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Bachour Y, Kadouch JA, Niessen FB. The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature. Aesthetic Plast Surg 2021; 45:1748-1759. [PMID: 33913021 PMCID: PMC8316155 DOI: 10.1007/s00266-021-02306-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/11/2021] [Indexed: 11/03/2022]
Abstract
Background Late inflammatory reactions (LIRs) are the most challenging complications after filler use. The immune system plays a prominent role in its etiology, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for LIRs. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of LIRs. Methods We undertook a systematic literature review focused on immunological factors and microbiota in relation to LIRs after filler use. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE and the Cochrane databases were searched from inception up to August 2019. Included studies were assessed for the following variables: subject characteristics, number of patients, primary indication for filler injection, implant type/amount and injection site, type of complication, follow-up or injection duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors. Results Data on immunological factors and bacterial contamination were retrieved from 21 included studies. Notably, the presence of histocytes, giant cells and Staphylococcus epidermidis within biopsies were often associated with LIRs. Conclusion This review provides a clear overview of the immunological factors associated with LIRs and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with LIRs has been provided. Follow-up research may result in clinical recommendations to prevent LIRs. Level of Evidence III 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.. Supplementary Information The online version contains supplementary material available at 10.1007/s00266-021-02306-3.
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Convery C, Davies E, Murray G, Walker L. Delayed-onset Nodules (DONs) and Considering their Treatment following use of Hyaluronic Acid (HA) Fillers. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:E59-E67. [PMID: 34840652 PMCID: PMC8570356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Delayed-onset nodules (DONs) represent a poorly understood and generally neglected group of complications. It is not a diagnosis. The underlying pathologies and their incidences are largely unknown due to the lack of specificity in clinical signs and the challenges in accessing diagnostic tests, cost implications, or reluctance from patients to undergo them. A lack of presumptive clinical diagnosis, coupled with management ranging from "scatter-gun" polypharmacy to clinical inertia, is believed to result in chronicity and increased morbidity. This paper provides guidance on the identification and understanding of the underlying pathologies and encourages the increased utilization of a medical model of care. The more routine adoption of histopathology, inflammatory markers, and ultrasound will permit a more targeted management and a greater understanding of the incidences and evolution of the pathologies.
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Affiliation(s)
- Cormac Convery
- Dr. Convery is with The Ever Clinic Glasgow in Glasgow, Scotland
- Ms. Davies is the Clinical Director of Save Face UK
- Ms. Murray is with the Clinical Academic Kings College London in London, England
- Dr. Walker is with B City Clinic in Liverpool, England
- All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC)
| | - Emma Davies
- Dr. Convery is with The Ever Clinic Glasgow in Glasgow, Scotland
- Ms. Davies is the Clinical Director of Save Face UK
- Ms. Murray is with the Clinical Academic Kings College London in London, England
- Dr. Walker is with B City Clinic in Liverpool, England
- All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC)
| | - Gillian Murray
- Dr. Convery is with The Ever Clinic Glasgow in Glasgow, Scotland
- Ms. Davies is the Clinical Director of Save Face UK
- Ms. Murray is with the Clinical Academic Kings College London in London, England
- Dr. Walker is with B City Clinic in Liverpool, England
- All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC)
| | - Lee Walker
- Dr. Convery is with The Ever Clinic Glasgow in Glasgow, Scotland
- Ms. Davies is the Clinical Director of Save Face UK
- Ms. Murray is with the Clinical Academic Kings College London in London, England
- Dr. Walker is with B City Clinic in Liverpool, England
- All authors are founding board members of the Complications in Medical Aesthetics Collaborative (CMAC)
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Decates T, Kadouch J, Velthuis P, Rustemeyer T. Immediate nor Delayed Type Hypersensitivity Plays a Role in Late Inflammatory Reactions After Hyaluronic Acid Filler Injections. Clin Cosmet Investig Dermatol 2021; 14:581-589. [PMID: 34103958 PMCID: PMC8178514 DOI: 10.2147/ccid.s312198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/12/2021] [Indexed: 12/02/2022]
Abstract
Purpose The exact etiology of late inflammatory reactions (LIRs) to hyaluronic acid (HA) fillers is currently unknown. Some argue that these result from a hypersensitivity reaction, although evidence to support this is very scarce. Most reports on such reactions are not substantiated by positive skin tests. The purpose of our study was to determine whether immediate or delayed type hypersensitivity reaction follows hyaluronic acid (HA) filler injections. Patients and Methods Twelve patients were referred for general allergic screening (patch tests), as well as specific intradermal testing (injection of 0.1cc boluses) on the medial upper arm with a selection of several currently available hyaluronic acid (HA) fillers on the market. A positive allergic reaction was defined as erythema, firmness or swelling. Results During the 4 month follow-up, no reactions to any of the tested HA fillers were reported. No correlation was found between results from the general allergic screening and a history with LIRs to HA fillers. Conclusion The results suggest that neither type I nor type IV hypersensitivity plays a role in late inflammatory reactions (LIRs) to hyaluronic acid (HA) fillers. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/ldw2cZOftOw
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Affiliation(s)
- Tom Decates
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jonathan Kadouch
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter Velthuis
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Rolim LSA, Barros CCDAS, Pinheiro JC, DE Oliveira PT, DE Souza LB, Santos PPDEA. Analysis of nine cases of oral foreign body granuloma related to biomaterials. J Biosci 2019; 44:78. [PMID: 31502556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Foreign bodies can penetrate the interior of soft and, sometimes, hard, tissues in various ways, including through open wounds, lacerations and traumatic accidents. However over the years, evidence of links between the use of dental materials and lately, significant involvement of aesthetic filler materials as foreign bodies in the oral and perioral region have been reported. Foreign body granulomas (FBGs) may develop from this exogenous material, histopathologically characterized by the presence of chronic inflammation and a high amount of macrophages. This study presents nine FBG cases affecting the oral and perioral regions, and carries out a literature review on the main clinical, histopathological and material characteristics used in dental and dermatological procedures related to the appearance of this type of granuloma.
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Marusza W, Olszanski R, Sierdzinski J, Ostrowski T, Szyller K, Mlynarczyk G, Netsvyetayeva I. Treatment of late bacterial infections resulting from soft-tissue filler injections. Infect Drug Resist 2019; 12:469-480. [PMID: 30863129 PMCID: PMC6390860 DOI: 10.2147/idr.s186996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose Late bacterial infections (LBIs) after esthetic facial augmentation using hyaluronic acid (HA) fillers are relatively rare yet severe complications that are difficult to treat. No adequate treatment standards have hitherto been formulated. We have bridged this gap by formulating a treatment scheme based on the principles of treating foreign-body implantation-related infections and treating bacterial growth in the form of biofilm. The objective of this study was to evaluate the efficacy of a comprehensive scheme for treating LBI complications after facial augmentation using cross-linked HA fillers. Methods A total of 22 patients with LBI symptoms at a site of cross-linked HA injection underwent treatment and observation. The comprehensive treatment scheme formulated by Marusza and Netsvyetayeva (M&N scheme) comprised draining the lesion, dissolution of cross-linked HA with hyaluronidase, broad-spectrum antibiotic combination therapy, and use of probiotics. While 17 patients underwent the M&N scheme, the remaining five were treated with other schemes. Statistical analysis of the data was performed using Mann–Whitney U and χ2 nonparametric tests with SAS 9.4 software. Results All 17 patients who underwent the M&N scheme experienced resolution of symptoms, with no recurrence of infection at the HA-injection sites. Conclusion To treat LBI at a site of cross-linked HA administration, the principles applicable to infections resulting from implantation of a foreign body must be followed. The treatment period should be sufficiently long for complete resolution of symptoms. The efficacy of treatment is considered proven if 2 months have elapsed without recurrence since the symptoms resolved. The M&N scheme is recommended for use as the first therapeutic option for treating LBI related to soft-tissue fillers.
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Affiliation(s)
| | | | - Janusz Sierdzinski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Ostrowski
- Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Grazyna Mlynarczyk
- Department of Microbiology, Medical University of Warsaw, Warsaw, Poland,
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Iannitti T, Morales-Medina JC, Merighi A, Boarino V, Laurino C, Vadalà M, Palmieri B. A hyaluronic acid- and chondroitin sulfate-based medical device improves gastritis pain, discomfort, and endoscopic features. Drug Deliv Transl Res 2018; 8:994-999. [PMID: 29796851 PMCID: PMC6133073 DOI: 10.1007/s13346-018-0531-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Gastritis is an inflammation of the gastric mucosa. In this study, we investigated the efficacy of a medical device, Esoxx®, based on hyaluronic acid and chondroitin sulfate on gastritis-related upper abdominal pain/discomfort and endoscopic features. Fifty patients, affected by gastritis, were randomised to receive the medical device or placebo. The primary endpoint was the medical device efficacy on upper abdominal pain/discomfort associated with gastritis and measured by Visual Analogue Scale (VAS). The secondary endpoints were the efficacy of the medical device on gastritis-related mucosal erosions, blood oozing, and hyperemia (redness)/edema, as assessed by endoscopy, and the patients’ rating of their compliance with the treatments. A significant reduction in VAS pain was observed in the treatment group after a 5-week treatment, if compared with placebo (p < 0.001). In summary, administration of a medical device, based on hyaluronic acid and chondroitin sulfate, improves gastritis-related upper abdominal pain/discomfort and decreases mucosal erosions, blood oozing, and hyperemia (redness)/edema at 5-week follow-up in patients affected by gastritis.
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Affiliation(s)
- Tommaso Iannitti
- KWS BioTest, 47-48 Martingale Way, Marine View Office Park, BS20 7AW, Portishead, Somerset, UK.
| | - Julio César Morales-Medina
- Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, AP 62, CP 90000, Tlaxcala, Mexico
| | - Alberto Merighi
- Department of Gastroenterology, Division of Digestive Endoscopy, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Valentina Boarino
- Department of Gastroenterology, Division of Digestive Endoscopy, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, 41124, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
| | - Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, 41124, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic, 41124, Modena, Italy.,Second Opinion Medical Network, Modena, Italy
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Netsvyetayeva I, Marusza W, Olszanski R, Szyller K, Krolak-Ulinska A, Swoboda-Kopec E, Sierdzinski J, Szymonski Z, Mlynarczyk G. Skin bacterial flora as a potential risk factor predisposing to late bacterial infection after cross-linked hyaluronic acid gel augmentation. Infect Drug Resist 2018; 11:213-222. [PMID: 29483779 PMCID: PMC5813765 DOI: 10.2147/idr.s154328] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction Cross-linked hyaluronic acid (HA) gel is widely used in esthetic medicine. Late bacterial infection (LBI) is a rare, but severe complication after HA augmentation. The aim of this study was to determine whether patients who underwent the HA injection procedure and developed LBI had qualitatively different bacterial flora on the skin compared to patients who underwent the procedure without any complications. Methods The study group comprised 10 previously healthy women with recently diagnosed, untreated LBI after HA augmentation. The control group comprised 17 healthy women who had a similar amount of HA injected with no complications. To assess the difference between the two groups, their skin flora was cultured from nasal swabs, both before and after antibiotic treatment in the study group. Results A significant increase in the incidence of Staphylococcus epidermidis was detected in the control group (P=0.000) compared to the study group. The study group showed a significantly higher incidence of Staphylococcus aureus (P=0.005), Klebsiella pneumoniae (P=0.006), Klebsiella oxytoca (P=0.048), and Staphylococcus haemolyticus (P=0.048) compared to the control group. Conclusion The bacterial flora on the skin differed in patients with LBI from the control group. The control group’s bacterial skin flora was dominated by S. epidermidis. Patients with LBI had a bacterial skin flora dominated by potentially pathogenic bacteria.
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Affiliation(s)
| | | | | | | | | | | | - Janusz Sierdzinski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland
| | - Zachary Szymonski
- Department of Zoology, Magdalen College, University of Oxford, Oxford, UK
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Wang Y, Leng V, Patel V, Phillips KS. Injections through skin colonized with Staphylococcus aureus biofilm introduce contamination despite standard antimicrobial preparation procedures. Sci Rep 2017; 7:45070. [PMID: 28332593 PMCID: PMC5362901 DOI: 10.1038/srep45070] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/13/2017] [Indexed: 12/12/2022] Open
Abstract
While surgical site preparation has been extensively studied, there is little information about resistance of skin microbiota in the biofilm form to antimicrobial decontamination, and there are no quantitative models to study how biofilm might be transferred into sterile tissue/implant materials during injections for joint spine and tendon, aspiration biopsies and dermal fillers (DF). In this work, we develop two in vitro models to simulate the process of skin preparation and DF injection using pig skin and SimSkin (silicone) materials, respectively. Using the pig skin model, we tested three of the most common skin preparation wipes (alcohol, chlorhexidine and povidone iodine) and found that during wiping they reduced the biofilm bacterial burden of S. aureus (CFU cm-2) by three logs with no statistically significant differences between wipes. Using the SimSkin model, we found that transfer of viable bacteria increased with needle diameter for 30G, 25G and 18G needles. Transfer incidence decreased as injection depth was increased from 1 mm to 3 mm. Serial puncture and linear threading injection styles had similar transfer incidence, whereas fanning significantly increased transfer incidence. The results show that contamination of DF during injection is a risk that can be reduced by modifying skin prep and injection practices.
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Affiliation(s)
- Yi Wang
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry and Materials Science, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Valery Leng
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry and Materials Science, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Viraj Patel
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry and Materials Science, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - K. Scott Phillips
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry and Materials Science, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
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Kim JH, Choi JS, Yun JH, Kang HK, Baek JO, Roh JY, Lee JR. Foreign body reaction to injectable hyaluronic Acid: late granuloma formation. Ann Dermatol 2015; 27:224-5. [PMID: 25834371 PMCID: PMC4377421 DOI: 10.5021/ad.2015.27.2.224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ji Hoon Kim
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Joon Seok Choi
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jeong Hwan Yun
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hong Kyu Kang
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Ok Baek
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Rok Lee
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
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Experimental and Clinical Efficacy of Two Hyaluronic Acid-based Compounds of Different Cross-Linkage and Composition in the Rejuvenation of the Skin. Pharm Res 2014; 33:2879-2890. [PMID: 24962508 DOI: 10.1007/s11095-014-1354-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/27/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the field of aesthetic medicine there is an increasing demand for safe and effective hyaluronic acid (HA) fillers to counteract the aging process. METHODS AND AIMS We designed a study to evaluate the safety and histological biocompatibility of Aliaxin® Global Performance, a cross-linked HA filler and Viscoderm® Skinkò E, a product composed of non-cross-linked HA and a complex including vitamins, antioxidants, amino acids and minerals injected into the skin of guinea pigs. Then, we translated our findings into the clinical setting, administering a combination of these compounds to patients seeking a facial rejuvenation procedure targeting moderate-to-severe wrinkles affecting the nasolabial folds. RESULTS The animal study showed that the two compounds did not induce any significant inflammatory reactions and increased collagen and elastic fibers in the skin. In the clinical setting, injection of Aliaxin® Global Performance, followed by Viscoderm® Skinkò E, resulted in a higher improvement in nasolabial fold hydration, trans-epidermal water loss and wrinkle aesthetic appearance, if compared with a protocol based on Aliaxin® Global Performance alone. CONCLUSION In summary, we show evidence on the safety and mechanism underlying two new HA-based compounds of different cross-linkage and composition, proposing that they can be safely used in combination in patients seeking facial rejuvenation procedures with long-lasting efficacy.
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Iannitti T, Rottigni V, Palmieri B. Corticosteroid transdermal delivery to target swelling, edema and inflammation following facial rejuvenation procedures. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:1035-41. [PMID: 24101860 PMCID: PMC3790836 DOI: 10.2147/dddt.s45722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM The use of transdermal therapeutic systems has spread worldwide since they allow effective local drug delivery. In the present study, we investigated the efficacy and safety of a new betamethasone valerate medicated plaster (Betesil®) to manage facial swelling, edema, inflammation, ecchymosis, and hematoma, when applied immediately after a facial rejuvenation procedure. MATERIALS AND METHODS We applied the plaster to the skin of 20 healthy patients for 12 hours immediately after hyaluronic acid-based procedure performed with the aim of erasing facial wrinkles of perioral and nasolabial folds and improving chin and eye contour. A further 20 patients underwent the same cosmetic procedure, but they were treated with an aescin 10% cream (applied immediately after the procedure, in the evening, and the morning after) and served as control group. RESULTS Betesil® application resulted in a significant improvement in swelling/edema/inflammation score, if compared with aescin 10% cream (P < 0.01). As for facial ecchymosis and hematoma around the needle injection track, only two patients in the active treatment group displayed minimal ecchymosis and hematoma. In the control group, two patients presented minimal ecchymosis and three slight hematoma. However, using the ecchymosis/hematoma score, no significant difference between Betesil® and aescin 10% cream groups was observed. Patients' satisfaction was significantly higher among subjects receiving Betesil®, if compared to patients receiving aescin 10% cream (P < 0.01). CONCLUSION The present study supports the use of Betesil® plaster immediately after facial cosmetic procedures in order to safely control swelling, edema, and inflammation.
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Affiliation(s)
- T Iannitti
- School of Biomedical Sciences, University of Leeds, Leeds, UK ; Poliambulatorio del Secondo Parere, Modena, Italy
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DUMITRAŞCU DINUI, GEORGESCU ALEXANDRUV. The management of biofilm formation after hyaluronic acid gel filler injections: a review. CLUJUL MEDICAL (1957) 2013; 86:192-5. [PMID: 26527945 PMCID: PMC4462513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/05/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIM One of the most popular procedures of facial fillers in recent years has become the use of hyaluronic acid (HA). However, this method may be associated with local side effects of different severity. Many of them are not due to allergies, as previously believed, but to the formation of biofilm. We review the current knowledge on biofilm after HA. METHODS All pertinent full text papers retrieved from PubMed under search words: "biofilm", "hyaluronic acid", "dermal fillers", "hyaluronic acid complications" and "hyaluronic acid side effects" were analyzed; 29 of 60 articles were selected fro analysis. RESULTS Local infections were reported: 13 cases are attributable to the activation of the biofilm. Clinical evolution is generally mild. Therapy should avoid NSAID and is based on the administration of antibiotics, oral corticosteroids, or 5-Flourouracil. Removal of HA with hyaluronidase has also been proposed. CONCLUSIONS The use of HA in cosmetic procedures might be accompanied by local adverse effects attributable to biofilm formation. This usually has a mild evolution, but in special cases requires specific therapy.
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