiter AP, Singh R, Singh S. Factors influencing pre-injection aspiration for hyaluronic acid fillers: A systematic literature review and meta-analysis. Dermatol Ther 2020; 34:e14360. [PMID: 33002269 DOI: 10.1111/dth.14360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/01/2020] [Accepted: 09/23/2020] [Indexed: 02/01/2023]
Abstract
Pre-injection aspiration of hyaluronic acid filler is a well-recognized yet controversial safety technique. Many consider aspiration to be an important safety measure to prevent inadvertent intravascular filler injection. To assess factors influencing pre-injection aspiration by understanding the relationship between aspiration time and a range of product, needle, and procedural characteristics. We conducted a systematic review and meta-analysis of data, adopting the preferred reporting items for systematic reviews and metaanalyses guidelines. Our literature search identified four articles presenting data on variables associated with aspiration time for different HA filler brands. Statistical models pooling data from the four articles suggest a robust association between aspiration time and a filler's elastic modulus (G'), drop weight (cohesivity), and cross-sectional area of the needle lumen. However, there is insufficient evidence to confirm a robust association between aspiration time and HA concentration, viscous modulus (G″), needle length, and pullback volume. A deeper understanding of the relationship between product, needle, and procedural characteristics, and aspiration time can provide a sound base for discussing the role of pre-injection negative aspiration as a safety measure. The understanding of the effect of various factors on preinjection aspiration would further benefit from studies under clinical conditions.
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Affiliation(s)
| | - Rachna Murthy
- Department of Ophthalmology and Oculoplastic Surgery, FaceRestoration, London, UK
| | | | | | | | - Anthony Paul Rossiter
- Centre of Excellence for Biosecurity Risk Analysis, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Shobhna Singh
- Nitai Medical and Cosmetic Centre, Melbourne, Victoria, Australia
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17
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Goodman GJ, Liew S, Callan P, Hart S, Somia N, Sullivan J, Heydenrych I. Re Facial aesthetic injections in clinical practice: Pretreatment and post-treatment consensus recommendations to minimise adverse outcome Region-specific changes in line with the Covid-19 pandemic. Australas J Dermatol 2020; 61:362-366. [PMID: 32779184 DOI: 10.1111/ajd.13374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/23/2020] [Indexed: 12/13/2022]
Abstract
Despite the recent publication in March 2020 of guidelines for facial injectable treatments, the speed of the COVID-19 pandemic and its safety implications necessitate changes to these guidelines The authors described what would constitute safest practice in the provision of facial injectable treatments and summarised these in table form. Adherence to a high standard of asepsis and infectious disease precautions remain a key patient safety requirement when performing facial aesthetic injections. A revision and update of these guideline summary tables follows. Changes made should enhance both patient and staff safety regarding COVID-19/SARS-CoV-2, a highly infective respiratory pathogen transmitted by respiratory droplets, respiratory/mucosal secretions and contaminated fomites. Some of the additions are COVID-19 specific and are likely to evolve and change, particularly should serological tests determining acquired immunity become available. Other additions represent further tightening of our infection control precautions.
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Affiliation(s)
- Greg J Goodman
- Monash University, Clayton, Victoria, Australia.,University College of London, London, UK
| | | | | | - Sarah Hart
- Skin Institute, Remuera, Auckland, New Zealand
| | - Naveen Somia
- Prince of Wales Hospital, Sydney and University of Sydney, Australia
| | - John Sullivan
- The Sutherland Hospital, University of New South Wales, Caringbah, NSW, Australia
| | - Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, University of Stellenbosch, Cape Town, South Africa
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