Legal vs. illegal injectable fillers: The adverse effects comparison study

Cosmetic Injection of Illicit Foreign Materials: Imaging Features and Patterns of Migration in 413 Cases

BACKGROUND

The injection of illicit, nonregulated foreign materials is increasingly common and has negative consequences relative to the inflammatory process that ensues.

OBJECTIVES

The aim of this study was to identify anatomical and imaging characteristics after the cosmetic injection of illicit foreign materials.

METHODS

A retrospective review of clinical and imaging records was performed. The issues analyzed were the anatomical site, type of injected substance, imaging method for diagnosis, and patterns of migration.

RESULTS

Data on 413 patients were collected. Most patients were female, with a mean age of 44 years. The most commonly infiltrated region was the buttocks (n = 284; 53.58%) followed by the breast (n = 99; 18.67%). Magnetic resonance imaging was the most common method of diagnosis in those patients who had an imaging study (159 out of 168). The most frequent depth of foreign material detected by imaging was the muscular plane (n = 103; 61.30%). Migration was detected in 56.55% of patients who had an imaging study. Most infiltrated substances were unknown; biopolymers were the most commonly identified substances. Depending on the type of substance, migration rates varied from 13% to 29%; rate differences were not statistically significant (P = .712). Migration was more common when the depth of infiltration was in muscle (77.66%) than in subcutaneous tissue (23.4%); this difference was statistically significant (P < .0001).

CONCLUSIONS

Deep infiltration is related to greater migration rates, apparently regardless of the substance injected.

LEVEL OF EVIDENCE: 3

Algorithmic Approach to Management of Complications of Permanent Facial Filler: A Saudi Experience

Facial filler is the most common type of cosmetic surgery next to Botox. Permanent filler is preferred nowadays due to low cost brought about by nonrecurring injection appointments. However, such fillers pose a higher risk for complications, with even greater adverse effects when the procedure is done using unknown dermal filler injections. This study aimed to establish an algorithm to categorize and manage patients that receive permanent fillers.

Methods

Twelve participants were presented to the service through emergency or as outpatient from November 2015 to May 2021. Demographic characteristics such as age, sex, date of injection, time of onset, and types of complications were collected. After examination, all cases were managed based on an algorithm established. FACE-Q was used to measure overall satisfaction and psychological well-being.

Results

An algorithm to diagnose and manage these patients effectively with high satisfaction rate was established in this study. All participants were non-smoking women, with no known medical comorbidities. The algorithm determined the treatment plan when faced with complications. Results revealed high appearance-related psychosocial distress before surgery, which significantly dropped after surgery. FACE-Q was able to establish evidence of satisfactory rating among patients before and after surgery.

Conclusion

This treatment algorithm can guide the surgeon in formulating a suitable plan with less complications and high satisfaction rate.

Social Media in Aesthetic Dermatology: Analysis of the Users Behind the Top Filler Posts

BACKGROUND

Within the aesthetic realm, the influence of social media is quite prominent, with a growing percentage of patients using this technology to seek out health care recommendations and education.

OBJECTIVE

To ascertain the most accurate representation of what our patients may encounter on social media, we sought to characterize the top posts on the most popular visually-based social media platform (Instagram).

MATERIALS AND METHODS

We queried Instagram with variations of hashtags related to filler to determine which hashtags had the greatest number of posts associated with them. We then reviewed the top 100 posts associated with the top 9 hashtags, making note of whether the poster was a physician or nonphysician and whether an off-label procedure was performed or discussed.

RESULTS

Most (85.6%) of the 900 reviewed posts were written by nonphysicians, and most (84.6%) of the posts focused on off-label procedures were posted by nonphysicians. Among the physician posters, the most common specialties were Plastic Surgery and Family Medicine, followed by Dermatology.

CONCLUSION

At a time when patients are increasingly turning to social media for health care recommendations and education, most "top" content related to soft tissue augmentation is being provided by nonphysicians, many of whom are performing off-label procedures.

Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes

BACKGROUND

In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations.

OBJECTIVE

Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes.

MATERIALS AND METHODS

A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison.

RESULTS

Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae.

CONCLUSION

Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.

Clinical Management of Complications Following Filler Injection

AIM

Dermal fillers have been progressively used for cosmetic procedures. Concurrently, the rates of filler complications have also increased. The aim of this study is to describe the clinical management and treatment we performed in patients with complications occurred after filler injection.

METHODS

From March 2000 to February 2020, 197 patients have been evaluated for complications due to filler injection. For each patient type of material, symptoms and signs were recorded. Ultrasound evaluation was used to obtain information about the type, amount and location of the injected material. Magnetic Resonance Imaging was performed in those patients who were candidate for surgery. Based on the clinical manifestations, we performed a targeted therapy.

RESULTS

The local and systemic medical therapy allowed us a complete remission of the clinical signs and symptoms in all patients presented with edema and erythema. We obtained optimal results with surgery, where a complete removal of the injected material was possible. In all the cases in which the complete removal of the infiltrated area could have led to functional impairments, we performed partial removal with poor outcomes.

CONCLUSION

We observed complex clinical manifestations in the patients subjected to permanent fillers. An accurate knowledge upon the effects of the materials on tissues, a specific instrumental evaluation and a targeted therapy are crucial. We suggest the use of absorbable fillers. Patient should be subjected to filler implant in authorized structures by an expert specialist with experience in filler injection and with a thorough knowledge of the anatomical structures.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An update on cosmetic procedures in people of color. Part 2: Neuromodulators, soft tissue augmentation, chemexfoliating agents, and laser hair reduction

Recent years have brought forth the undeniable practice gap in dermatology concerning knowledge and experience of cosmetic procedures in people of color (POC). A paucity in the literature regarding evidence-based recommendations for the management of POC undergoing cosmetic procedures and the rise of cosmetic procedures in dermatology serves as a call to action to provide education regarding differences in skin of color that may impact the cosmetic outcomes. To mitigate the current practice gap on the safety, use, and benefits of cosmetic procedures in POC, part 2 will discuss the authors' recommendations and clinical pearls, as well as evidence-based management for neuromodulators, soft tissue augmentation, chemexfoliating agents, and laser hair reduction in POC undergoing cosmetic procedures.

Clinical and radiographic features of facial cosmetic materials: A systematic review

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.

ASIA syndrome symptoms induced by gluteal biopolymer injections: Case-series and narrative review

Background

The number of plastic surgery procedures have been rising in the last few years. The morbi-mortality due to illegal use of biopolymers is a public health problem. One of the clinical consequences, foreign body modelling reaction, may be a precursor of ASIA (Autoimmune/Inflammatory disease induced by adjuvants) syndrome.The objective of this article is to present a case-series study of patients who developed ASIA syndrome following gluteal injection with biopolymers and emphasize the importance of toxic exposure in triggering autoimmune responses. A surgical technique used on some of the patients in the study is described.

Methods

A group of thirteen patients, diagnosed with foreign body modelling reaction, who developed ASIA syndrome confirmed by approved criteria was followed between May 2016 and May 2018. The "Butterfly Wings Technique," a new surgical procedure for patients who have medium to severe compromise, was used on five of them.A narrative literature review was done to look for subjects with ASIA syndrome and gluteal biopolymer infiltration.

Results

All the patients in the present case-series with foreign body modelling reaction developed ASIA syndrome. Some of them had a background of familial autoimmunity. Five of the patients were surgically treated and saw a clinical improvement after the extraction of the biopolymer with the proposed technique.The narrative literature review identified 7 articles related to the disease through the database search.

Conclusions

We suggest that foreign body modelling reaction should be considered a precursor to ASIA syndrome. New research projects will be needed in the future to evaluate the factors that determine when ASIA syndrome is triggered in a patient with this reaction.

Complications after cosmetic periocular filler: prevention and management

Soft tissue fillers are a mainstay in contemporary, minimally invasive facial rejuvenation procedures owing to timely results and minimal recovery period. Although associated with a low complication rate, soft tissue fillers are not without risk. Complications range from mild superficial skin irregularities to granuloma formation to vascular occlusion leading to skin necrosis or even blindness. Fillers vary in composition, elasticity, hydrophilicity and duration of effect that is tailored to specific cosmetic indications. Selecting the right product for the desired effect can cut down on unwanted outcomes. Severe adverse events can be avoided with safe injection technique, early recognition of symptoms and a thorough knowledge of the local anatomy. This review outlines several complications all providers should recognize and discusses strategies for their prevention and management.