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Salame N, Brody HJ. Highly Purified Microdroplet Liquid Injectable Silicone for the Treatment of Acne Scars in Lighter and Darker Skin Types: A Retrospective Review. Dermatol Surg 2023; 49:363-367. [PMID: 36799864 DOI: 10.1097/dss.0000000000003712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Treatment of acne scarring in darker skin types is fraught with challenges. Highly purified liquid injectable silicone (LIS) is effective in the treatment of acne scars, although its use in darker skin types has yet to be evaluated. OBJECTIVE Retrospective evaluation of the safety and efficacy of highly purified LIS for the treatment of acne scars in lighter and darker skin types. MATERIALS AND METHODS A retrospective chart review of patients who received highly purified LIS for acne scars between July 2010 and March 2021. RESULTS Two hundred six total treatments in 96 patients, 32.29% ( n = 31) of whom were Fitzpatrick skin type IV ( n = 20, 20.83%) and V ( n = 11, 11.46%), with depressed and both broad-based and shallow acne scarring were reviewed. Mean age was 50.77 years (SD 16.77), and 83% were female. Complications such as granuloma formation, migration, extrusion of silicone, hyperpigmentation, hematoma, or infection were not observed. The average follow-up time was 6.31 years (SD 3.02). CONCLUSION Highly purified LIS is a safe and effective permanent treatment for acne scars in all skin types. Injection of highly purified LIS using small volume microdroplet technique at 6- to 8-week intervals did not yield any complications, including in patients with darker skin types.
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Affiliation(s)
- Nicole Salame
- Both authors are affiliated with the Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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Ten-Year and Beyond Follow-up After Treatment With Highly Purified Liquid-Injectable Silicone for HIV-Associated Facial Lipoatrophy: A Report of 164 Patients. Dermatol Surg 2019; 45:941-948. [PMID: 30893157 DOI: 10.1097/dss.0000000000001889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Highly purified liquid-injectable silicone (LIS) has been established as a permanent agent for off-label correction of HIV-associated facial lipoatrophy (HIV-FLA). However, controversy exists about long-term safety. OBJECTIVE To establish the safety and efficacy at 10 years or greater of LIS for HIV-FLA. METHODS Patients from 3 practices with 10-year or greater in-person office follow-up were analyzed to determine the number of LIS treatments and total volume required to achieve optimal correction. The nature of any treated adverse events was noted. RESULTS One hundred sixty-four patients had 10-year or greater in-office follow-up. All subjects maintained long-term correction with an average of 9 treatments, average of 1.56 mL per treatment, and an average total of 14.1 mL. Two patients had severe adverse events manifesting as temporary facial edema. Four patients experienced mild-to-moderate excess fibroplasia presenting as perceived overcorrection, and 6 patients had nondisfiguring subcutaneous firmness. All adverse events were successfully treatable, mostly with intralesional 5-fluorouracil and triamcinolone. CONCLUSION Liquid-injectable silicone is an effective long-term treatment option for HIV-FLA. When injected in small quantities with the microdroplet serial puncture technique at monthly or greater intervals, optimal correction appears durable for more than 10 years. Adverse events consisted mostly of excess fibroplasia and were treatable.
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Silicone-induced Granuloma After Buttock Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e624. [PMID: 27014553 PMCID: PMC4778895 DOI: 10.1097/gox.0000000000000618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
Liquid silicone is inexpensive, minimally antigenic, and likely noncarcinogenic. Its simplicity of use has made it popular as a soft-tissue filler in some parts of the world for patients seeking rapid soft-tissue augmentation of the face, breast, and buttocks. However, multiple reports describe the complications of silicone injections such as cellulitis, abscess, ulceration, and foreign body migration. We present an unusual complication of granulomatous reaction secondary to silicone injection for buttock augmentation, with a literature review of this entity and treatment options. Our patient was a 54-year-old woman who underwent bilateral buttock augmentation in the Dominican Republic using percutaneous injection of liquid silicone. She presented to our facility 1 year after this procedure with pain and inflammation of both buttocks. She was diagnosed with multiple silicone granulomas. Her symptoms completely resolved with a 3-week course of minocycline. Granulomatous reactions to silicone may occur months to years after the silicone injection. The incidence of such complications may be increased when nonmedical-grade silicone is used, and hence, when these procedures are performed in developing countries. Tetracycline antibiotics, especially minocycline, may be used to achieve sustained remission.
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Affiliation(s)
- John H Joseph
- 9400 Brighton Way, Suite 203, Beverly Hills, CA 90210, USA.
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Rewriting History: Fever of Unknown Origin. Am J Med 2015; 128:956-8. [PMID: 26007673 DOI: 10.1016/j.amjmed.2015.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 11/23/2022]
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Nasseri E. Gluteal Augmentation With Liquid Silicone of Unknown Purity Causes Granulomas in an Adult Female. J Cutan Med Surg 2015. [DOI: 10.1177/1203475415598065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A 39-year-old woman presented with a history of relapsing painful erythema and progressive fibrosis of the lower back. Upon questioning, the patient admitted to receiving liquid silicone (LS) injections for gluteal augmentation abroad and was diagnosed with silicone migration, granulomatous reaction, and fibrosis of the lower back. Objective: To review the history of LS injections for cosmetic soft tissue augmentation (STA) as well as its complications and potential treatments. Methods: The author reviewed articles that involved the use of LS for STA and summarized their findings. Results: The author summarizes the various treatments that have been described for inflammatory reactions following LS injection. Conclusion: The growth of cosmetic medical tourism and its inherent lack of after-care as well as patients’ ability to obtain restricted products at home raise the likelihood of encountering granulomatous or fibrotic reactions to fillers during consultations. Physicians should have a structured approach to these patients.
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Affiliation(s)
- Eiman Nasseri
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
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7
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Carruthers J, Carruthers A. Non-operative facial rejuvenation. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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8
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Paul S, Goyal A, Duncan LM, Smith GP. Granulomatous reaction to liquid injectable silicone for gluteal enhancement: review of management options and success of doxycycline. Dermatol Ther 2015; 28:98-101. [PMID: 25649644 DOI: 10.1111/dth.12204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Liquid injectable silicone (LIS) for cosmetic purposes has been widely available and commonly used for almost half a century. An increase in buttock augmentation procedures because of patients wanting to emulate the look of some celebrities has recently highlighted cases in the media of unsafe administration of liquid silicone injections. Severe complications including death have been reported. In this article, we report a case in which liquid silicone was injected in the patient's gluteal tissue resulting in granulomatous reactions in the surrounding tissues. The patient responded well to doxycycline, presumably because of both its antimicrobial properties and immunomodulatory effects.
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Kadouch JA, Tutein Nolthenius CJ, Kadouch DJ, van der Woude HJ, Karim RB, Hoekzema R. Complications After Facial Injections With Permanent Fillers: Important Limitations and Considerations of MRI Evaluation. Aesthet Surg J 2014; 34:913-23. [PMID: 24948821 DOI: 10.1177/1090820x14539504] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Soft-tissue fillers have become more prevalent for facial augmentation in the last 2 decades, even though complications of permanent fillers can be challenging to treat. An investigative imaging tool could aid in assessing the nature and extent of these complications when clinical findings are ambiguous. OBJECTIVES The authors analyzed the value of magnetic resonance imaging (MRI) in the assessment of delayed-onset complications after injection of patients with permanent fillers. METHODS Thirty-two patients with complications related to facial fillers were evaluated in this prospective cohort study. Their medical history was documented, and MRI was conducted before treatment of the complications. Radiologists were informed of the injection sites but were blinded to the results of other clinical evaluations. Levels of agreement between clinical and radiologic findings were calculated with the Jaccard similarity coefficient. RESULTS A total of 107 site-specific clinicoradiologic evaluations were analyzed. The level of agreement was assessed as strong for deposits without complications and noninflammatory nodules (combined 85%), moderate for abscesses (60%), fair for low-grade inflammations (32%), and slight for migrations (9%). Results from the MRI examinations aided in subsequent treatment decisions in 11% of cases. CONCLUSIONS Study results show that MRI may be useful for diagnosing complications associated with fillers that have migratory potential, for depiction of the extent of deposits before treatment, and for follow-up of low-grade inflammation and abscesses after surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jonathan A Kadouch
- Dr J.A. Kadouch is a resident, Division of Dermatology, Free University Medical Center, Amsterdam, Netherlands
| | - Charlotte J Tutein Nolthenius
- Dr Tutein Nolthenius is a resident in a teaching hospital, Division of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Daniel J Kadouch
- Dr D.J. Kadouch is a resident, Division of Dermatology, Academic Medical Center, Amsterdam, Netherlands
| | - Henk-Jan van der Woude
- Dr van der Woude is a radiologist in a teaching hospital, Division of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Refaat B Karim
- Dr Karim is a plastic surgeon in private practice in Amstelveen, Netherlands
| | - Rick Hoekzema
- Dr Hoekzema is the Head of the Division of Dermatology, Free University Medical Center and Academic Medical Center, Amsterdam, Netherlands
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Hizal E, Buyuklu F, Ozdemir BH, Erbek SS. Long-term inflammatory response to liquid injectable silicone, cartilage, and silicone sheet. Laryngoscope 2014; 124:E425-30. [DOI: 10.1002/lary.24800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/22/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Evren Hizal
- Department of Otorhinolaryngology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
| | - Fuat Buyuklu
- Department of Otorhinolaryngology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
| | - B. Handan Ozdemir
- Department of Pathology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
| | - Selim S. Erbek
- Department of Otorhinolaryngology; Baskent University, Faculty of Medicine; 06490 Ankara Turkey
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de Vries CGJCA, Geertsma RE. Clinical data on injectable tissue fillers: a review. Expert Rev Med Devices 2013; 10:835-53. [PMID: 24164663 DOI: 10.1586/17434440.2013.839211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment with injectable tissue fillers for aesthetic purposes is increasingly popular. In parallel with this success, questions related to the safety of these treatments and the products involved are being raised more prominently. To gain insight in the safety aspects of injectable tissue fillers, we performed a literature review to collect studies reporting clinical data of injectable tissue fillers. We found several case reports where serious complications after more than three years are described. However, there are only a limited number of well-defined prospective clinical studies available with follow-up periods longer than three years. Furthermore, causes of complications, that is, treatment or product related, are often not specified in literature. Considering the intended functional period of fillers in combination with the known occurrence of long-term complications, there is a need for well-defined prospective clinical studies. In order to be able to discriminate between product failure (a product safety issue) or application methodology (a physician expertise or training issue), better identification of observed complications and whether they are product or treatment related, is needed. For the safe use of the fillers it is important that treatment with injectable tissue fillers is performed by a trained physician, who knows the product specifications and its applications.
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Affiliation(s)
- Claudette G J C A de Vries
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, NL-3720 BA Bilthoven, The Netherlands
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Ledon JA, Savas JA, Yang S, Franca K, Camacho I, Nouri K. Inflammatory nodules following soft tissue filler use: a review of causative agents, pathology and treatment options. Am J Clin Dermatol 2013; 14:401-11. [PMID: 24037757 DOI: 10.1007/s40257-013-0043-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Nodule development is a common complication following the use of fillers for soft tissue augmentation and is commonly categorized as inflammatory or non-inflammatory in nature. Inflammatory nodules may appear anywhere from days to years after treatment, whereas non-inflammatory nodules are typically seen immediately following implantation and are usually secondary to improper placement of the filler. Although inflammatory nodules are more common with permanent fillers such as silicone, inflammatory nodule development following administration of temporary fillers such as hyaluronic acid and collagen has also been reported. Treated many times with corticosteroids due to their anti-inflammatory properties, inflammatory nodules may be secondary to infection or biofilm formation, warranting the use of alternative agents. Appropriate and prompt diagnosis is important in avoiding delay of treatment or long-term complications for the patient. This paper addresses the etiology, development, and studied treatment options available for inflammatory nodules secondary to each of the major classes of fillers. With this knowledge, practitioners may expeditiously recognize and manage this common side effect and thus maximize functional and aesthetic benefit.
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Affiliation(s)
- Jennifer A Ledon
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, 2nd floor, Miami, FL, 33136, USA,
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Ginat DT, Schatz CJ. Imaging features of midface injectable fillers and associated complications. AJNR Am J Neuroradiol 2013; 34:1488-95. [PMID: 22837310 DOI: 10.3174/ajnr.a3161] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Injectable fillers are increasingly used for midface augmentation, which can be performed for facial rejuvenation and treatment of HIV facial lipoatrophy. A variety of temporary and permanent filler agents has been developed, including calcium hydroxylapatite, collagen, liquid silicone, polytetrafluoroethylene, hyaluronic acid, poly-l-lactic acid, and polyacrylamide gel. Facial fillers are sometimes encountered on radiologic imaging incidentally and should not be mistaken for pathology. Alternatively, patients with facial fillers may undergo imaging specifically to evaluate associated complications, such as infection, overfilling, migration, foreign-body reaction, and scarring. Therefore, it is important to be familiar with the imaging appearances of the various filler materials and their complications.
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Affiliation(s)
- D T Ginat
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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14
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Kadouch JA, van Rozelaar L, Karim RB, Hoekzema R. Current treatment methods for combination antiretroviral therapy-induced lipoatrophy of the face. Int J STD AIDS 2013; 24:685-94. [DOI: 10.1177/0956462412474539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Summary Combination antiretroviral therapy (CART) reduces the mortality and morbidity in HIV-infected patients. However, facial lipoatrophy (FLA) is one of the well-known side-effects of this treatment and subsequently imposes major problems for HIV-infected patients. In the last decade, ample experience has been obtained with both local therapeutic options as well as possible systemic treatment options. Soft tissue fillers are a relatively simple and efficient treatment option for FLA. Especially, the biodegradable semi-permanent fillers combine a good effect with durability and an acceptable safety profile. The best way to prevent or restrict the development of FLA remains the exclusion of thymidine analogue nucleoside reverse-transcriptase inhibitors from the CART schedule.
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Affiliation(s)
- J A Kadouch
- Department of Dermatology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - R B Karim
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - R Hoekzema
- Department of Dermatology, VU Medical Centre, Amsterdam, The Netherlands
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15
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Luebberding S, Alexiades-Armenakas M. Critical Appraisal of the Safety of Dermal Fillers: A Primer for Clinicians. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0042-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Levy LL, Emer JJ. Complications of minimally invasive cosmetic procedures: prevention and management. J Cutan Aesthet Surg 2012; 5:121-32. [PMID: 23060707 PMCID: PMC3461789 DOI: 10.4103/0974-2077.99451] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care.
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Affiliation(s)
- Lauren L Levy
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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Camacho D, Machan S, Pilesanski U, Revelles JM, Martín L, Requena L. Generalized Livedo Reticularis Induced by Silicone Implants for Soft Tissue Augmentation. Am J Dermatopathol 2012; 34:203-7. [DOI: 10.1097/dad.0b013e31821cb3c5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schäfer CN, Hvolris J, Karlsmark T, Plambech M. Muscle enhancement using intramuscular injections of oil in bodybuilding: review on epidemiology, complications, clinical evaluation and treatment. Eur Surg 2011. [DOI: 10.1007/s10353-011-0033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Shvartsbeyn M, Rapkiewicz A. Silicon-associated subcutaneous lesion presenting as a mass: a confounding histopathologic correlation. Hum Pathol 2011; 42:1364-7. [DOI: 10.1016/j.humpath.2011.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 11/21/2010] [Accepted: 01/11/2011] [Indexed: 11/25/2022]
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Cakmak O, Turkoz HK, Polat S, Serin GM, Hizal E, Tanyeri H. Histopathologic response to highly purified liquid silicone injected intradermally in rats' skin. Aesthetic Plast Surg 2011; 35:538-44. [PMID: 21369870 DOI: 10.1007/s00266-011-9657-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to assess and compare the tissue response to small- and large-volume injections of pure liquid silicone in rats. METHODS The study used 25 Sprague-Dawley rats. Two different injection sites were determined for a single rat, and 5000 centistoke liquid silicone was injected subdermally using 0.2-0.3 ml (small volume) and 1 ml (large volume) injections. After the injections, 15 animals were killed at 4 weeks and 10 animals at 10 weeks. Tissue responses were evaluated under a light microscope. RESULTS At week 4, the numbers of lymphocytes and neutrophils were higher in the small-volume injection group. At week 10, the number of neutrophils decreased, and the numbers of macrophages and foreign body giant cells increased in the small-volume injection group, whereas the intensity and type of infiltrate in the large-volume injection group did not change significantly. The thickness of the fibrous capsule was greater in large-volume injection group at weeks 4 and 10. The thickness of the fibrous capsule did not change significantly in either group through time. CONCLUSIONS Purified high-density liquid injectable silicone causes a low-grade and well-tolerated inflammatory response during the long term and can be used when given as small-volume injections.
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Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1-34; quiz 35-6. [DOI: 10.1016/j.jaad.2010.02.064] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
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Rocchio TM. Augmentation of atrophic plantar soft tissue with an acellular dermal allograft: a series review. Clin Podiatr Med Surg 2009; 26:545-57. [PMID: 19778688 DOI: 10.1016/j.cpm.2009.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Treatment of plantar fat pad migration and atrophy has caused concern for decades. Patients can present with pain, callus formation, or ulceration. The purpose of this article is to review the results of a consecutive series of patients treated for fat pad atrophy of the plantar foot, using a minimally invasive implantation of an acellular human dermal allograft as a tissue augmentation. This material was chosen for the fat pad supplementation because of previous reports of success in tendon and ligament augmentation, wound healing, and interpositional arthroplasty.
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HEVIA OSCAR. Six-Year Experience Using 1,000-Centistoke Silicone Oil in 916 Patients for Soft-Tissue Augmentation in a Private Practice Setting. Dermatol Surg 2009; 35 Suppl 2:1646-52. [DOI: 10.1111/j.1524-4725.2009.01343.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Foreign body granulomas after all injectable dermal fillers: part 2. Treatment options. Plast Reconstr Surg 2009; 123:1864-1873. [PMID: 19483588 DOI: 10.1097/prs.0b013e3181858f4f] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Foreign body granulomas occur at certain rates with all injectable dermal fillers. They have to be distinguished from early implant nodules, which usually appear 2 to 4 weeks after injection. In general, foreign body granulomas appear after a latent period of several months at all injected sites at the same time. If diagnosed early and treated correctly, they can be diminished within a few weeks. The treatment of choice of this hyperactive granulation tissue is the intralesional injection of corticosteroid crystals (triamcinolone, betamethasone, or prednisolone), which may be repeated in 4-week cycles until the right dose is found. To lower the risk of skin atrophy, corticosteroids can be combined with antimitotic drugs such as 5-fluorouracil and pulsed lasers. Because foreign body granulomas grow fingerlike into the surrounding tissue, surgical excision should be the last option. Surgery or drainage is indicated to treat normal lumps and cystic foreign body granulomas with little tissue ingrowth. In most patients, a foreign body granuloma is a single event during a lifetime, often triggered by a systemic bacterial infection.
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Foreign Body Granulomas after All Injectable Dermal Fillers: Part 1. Possible Causes. Plast Reconstr Surg 2009; 123:1842-1863. [DOI: 10.1097/prs.0b013e31818236d7] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To assess patient outcome and imaging findings of patients with pulmonary embolism of fluid silicone. METHODS Medical records and imaging examinations of 10 patients with respiratory distress after illicit injection of fluid silicone were reviewed. Population consisted of 8 male (6 male-to-female transsexuals) and 2 female subjects. RESULTS Average age was 29 years. Most common injection sites were gluteal and trochanteric. Respiratory symptoms developed between 15 minutes and 2 days after silicone injection. Five referred fever, 6 developed adult respiratory distress syndrome, and 2 subsequently died. Alveolar hemorrhage was demonstrated on pathological examination in 6, with silicone vacuoles in the lung parenchyma in 3. Computed tomography demonstrated peripheral ground glass opacities with interlobular septal thickening in all and peripheral airspace disease in 7. CONCLUSIONS Illicit injection of large volumes of fluid silicone for cosmetic purposes is associated with pulmonary embolism and acute alveolar hemorrhage and is associated with a significant mortality.
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Anastassov G, Schulhof S, Lumerman H. Complications after facial contour augmentation with injectable silicone. Diagnosis and treatment. Report of a severe case. Int J Oral Maxillofac Surg 2008; 37:955-60. [DOI: 10.1016/j.ijom.2008.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 11/08/2007] [Accepted: 04/24/2008] [Indexed: 10/22/2022]
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Abstract
In today's society the desire to maintain a youthful appearance has driven the development of minimally invasive dermatological procedures that are designed to rejuvenate the ageing face. The aim of this review is to present evidence for the use of techniques which can easily be incorporated into outpatient dermatology practice with low overhead expenditure. For this reason, laser and light-based treatments have been omitted. This review will instead focus on chemical peels, intradermal fillers and botulinum toxin. These techniques address the main aspects of facial ageing, namely photodamage, volume loss and dynamic lines, which correlate anatomically to skin, subcutaneous fat and muscle. A combination of such techniques will provide the practitioner with a reasonable portfolio of treatments for a balanced, holistic result.
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Affiliation(s)
- S Ogden
- Dermatological Sciences, University of Manchester, Manchester, U.K.
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Topaz M. Injectable volumetric fillers and botulinum toxin in facial rejuvenation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2008. [DOI: 10.1007/s00238-008-0296-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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32
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Abstract
PURPOSE OF REVIEW Facial aging results from multiple microscopic (histopathologic) and macroscopic (anatomic) changes. Whereas skin care and traditional surgery have much to offer patients desiring cosmetic improvement, they can fail to adequately address certain signs of facial aging. Soft-tissue augmentation with dermal fillers can successfully address these signs of aging by filling soft-tissue defects caused by age, scar formation, or disease. All dermal fillers aim to achieve the same goal: long-lasting soft-tissue augmentation without side effects. Each dermal filler preparation available for patient use has unique compositions and characteristics that impact its proper handling, therapeutic results, potential complications, and, ultimately, its ideal use. This review surveys the currently available preparations for soft-tissue augmentation. RECENT FINDINGS A review of the medical literature and manufacturers' information are included for dermal fillers currently approved for use by the US Food and Drug Administration. The composition, use, and potential limitation of each available preparation are reviewed. SUMMARY Dermal filling agents offer an excellent option for management of certain facial cosmetic changes. Since a wide range of products with significantly different characteristics is available, the treating physician should have sound knowledge of them all.
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Affiliation(s)
- Sukhjit S Johl
- Oculofacial Surgery, Department of Ophthalmology, The Permanente Medical Group, Inc., Sacramento, California 95815, USA.
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Narins RS, Beer K. Liquid Injectable Silicone: A Review of Its History, Immunology, Technical Considerations, Complications, and Potential. Plast Reconstr Surg 2006; 118:77S-84S. [PMID: 16936547 DOI: 10.1097/01.prs.0000234919.25096.67] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For over five decades, liquid injectable silicone has been used for soft-tissue augmentation. Its use has engendered polarized reactions from the public and from physicians. Adherents of this product tout its inert chemical structure, ease of use, and low cost. Opponents of silicone cite the many reports of complications, including granulomas, pneumonitis, and disfiguring nodules that are usually the result of large-volume injection and/or industrial grade or adulterated material. Unfortunately, as recently as 2006, reports in The New England Journal of Medicine and The New York Times failed to distinguish between the use of medical grade silicone injected by physicians trained in the microdroplet technique and the use of large volumes of industrial grade products injected by unlicensed or unskilled practitioners. This review separates these two markedly different procedures. In addition, it provides an overview of the chemical structure of liquid injectable silicone, the immunology of silicone reactions within the body, treatment for cosmetic improvement including human immunodeficiency virus lipoatrophy, technical considerations for its injection, complications seen following injections, and some considerations of the future for silicone soft-tissue augmentation.
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Affiliation(s)
- Rhoda S Narins
- Dermatology Surgery and Laser Center, Department of Dermatology, New York University Medical School, White Plains 10604, USA.
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Jacinto SS. Ten-Year Experience Using Injectable Silicone Oil for Soft Tissue Augmentation in the Philippines. Dermatol Surg 2006; 31:1550-4; discussion 1554. [PMID: 16416637 DOI: 10.2310/6350.2005.31240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND No ideal, permanent filler is approved by the U.S. Food and Drug Administration. Repeated injections of new temporary fillers make this cosmetic procedure expensive. OBJECTIVE To show that silicone oil is effective, safe, economical, and permanent. MATERIALS AND METHOD The age, sex, number, indications, sites, adverse reactions, total amounts injected, and clinical cosmetic results of 206 cases were tallied. RESULTS Females (82%) outnumbered males (18%). The majority were in the 21- to 30-year age group. Fifty-five percent had acne scars, 42% nasolabial grooves, 13.5% marionette lines, 12.6% glabellar lines, 9.8% postvaricella scars, 9.3% inframalar depressions, 1.8% post-traumatic scars, 1.4% lipodystrophy, 1% lip augmentation, 0.9% sleep lines, and 0.4% contour defect. Fifty-one percent had < or = 0.5 cc, 22% 1 cc, 7% < or = 1.5 cc, 7% < or = 2 cc, and 12% >2 cc. Clinical improvement was graded excellent (76-100%), good (50-75%), fair (26-50%), and poor (< 25%). Seventy-two percent had excellent results, 18% good, 2% fair, and 0.5% poor. Seven percent were lost to follow-up. Two percent (n=5) had transient erythematous papules lasting 2 to 6 weeks, with the exception of two patients. CONCLUSION Silicone oil injected with the correct indications and techniques and with microdroplet injections is a safe, economical, and permanent dermal and subcutaneous filler. Rare permanent erythematous papules and transient ecchymoses appear on deep dermal injections.
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