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Schelke L, Lowrey N, Mojallal A, Rowland-Warmann MJ, Wortsman X, Sigrist RM, Velthuis PJ, Cotofana S. Post-Treatment Displacement of Facial Soft Tissue Fillers-A Retrospective Ultrasound-based Investigation of 382 Zygomatic Regions. Dermatol Surg 2024:00042728-990000000-00828. [PMID: 38833408 DOI: 10.1097/dss.0000000000004257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Clinical and ultrasound experience has revealed that after soft tissue injections of the lateral cheek, the filler may displace from the zygoma to the caudal temporal area. OBJECTIVE To obtain more data to provide insight into product distribution when soft tissue fillers are injected in the zygomatic region. METHODS Two hundred patients were examined with facial ultrasound imaging of the zygomatic and temporal region. Inclusion criteria were simply a positive response on the screening questionnaire as to whether or not they had filler injections placed in their lateral cheek. Control injections were also performed to the zygomatic regions of a body donor and in 10 patients ultrasound-guided. RESULTS A correlation was found between the layers in which filler was detected on the zygoma and where it was ultimately found in the temples. Four different redistribution patterns were observed: (1) migration of filler within the superficial muscular aponeurotic system (SMAS) on the zygoma into the superficial temporal fascia. Migration of filler from the lateral suborbicularis oculi fat to (2) the deep interfacial plane of the temple or (3) to the superficial temporal fat pad; (4) migration from the supraperiosteal layer of the zygoma to the superficial temporal fat pad. Body donor and patients: filler deposits injected on the zygoma were witnessed to shift during injection into the caudal part of the temple. CONCLUSION Soft tissue filler aliquots may be redistributed into the temples after injections of the lateral side of the zygomatic arch. The displacement follows a distinct pattern depending on the initial layer of injection.
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Affiliation(s)
- Leonie Schelke
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicola Lowrey
- Department of Plastic, Reconstructive, and Aesthetic Surgery, N2 Aesthetics, Manhattan Beach, CA
| | - Ali Mojallal
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospices Civils de Lyon, Lyon, France
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Université Claude Bernard, Lyon, France
| | - M J Rowland-Warmann
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Smileworks Liverpool, Liverpool, UK
| | - Ximena Wortsman
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Institute for Diagnostic Imaging of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Universidad de Chile, Santiago, Chile
| | - Rosa M Sigrist
- Department of Radiology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Peter J Velthuis
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sebastian Cotofana
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
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Gonzalez C, Duque-Clavijo V, Kroumpouzos G, Concha AMG, Perez MO. ULTRASONOGRAPHIC FEATURES OF NON-VASCULAR COMPLICATIONS OF HYALURONIC ACID FILLERS: A RETROSPECTIVE STUDY AT A REFERENCE CENTER FOR DERMATOLOGIC ULTRASONOGRAPHY. Clin Dermatol 2024:S0738-081X(24)00080-4. [PMID: 38763380 DOI: 10.1016/j.clindermatol.2024.05.006] [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: 05/21/2024]
Abstract
Hyaluronic acid (H.A.) filler injections have been associated with early, temporary, and delayed-onset onset complications. High-resolution ultrasound (HRUS) with Doppler analysis has been increasingly used to detect and identify such complications. We describe comprehensively the most common ultrasonographic findings of non-vascular complications associated with H.A. filler injections. This retrospective, cross-sectional observational study was conducted at a reference center for dermatologic ultrasound in Bogotá, Colombia. Ultrasound reports documented the ultrasonographic findings of non-vascular complications of H.A. filler injections. Fifty-two complications were documented in a cohort of 50 patients (women, 88%). The infraorbital region was the most common site affected (23%), followed by the nasolabial (22%). The Tyndall effect was the most common complication (25% of all), followed by changes in rheology (21%) and pseudo-sarcoidal (foreign body granuloma) reaction (15%). The Tyndall effect stood out for its distinctive ultrasonographic characteristics. We discuss the ultrasonographic findings and pathogenesis of other complications, including filler migration, early hypersensitivity, aseptic abscess, overcorrection, and filler material interaction. The clinical presentation of H.A. filler complications can be confusing, delaying timely diagnosis and treatment. HRUS with Doppler analysis is a valuable tool for avoiding unnecessary treatments and ensuring timely diagnosis and treatment.
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Affiliation(s)
- Claudia Gonzalez
- Department of Radiology, Rosario University, Bogotá D.C., Colombia.
| | | | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Ana Maria Garcia Concha
- Department of Dermatology, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia
| | - Miguel Olmos Perez
- Dermatology Department, San José Hospital, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia
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Park KE, Mehta P, Tran C, Parikh AO, Zhou Q, Zhang-Nunes S. A comparison of five point-of-care ultrasound devices for use in ophthalmology and facial aesthetics. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:28-35. [PMID: 38314019 PMCID: PMC10836224 DOI: 10.1177/1742271x231166895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 02/06/2024]
Abstract
Introduction Point-of-care ultrasound is becoming increasingly popular, and we sought to examine its role in evaluating ocular and periocular structures and facial vasculature. With the large number of point-of-care ultrasound devices available, it is difficult to determine which devices may be best suited for ophthalmic and facial aesthetic applications. This study compares five popular handheld point-of-care ultrasound devices to help guide clinicians in choosing the device best suited for their needs. Methods We compared five point-of-care ultrasound devices: Butterfly IQ+ (Butterfly, Burlington, MA), L15 (Clarius Mobile Health, Vancouver, British Columbia, Canada), L20 (Clarius Mobile Health, Vancouver, British Columbia, Canada), Lumify (Philips, Amsterdam, Netherlands) and Vscan Air (GE, Boston, MA). Three ophthalmologists obtained the following views on three volunteers: eight arteries, four ocular and periocular structures and areas of filler injections. The image quality of each view was graded on a four-point Likert-type scale. In addition, graders filled out a survey. The data were analysed using analysis of variance tests with the significance level set to p < 0.05. Results In terms of overall image quality, the L20 received the highest mean rating, followed by the L15, Vscan Air, Butterfly IQ+ and the Lumify (p < 0.05). With further stratification for structure type, the L20 was ranked first for filler, artery and orbital imaging (p < 0.05). Conclusions The L20 received the highest image quality rankings. While image quality is an important aspect of point-of-care ultrasound device selection, other factors such as cost, wireless capabilities, range of presets and battery life should also be considered.
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Affiliation(s)
| | - Preeya Mehta
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Charlene Tran
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alomi O Parikh
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Qifa Zhou
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sandy Zhang-Nunes
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
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Schelke L, Liplavk O, Cotofana S, Shah-Desai S, Velthuis P. Periorbital venous stasis may be involved with filler induced malar edema-A duplex ultrasound-imaging-based case series. J Cosmet Dermatol 2023; 22:3246-3251. [PMID: 37786282 DOI: 10.1111/jocd.16012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/26/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Filler injections in the periocular region are regarded as a challenging and advanced maneuver in a high-risk area. Adverse events as malar edema due to filler treatment may occur. To evaluate the possible reasons, the ultrasound images, and medical data of patients that were prospectively referred with malar edema were evaluated. MATERIALS AND METHODS A total of 17 patients (26 eyes) with malar edema after hyaluronic acid filler treatment were included. All cases were assessed with an 18 MHz linear ultrasound device. Exact location of the filler material was noted. Relations with clinical data were analyzed using chi-square tests. RESULTS Onset of malar edema after treatment showed a wide range from immediate (0 days) to 3 years. Most patients had an early onset N = 13 (76%), a minority showed late onset N = 4 (24%). In 23 eyes, the filler material was found to be located inside the SMAS. In 3 cases filler material was located on the periosteum of the orbital rim. After duplex-ultrasound guided filler removal, restored venous flow could be seen in the superficial and/or deep fatty layer often accompanied by flow piercing through the SMAS. Minutes after treatment, clinical improvement of malar edema was observed. CONCLUSION Malar edema after by filler treatments in the periocular region may be caused by veno-lymphatic compression by filler deposits.
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Affiliation(s)
- L Schelke
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - O Liplavk
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Cotofana
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | | | - P Velthuis
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Beiu C, Popa LG, Bălăceanu-Gurău B, Iliescu CA, Racoviță A, Popescu MN, Mihai MM. Personalization of Minimally-Invasive Aesthetic Procedures with the Use of Ultrasound Compared to Alternative Imaging Modalities. Diagnostics (Basel) 2023; 13:3512. [PMID: 38066753 PMCID: PMC10705986 DOI: 10.3390/diagnostics13233512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 04/12/2024] Open
Abstract
Ultrasonography is a well-tolerated procedure that aids in the targeted esthetic therapies of special cutaneous regions, as well as in the prevention (vascular mapping, identification of previous filler, and others) and management of potential complications (vascular occlusion, external vascular compression, product misplacement or migration, inflammatory reactions, and others). It has lately been promoted as the first-line imaging tool to address injectables. In this article, we aim to review the evolving role of ultrasonography in cosmetic filler procedures, from the fundamental ultrasound characterization of cosmetic fillers to the ultrasound-enhanced detection and management of cosmetic filler complications, including ultrasound's role in hyaluronidase-guided injections for cosmetic filler dissolution. Furthermore, the paper explores the integral role played by ultrasound in enhancing the precision, efficacy, and safety of additional minimally invasive aesthetic techniques such as mesotherapy, radiofrequency, cryolipolysis, and polydioxanone procedures.
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Affiliation(s)
- Cristina Beiu
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.B.); (L.G.P.); (M.M.M.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania;
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.B.); (L.G.P.); (M.M.M.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania;
| | | | - Carmen Andrada Iliescu
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania;
| | - Andreea Racoviță
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania;
| | - Marius Nicolae Popescu
- Department of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Clinic of Physical and Rehabilitation Medicine, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Mara Mădălina Mihai
- Department of Oncologic Dermatology, “Elias” Emergency University Hospital, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.B.); (L.G.P.); (M.M.M.)
- Clinic of Dermatology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania;
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Wortsman X, Quezada N, Peñaloza O, Cavallieri F, Schelke L, Velthuis P. Ultrasonographic Patterns of Calcium Hydroxyapatite According to Dilution and Mix With Hyaluronic Acid. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2065-2072. [PMID: 36972372 DOI: 10.1002/jum.16226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To assess the ultrasonographic patterns of different calcium hydroxyapatite (CaHA) formulations, including the undiluted, diluted, and mixed with hyaluronic acid (HA) compounds. METHODS To review the ultrasonographic images of patients ≥18 years with confirmed injections of CaHA clinically and ultrasonographically, and without different concomitant types of fillers in the same region or other systemic or localized cutaneous diseases. RESULTS Twenty-one patients met the criteria (90% female; 10% male; mean age: 52 years ± 12.8). Of these, 33.3% have been injected with an undiluted formulation, 33.3% with diluted, and 33.3% with a mixed formulation. All cases were studied with devices presenting frequencies that ranged from 18 to 24 MHz. Twelve cases (57%) were also studied with the 70 MHz. The ultrasonographic patterns of CaHA presented differences in the presence and intensity of PAS and the degree of inflammation according to the dilution and mix with HA. Diluted formulations show a milder intensity posterior acoustic shadowing (PAS) artifact than undiluted at 18-24 MHz. In mixed formulations, 57% showed mild PAS, and 43% demonstrated no PAS artifact at 18-24 MHz, besides fewer inflammatory changes in the periphery of the deposits. CONCLUSIONS The ultrasonographic patterns of CaHA show differences in the presence and intensity of PAS and the degree of inflammation according to the dilution and mix with HA. Awareness of these ultrasonographic variations can support better discrimination of CaHA.
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Affiliation(s)
- Ximena Wortsman
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
| | - Natacha Quezada
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Dermaline Clinic, Santiago, Chile
| | | | | | - Leonie Schelke
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
| | - Peter Velthuis
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
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Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. J Plast Reconstr Aesthet Surg 2023; 84:656-669. [PMID: 37002059 DOI: 10.1016/j.bjps.2023.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/30/2022] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
An ever-increasing interest in perioral rejuvenation with dermal fillers reflects the esthetic importance of this region. However, filler injections in the lips and perioral area have been associated with various complications. Such complications are classified according to severity (mild, moderate, severe) or by the time of onset: immediate (within 24 h after injection), early (24 h to 4 weeks post-procedure), and late or delayed (>4 weeks after injection). While most complications are mild and manageable, vascular compromise, infections, and the development of delayed-onset nodules may significantly undermine the ultimate esthetic outcome and cause substantial morbidity. These more serious complications often require more invasive treatment modalities. This article details the prevention and management of such adverse events and discusses safe filler injection principles, including safety recommendations for the lips. Lastly, we highlight the use of ultrasound guidance in complication prevention (vascular mapping, filler identification, location, and extent), assessment (identification of intravascular embolus or external vascular compression by the filler implant), and management (real-time imaging of hyaluronidase or other drug injection in the affected area). Esthetic practitioners should be versed in injection anatomy, and the prevention, recognition, and management of filler complications in the perioral area.
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Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | | | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College and C.R. Gardi Hospital, Ujjain, India.
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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8
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Wortsman X. Key Points to Select a Device for Dermatologic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:521-545. [PMID: 36394307 DOI: 10.1002/jum.16000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 05/26/2023]
Abstract
What points to consider when selecting a device for practicing dermatologic ultrasound is an excellent question. After we met the requisites published in the guidelines for practicing dermatologic ultrasound, it is necessary to consider the main objective of the use because it is not the same to be focused mostly on the avoidance of the puncture of important facial vessels such as the case of injectors of cosmetic fillers in comparison to the use of operators that need to deal with the diagnosis and monitoring of a wide range of dermatologic pathologies. Currently, a broad variety of ultrasound devices meets the minimum requirements for practicing these examinations in the market. Thus, small, portable, and high-end devices may present advantages and limitations that must be balanced according to the primary purposes and the budget. Moreover, the shape and footprint of the probes can make difficult or facilitate a dermatologic procedure. Other points to consider are the type of storage and the need for technical service. In summary, there are key points that we need to consider when we select a dermatologic ultrasound device in dermatology or aesthetics.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Schelke LW, Decates TS, Cartier H, Cotofana S, Velthuis PJ. Investigating the Anatomic Location of Soft Tissue Fillers in Noninflammatory Nodule Formation: An Ultrasound-Imaging-Based Analysis. Dermatol Surg 2023; 49:588-595. [PMID: 36942950 PMCID: PMC10227930 DOI: 10.1097/dss.0000000000003756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Noninflammatory nodules may be persistent to dissolve. To evaluate the possible reasons, a case series of ultrasound images and medical data of patients who were prospectively referred with noninflammatory nodules were evaluated. MATERIALS AND METHODS A total of 27 patients with nodules but without signs of inflammation were included. All cases were assessed with an 18-MHz linear ultrasound device. Exact location of the filler material was noted. Relations with clinical data were analyzed using chi-square tests. RESULTS Early onset of complaints (<2 weeks) was found in 16 patients and late onset (>2 weeks) in 11. All patients had multiple nodules. In all cases, the filler nodule was found to be located inside the fascia. Extension to the subcutaneous tissue was seen in 8 cases and to the deeper planes in 5. In 14 cases, the filler material was completely located inside layers of the fascia, and migration was observed in 5 cases. DISCUSSION Accumulation of filler material in the superficial musculoaponeurotic system or fascia may be an important cause for the occurrence of persistent noninflammatory nodules, either by initial faulty injection technique or by later accumulation through the pathway generated with a needle or cannula. Ultrasound-guided injections are helpful to dissolve the nodule.
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Affiliation(s)
- Leonie W. Schelke
- Department of Dermatology, Erasmus University Medical Center, Roterdam, The Netherlands
| | - Tom S. Decates
- Department of Dermatology, Erasmus University Medical Center, Roterdam, The Netherlands
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Peter J. Velthuis
- Department of Dermatology, Erasmus University Medical Center, Roterdam, The Netherlands
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Wortsman X. Aplicaciones frecuentes de la ecotomografía Doppler color en dermatología que permiten ayudar al diagnóstico y manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Haykal D, Cartier H, Benzaquen M, Damiani G, Habib SM. The growing importance of ultrasonography in cosmetic dermatology: An update after the 23rd IMCAS Annual World Congress (2022). J Cosmet Dermatol 2023; 22:222-225. [PMID: 36374262 DOI: 10.1111/jocd.15503] [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: 09/13/2022] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound (US) has been used for many years in the field of medicine. Many specialties have embraced US as a quick, painless, and relatively inexpensive tool to assist the clinician in determining anatomy, pathology, and aid in diagnostic or therapeutic procedures. US allows for precise mapping of cutaneous and subcutaneous structures in the face, in particular vascular structures. The use of US leads to reduced chances of complications and clinical failures, rendering more safety and high quality. METHODS US is considered the first-imaging technique for dealing with fillers and managing their potential complications. US can be deployed for vascular mapping, safe placement of fillers, and directed low-dose hyaluronidase reversal of vascular adverse events. It is a noninvasive imaging modality that provides a good definition for studying the skin, deeper layers, and blood flow in real time. In other words, we go from static to dynamic anatomy. In addition, US can guide with the application of botulinum toxin, in order to define the muscular planes. US may contribute to a more personalized procedure, better cosmetic results, and help to avoid complications. In general, physicians tend to use it for prevention. Last, for research purposes, US examination provides valuable information on the behavior, longevity, and interaction of the filler within the tissues. CONCLUSION This new approach for US-guided treatments is a very practical and an effective method in cosmetic dermatology. As doctors, we owe it to our patients to do our best to prevent any harm. We feel that in near future, US will be an essential diagnostic tool in any dermatology or cosmetic doctor's office to both ensure safety and provide legal protection for the professional.
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Affiliation(s)
| | | | | | - Giovanni Damiani
- Dermatology Unit, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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High-Frequency Ultrasound of Facial Filler Materials in the Nasolabial Groove. Aesthetic Plast Surg 2022; 46:2972-2978. [PMID: 35699759 DOI: 10.1007/s00266-022-02967-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Various dermal fillers are often used for nasolabial groove filling. High-frequency ultrasonography might be a valuable tool for assessing facial filler materials. METHODS The facial ultrasound images of plastic surgery hospital of the Chinese Academy of Medical Sciences from November 2014 to November 2021 were analyzed and judged. RESULTS A total of 94 patients who underwent high-frequency ultrasound with a nasolabial groove filler were included in the study. Hyaluronic acid was detected in 35 cases, polyacrylamide in 34 cases, lipofilling in 10 cases, silicon oil in seven cases, calcium hydroxyapatite in six cases, and silicone implant in two cases. The ultrasonic performance of hyaluronic acid was divided into four types: aggregation, diffusion, mixed pattern, and associated infection; of polyacrylamide was divided into five types: aggregation and inclusion, aggregation and non-inclusion, diffusion, mixed pattern, and associated infection; and of lipofilling was divided into four types: aggregation, diffusion, fat liquefaction necrosis, and cystic change. Echo intensity, echo characteristics, boundary clarity, fluidity, and blood flow signals can be used as the basis for identifying filler materials. CONCLUSION High-frequency ultrasound has an identification significance for the filling materials in the area of nasolabial groove. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Chai H, Su X, Yuan L, Li Z, Jiang L, Liu Y, Dou M, Hu J. High-Frequency Ultrasound Imaging Findings of Different Mental Injectable Soft Tissue Fillers. Aesthetic Plast Surg 2022; 46:2995-3002. [PMID: 35984469 DOI: 10.1007/s00266-022-03057-5] [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: 06/08/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In recent years, the use of mental injectable soft tissue fillers is popular. However, some fillers are difficult to distinguish from pathological tissue, and some non-absorbable fillers need to be removed in time. Therefore, identification of different fillers is important. In this study, we summarized the ultrasonic manifestations of different mental injectable soft tissue fillers to provide references for clinical practice. METHODS We screened the mental ultrasound images from November 2014 to November 2021 in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences, identified different filling injection materials, and summarized and classified the ultrasonic characteristics of each filling material. RESULTS A total of 244 cases were included, involving 62 cases of hyaluronic acid, 126 cases of polyacrylamide hydrogel, 19 cases of growth factor, 16 cases of calcium hydroxyapatite, 15 cases of silicone oil and 6 cases of fat. The ultrasonic manifestation of hyaluronic acid was anechoic area, which could be divided into six types according to the distribution characteristics. The ultrasonography of polyacrylamide hydrogel showed fine punctate echo, which could be divided into nine types. The ultrasonographic appearance of growth factor was similar to the echo of the surrounding tissue, and the boundary was not clear. Calcium hydroxyapatite was characterized by uneven hyperechoic area, which was spread in the tissue space, with unclear boundary with surrounding tissues. Sonographic patterns of silicone oil were hyperechoic and cloudy on high-frequency ultrasound. The deep tissue and periosteum layer were not clear. Transplanted fat showed isoechoic area or uneven low-echo area, with clear boundary and peripheral adipose tissue acoustic enhancement. CONCLUSIONS High-frequency ultrasound is safe and reliable for identification and typing of chin filling injection materials, which can be applied in clinical practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hongli Chai
- Department of Ultrasound, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Li Yuan
- Department of Ultrasound, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Zehui Li
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Liya Jiang
- The 1st Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China
| | - Yue Liu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Maomei Dou
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Thirty-three Badachu Road, Shijingshan District, Beijing, 100144, 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, Thirty-three Badachu Road, Shijingshan District, Beijing, 100144, 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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15
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Sigrist RM, de Noronha MGO, Borelli SS, Teixeira SP, Funes HLX, Lourenço LM. Dynamic ultrasound evaluation of body fillers and biostimulators in the buttocks of fresh-frozen specimen. J Cosmet Dermatol 2022; 21:5621-5627. [PMID: 36029286 DOI: 10.1111/jocd.15333] [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: 04/07/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ultrasound imaging is a useful tool to study the injection of fillers and biostimulators in the body. OBJECTIVE Sonographically evaluate real-time injections of fillers and biostimulators and describe their behavior in the subcutaneous tissue of the buttocks of fresh-frozen specimen. METHODS injection of two brands of high-density hyaluronic acid (HA), one brand of calcium hydroxyapatite (CaHA), one brand of hybrid injectable (CaHa + HA), one brand of polycaprolactone (PCL) and three brands of poly-l-lactic acid (PLLA) were performed in the subcutaneous tissue of the gluteal region under ultrasonography visualization on a fresh-frozen specimen. Videos during injection and static images immediately after injection were obtained. The sonographic aspects of the substances and their dispersion and interaction with the surrounding tissues were described. RESULTS Real-time ultrasound showed different dispersion patterns of the two brands of HA, CaHA, hybrid injectable (CaHa + HA) and the three brands of PLLA. The sonographic aspects among the brands of PLLA were also different. CONCLUSIONS The dynamic ultrasound evaluation of the injection of HA, CaHA, hybrid injectable (CaHa + HA), PCL and PLLA in a fresh-frozen specimen shed some light on their aspects and dispersion pattern in the buttock. If these patterns are confirmed in further studies in vivo, there will be a positive impact on the selection and development of safer and more effective techniques to enhance buttock contour.
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Affiliation(s)
- Rosa M Sigrist
- Hospital das Clínicas da faculdade de Medicina da USP, São Paulo, Brazil
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16
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Chai H, Su X, Yuan L, Li Z, Liu Y, Dou M, Hu J. “Application of High Frequency Ultrasound in Detection and Identification of Nasal Filling Injection Materials”. J Cosmet Dermatol 2022; 21:4276-4287. [PMID: 35279941 DOI: 10.1111/jocd.14912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/06/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hongli Chai
- Department of Ultrasound Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Li Yuan
- Department of Ultrasound Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Zehui Li
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Yue Liu
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Maomei Dou
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China
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Abstract
ABSTRACT With the sudden emergence of new medical aesthetic fillers, the number of fillers injected worldwide has exploded, but there are also worrying risks in the pursuit of beauty. At present, many cases of blindness caused by injection of aesthetic fillers have been reported. Most of the cases are caused by irreversible vascular embolism. This is a rare yet greatly feared complication of using facial cosmetic fillers. This article reviewed and analyzed the literature and summarized the changes in the anatomical structure of facial blood vessels related to blindness during facial injection.
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Affiliation(s)
- Dan Li
- From the Department of Plastic and Burn Surgery, the First Affiliated Hospital Chongqing Medical University, Chongqing, China
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18
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Wortsman X, Moll-Manzur C, Ramírez-Cornejo C, Alfaro-Sepúlveda D, Mellado-Francisco G, Rezende J, Vera-Kellet C. Ultrasonographic Subclinical Signs of Inflammation of the Lacrimal, Parotid, and Submandibular Glands in Users of Cosmetic Fillers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2377-2389. [PMID: 33417303 DOI: 10.1002/jum.15621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To detect ultrasonographic inflammatory signs in the lacrimal, parotid, and submandibular glands in cosmetic fillers (CFs) users. METHODS A prospective and cross-sectional ultrasound study of the glands in cases with CFs was performed. The sample included users of hyaluronic acid, silicone oil, polymethylmethacrylate, polycaprolactone, calcium hydroxyapatite, and polyacrylamide. Abnormalities of the parenchyma and hypervascularity signs of the glands were compared with a control group (n = 10), evaluated by 2 observers, and correlated with the type, number, and location of the facial CFs. Cohen's kappa test and logistic regression models with odds ratios (OR) adjusted by age with 95% CI were performed. RESULTS Sixty-three patients with CFs met the criteria. Parotid and submandibular glands had the highest percentage of parenchymal involvement: 87.3 and 88.9%, respectively (p <.01). Abnormalities of the echostructure of the parenchyma and hypervascularity of the glands were detected with all kinds of fillers without significant differences per type. A significant substantial interrater kappa (0.61) with an agreement of 90% for all glands among observers was found. CONCLUSION Users of common types of CFs frequently present subclinical ultrasonographic signs of inflammation of the lacrimal, parotid, and submandibular glands. Further research on the topic seems necessary.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catherina Moll-Manzur
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Ramírez-Cornejo
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Juliana Rezende
- Department of Radiology, Fernandes Figueira Institute, Niteroi Hospital, Rio de Janeiro, Brazil
| | - Cristian Vera-Kellet
- Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Connective Tissue Diseases Unit, Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile
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19
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Velthuis PJ, Jansen O, Schelke LW, Moon HJ, Kadouch J, Ascher B, Cotofana S. A Guide to Doppler Ultrasound Analysis of the Face in Cosmetic Medicine. Part 1: Standard Positions. Aesthet Surg J 2021; 41:NP1621-NP1632. [PMID: 33954581 DOI: 10.1093/asj/sjaa410] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Interest in Doppler ultrasound (DUS) analysis of the face has grown in cosmetic medicine, in particular for injectable fillers. When dealing with complications, DUS has the advantage of easily visualizing the filler and identifying the problem in relation to the patient's anatomy. When working with hyaluronic acid filler, ultrasound-guided injections with hyaluronidase can precisely target the problem. In addition, DUS can be used to study the anatomy of a patient, specifically to prevent intravascular injections. We predict that in a few years' time DUS will become standard equipment in the offices of cosmetic doctors. We discuss the basics of ultrasound imaging of different tissues with the concomitant terminology. With the use of 7 basic DUS probe positions, key anatomic reference points can be easily found. From these, all relevant anatomic structures in the face can be observed and analyzed. With some practice, physicians will ultimately be able to acquire a complete 3-dimensional mental image of a patient's face.
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20
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Kadouch J, Schelke LW, Swift A. Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples. Aesthet Surg J 2021; 41:603-612. [PMID: 32162653 DOI: 10.1093/asj/sjaa066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Autologous fat is known for a reliable and natural safety profile, but complications do occur-even serious vascular adverse events. OBJECTIVES The authors sought to examine doppler-ultrasound (DUS) imaging for the harvesting and subsequent facial implantation of autologous fat tissue. METHODS All patients underwent lipofilling treatment of the temporal fosse of the face. DUS examination was performed for preprocedural vascular mapping and imaging of previously injected (permanent) fillers. In addition, the injection of autologous fat was performed DUS-guided. RESULTS Twenty patients (all female; mean age, 57.9 years; range, 35-64 years). DUS examination showed that 16 of the 20 patients (80%) had been injected with resorbable or nonresorbable fillers elsewhere in the past. The temporal artery could be visualized and avoided in all cases. An average of 1.1 cc of autologous fat was injected in the temporal fossa per side. One case of edema and nodules was described, but no other adverse events were reported. CONCLUSIONS The utilization of DUS can add valuable information to a lipofilling procedure and should be considered an integral part of a safe lipofilling treatment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jonathan Kadouch
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Leonie W Schelke
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Arthur Swift
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands
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21
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Urdiales-Gálvez F, De Cabo-Francés FM, Bové I. Ultrasound patterns of different dermal filler materials used in aesthetics. J Cosmet Dermatol 2021; 20:1541-1548. [PMID: 33641224 PMCID: PMC8252486 DOI: 10.1111/jocd.14032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
Background Hyaluronic acid (HA) injection procedures has experienced an unprecedented increase. Aims To assess and determine, by using ultrasound examinations, the patterns corresponding to different dermal fillers. Patients/Methods Observational and retrospective bicenter study conducted on patients who underwent previous aesthetic treatments with dermal fillers. Ultrasound examinations were performed, at each study center, by one experienced observer. Results Sixty patients were included in the analysis. Among them, 48 patients showed a well-defined ultrasound pattern, while 12 exhibited a mixed one. According to ultrasound images, 4 different patterns were identified: [1] Heterogeneous, characterized by alternating hyperechoic and anechoic areas, which are visualized in the tissue in a heterogeneous way. This pattern is associated with healthy skin/subcutaneous cellular tissue and with fully integrated HA fillers. [2] Fine grain snowfall, characterized by alternating hyperechoic imaging, with posterior echogenic shadows. It is typical of liquid injectable silicone. [3] Coarse grain snowfall, characterized by hyperechoic images distributed all over the tissue. This is typical of calcium hydroxyapatite and polymethyl methacrylate-based fillers. [4] Globular, typical "cystic" imaging, with anechoic images indicative of liquid semi-liquid content. This pattern is characteristic of polyalkylamides and polyacrylamides, and HA-based fillers immediately after their injection. The presence of "mixed" patterns is mainly due to different aesthetic procedures performed at different times. Conclusions Ultrasound imaging may be a valuable tool for assessing the nature of former dermal filler procedures in daily practice. The identification of these patterns will allow specialists to choose the best therapeutic approach in patients who underwent previous aesthetictreatments.
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22
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Mlosek RK, Migda B, Skrzypek E, Słoboda K, Migda M. The use of high-frequency ultrasonography for the diagnosis of palpable nodules after the administration of dermal fillers. J Ultrason 2021; 20:e248-e253. [PMID: 33500791 PMCID: PMC7830082 DOI: 10.15557/jou.2020.0044] [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: 09/27/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Esthetic medicine is a buoyant field of medicine. As the number of performed procedures – mainly injections of botulin toxin and dermal fillers – is increasing, the number of complications is rising as well. The most popular dermal filler is hyaluronic acid. Injection of hyaluronic acid dermal fillers is considered a minimally invasive procedure, but complications in the form of skin nodules and lumps are being encountered more and frequently. Esthetic medicine does not currently offer its own diagnostic methods that would allow one to diagnose complications. In these circumstances, the implementation of objective diagnostic methods from other fields of medicine becomes significant. High-frequency ultrasound is one of such methods. Aim of the study The aim of this study was to implement high-frequency ultrasound for the diagnosis of palpable nodules after the administration of dermal fillers. Material and method The study group included 15 women who developed palpable nodules in the region of hyaluronic acid injection. The study includes both early and late complications. An EPIQ 5 (Philips, Bothell, USA) ultrasound machine and a L5–18 transducer were used to examine the nodules. Ultrasound images were evaluated qualitatively by 2 independent investigators. Results Ultrasound enabled the diagnosis of hyaluronic acid deposition in 9 women, granulomas in 3 women, fibrosis in 2 women and a deposition with inflammation in 1 case. Each of the diagnosed structures presented a typical ultrasound appearance. Conclusions High-frequency ultrasound is a useful diagnostic method that has a chance to become a widespread tool to diagnose and treat complications. Because of a low number of study reports in this area, continued research is warranted.
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Affiliation(s)
- Robert Krzysztof Mlosek
- Ultrasound Diagnostic Department, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Migda
- Ultrasound Diagnostic Department, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Skrzypek
- Department of History of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Słoboda
- 1st Radiology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michał Migda
- Clinical Unit of Obstetrics, Women's Diseases and Gynecological Oncology, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Torun, Torun, Poland
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23
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Habib SM, Schelke LW, Velthuis PJ. Management of dermal filler (vascular) complications using duplex ultrasound. Dermatol Ther 2020; 33:e13461. [PMID: 32495477 DOI: 10.1111/dth.13461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sayed M Habib
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leonie W Schelke
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter J Velthuis
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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