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Yang CY, Chang YC, Tai HC, Liao YH, Huang YH, Hui RCY, Kuo YS, Horng SY, Sheen YS, Chen TM, Tzeng YS, Wang CH, Teng SC, Chang CKO, Chou CY. Evaluation of Collagen Dermal Filler with Lidocaine for the Correction of Nasolabial Folds: A Randomized, Double-Blind, Multicenter Clinical Trial. Clin Cosmet Investig Dermatol 2024; 17:1621-1631. [PMID: 39006129 PMCID: PMC11244637 DOI: 10.2147/ccid.s447760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/06/2024] [Indexed: 07/16/2024]
Abstract
Purpose Porcine-based dermal injectable collagen is effective for nasolabial fold correction. In the present study, a new dermal injectable collagen, incorporating a novel cross-linking technology and premixed with lidocaine, was introduced. The study aimed to determine the efficacy of the new dermal injectable collagen in improving bilateral nasolabial fold wrinkles, and reducing pain during injection. Patients and Methods This prospective, double-blind, multicenter, parallel-group, randomized trial enrolled participants with moderate-to-severe bilateral nasolabial fold wrinkles from February 2019 to March 2021. Participants were randomly assigned to the test group (new dermal injectable collagen with lidocaine featuring a novel cross-linking technology) or control group (traditionally cross-linked dermal injectable collagen with lidocaine). Participants were monitored for adverse events (AEs), and for pain using the Thermometer Pain Scale (TPS) and a visual analog scale (VAS). Efficacy was measured using the Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS). Results On the poor or better sides, the 2 groups exhibited a significant decrease in WSRS scores at 4, 12, 24, and 36 weeks after treatment, compared to baseline WSRS scores (all, p < 0.05). Compared to the control group, the test group had a greater decrease in WSRS score (poor or better sides) at 12, 24, 36, and 52 weeks after treatment (all, p < 0.05). A similar observation was also found in the WSRS response rate and GAIS score of the 2 groups. VAS and TPS scores were not significantly different between the 2 groups (p > 0.05), indicating that pain reduction was similar in the 2 groups. All AEs were anticipated AEs associated with facial aesthetic injections, and most recovered within 0 to 30 days without sequelae. There were no differences in AEs between the 2 groups (all, p > 0.05). Conclusion The new dermal injectable collagen with lidocaine exhibited better efficacy for correcting nasolabial fold wrinkles compared to the control group. Both relieved pain and produced only transient and tolerable AEs.
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Affiliation(s)
- Chin-Yi Yang
- Department of Dermatology, New Taipei Municipal TuCheng Hospital, New Taipei City, 236, Taiwan
- Department of Dermatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Ya-Ching Chang
- Department of Dermatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Hao-Chih Tai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | | | - Yuan-Sung Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100, Taiwan
| | - Shyue-Yih Horng
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100, Taiwan
| | - Yi-Shuan Sheen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100, Taiwan
| | - Tim-Mo Chen
- Division of Plastic Surgery, Tri-Service General Hospital, Taipei, 100, Taiwan
| | - Yuan-Sheng Tzeng
- Division of Plastic Surgery, Tri-Service General Hospital, Taipei, 100, Taiwan
| | - Chih-Hsin Wang
- Division of Plastic Surgery, Tri-Service General Hospital, Taipei, 100, Taiwan
| | - Shou-Cheng Teng
- Division of Plastic Surgery, Tri-Service General Hospital, Taipei, 100, Taiwan
| | | | - Chang-Yi Chou
- Division of Plastic Surgery, Tri-Service General Hospital, Taipei, 100, Taiwan
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Abreu VRLS, Xavier JA. Imaging Nasal Obstruction: An Objective Evaluation for a Subjective Complaint. Facial Plast Surg 2024; 40:294-303. [PMID: 38016660 DOI: 10.1055/a-2218-7060] [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: 11/30/2023] Open
Abstract
Nasal obstruction (NO) is a common clinical symptom characterized by a subjective sensation of insufficient airflow through the nasal cavity and may result from various factors, including changes in nasal anatomy, inflammatory conditions, tumoral lesions, and other etiologies. While a thorough medical history and physical examination can often identify its cause, imaging is usually necessary to fully understand the problem. Computed tomography (CT) is the primary imaging modality used to evaluate the nasal cavity and paranasal sinuses, allowing for the identification of potential causes and structural abnormalities. However, when soft tissue characterization is required, magnetic resonance imaging (MRI) is also useful. Understanding the anatomical and pathological basis of NO is crucial for accurate diagnosis and appropriate management. Imaging techniques provide valuable information for identifying the underlying causes of NO and guiding treatment decisions. This article reviews the normal anatomy of the nasal cavity and adjacent paranasal sinuses as well as the several conditions that may affect breathing comfort (tumors, inflammatory diseases, bony and cartilaginous anatomical variants, and "nonobstructive" mucosal thickenings), showing their normal presentation on CT and MRI.
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Affiliation(s)
- Vasco R L S Abreu
- Neuroradiology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João A Xavier
- Neuroradiology Department, Centro Hospitalar Universitário de Santo António, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
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Huang DW, Lai CY, Chen JE, Yi CC, Chen YH, Wang CH, Chen SG. Three-Dimensional Photography for Evaluating the Effectiveness of Botulinum Toxin Injection for Masseter Hypertrophy. Aesthetic Plast Surg 2024:10.1007/s00266-024-03974-7. [PMID: 38740625 DOI: 10.1007/s00266-024-03974-7] [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: 01/11/2024] [Accepted: 02/27/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Masseter hypertrophy is a common condition that causes a undesirable square face, and often treated with botulinum toxin type A (BoNTA). Subjective assessments of BoNTA effectiveness vary from physician to patient, necessitating an objective approach for evaluation. This study introduces three-dimensional photography (3DP) for the first time in clinical assessment to evaluate BoNTA treatment for masseter hypertrophy. METHODS Ten patients received 36U of BoNTA at three injection points on each side masseter muscle. 3DP scanner using Artec Eva® was taken at the first, third, and sixth postoperative months for objective evaluation. Patient's self-perceived prominence, patients self-rated satisfaction, and physicians provided 5-grade scores were the subjective indicators. RESULTS A significant decrease in left masseter volume at the sixth month (P = 0.002, P = 0.004 at rest and clenching, respectively) was observed. Patient's self-perceived prominence decreased at the first (P = 0.021) and third (P = 0.039) months. Physicians' scores significantly decreased at all postoperative months. No significant changes were noted in the right masseter volume and patients self-rated satisfaction. Patient self-rated satisfaction did not consistently correlate with objective measures, except for left masseter with clenching at the sixth month. CONCLUSION Three-dimensional photography accurately quantifies facial changes post-BoNTA treatment. Despite objective improvements, patient satisfaction may not align consistently. Reliable assessment tools are crucial in cosmetic surgery to manage expectations and prevent disputes. 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)
- Dun-Wei Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 11490, Taiwan, ROC
- Department of Orthopedics, Hand and Arm Center, Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Chung-Yu Lai
- National Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan, ROC
| | - Jia-En Chen
- Medical 3D Printing Center, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan, ROC
- Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK
| | - Chin-Chieh Yi
- Medical 3D Printing Center, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Ya-Hsin Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Chih-Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 11490, Taiwan, ROC
| | - Shyi-Gen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 11490, Taiwan, ROC.
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Hisatomi M, Takeshita Y, Yanagi Y, Okada S, Fujikura M, Yoshida S, Kawazu T, Asaumi J. Imaging characteristics of incidentally detected cosmetic surgery-derived foreign bodies on CT images in the maxillofacial region. Oral Radiol 2024; 40:277-284. [PMID: 38252389 DOI: 10.1007/s11282-023-00734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/10/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES This study examined the imaging characteristics of cosmetic surgery-derived foreign bodies in the maxillofacial region through a retrospective review of cosmetic material foreign bodies incidentally detected on computed tomography (CT) images in routine clinical practice. METHODS We retrospectively investigated cases of cosmetic surgery-derived foreign bodies other than dental materials in the maxillofacial region, using 5 years of CT image data stored on an imaging server. The imaging findings of these foreign bodies were investigated, along with patient age, patient sex, whether the foreign bodies were associated with the disease targeted by the CT scan, and the availability of cosmetic surgery information prior to examination. RESULTS Foreign bodies were more common in women (19/21 cases), and affected patients displayed a wide age range (20-84 years). Four types of cosmetic surgery-derived foreign bodies in the maxillofacial region were detected by CT examination: nasal prostheses (nasal region), lifting sutures and injectable facial fillers (both in the buccal region), and silicone chin implants (chin region). CONCLUSIONS A cosmetic surgery-derived foreign body should be suspected when a foreign body is identified without a dental source of infection. In addition, cosmetic surgery-derived foreign bodies may be present in numerous patients, regardless of age or sex.
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Affiliation(s)
- Miki Hisatomi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoshinobu Yanagi
- Department of Dental Informatics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Shunsuke Okada
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Mamiko Fujikura
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Suzuka Yoshida
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiyuki Kawazu
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Junichi Asaumi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Pascali M, Chirico F, Rugge L, Rauso R. Aesthetic Surgical Pathway in Permanent Facial Filler Removal. Facial Plast Surg 2024; 40:19-30. [PMID: 36696919 DOI: 10.1055/a-2019-5131] [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: 01/27/2023] Open
Abstract
Although permanent fillers have been introduced in order to get long-lasting results, many studies have shown numerous severe and disfiguring complications. Nonsurgical procedures may mitigate those adverse events but the only way to remove the filler previously injected is represented by surgical excision. We present a pathway of facial surgical accesses to be performed achieving two goals: permanent filler removal and restore facial aesthetic balance. The proposed surgical accesses are already standardized in aesthetic surgical practice in order to avoid direct excision and unpleasant facial scar. A total of 231 patients underwent surgery for permanent filler removal and aesthetic restoration of the involved facial area, represented by forehead, glabella, nose, cheeks, eyelids, chin, jawline, and lips. Magnetic resonance evaluation was performed with the exception of lip patients who were evaluated with ultrasound. Postoperative follow-up was 12 months to 6 years. Subjective and objective methods were used for outcome evaluation according to the FACE-Q questionnaire. Functional and aesthetic correction was scored using the patient-graded Global Aesthetic Improvement Scale (GAIS), overall patient satisfaction was assessed by a five-point scale questionnaire. Functional and aesthetic restoration was globally recognized as improved according to the GAIS. Patients reported high levels of satisfaction assessed by a five-point scale questionnaire. A very good satisfaction level was registered in both subjective and objective judgment scores. To the best of our knowledge, we present the largest case series regarding surgical removal of permanent facial fillers. A proper preoperative evaluation, filler removal followed by restorative facial aesthetic surgery technique is paramount to approach challenging cases.
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Affiliation(s)
- Michele Pascali
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Roma, Lazio, Italy
| | - Fabrizio Chirico
- Department of Maxillo Facial Surgery, University of Rome La Sapienza, Rome, Lazio, Italy
| | - Luigi Rugge
- Private Practice - Maxillo Facial Unit, Naples, Italy
| | - Raffaele Rauso
- Department of Cranio-maxillo Facial Surgery, Private Hospital 'L. Cobellis', Vallo Della Lucania (SA), Italy
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de Sousa AMS, Duarte AC, Decnop M, Guimarães DDF, Coelho Neto CAF, Sarpi MDO, Duarte LGP, Souza SA, Segato LF, Zavariz JD, Mukherji SK, Garcia MRT. Imaging Features and Complications of Facial Cosmetic Procedures. Radiographics 2023; 43:e230060. [PMID: 37943699 DOI: 10.1148/rg.230060] [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: 11/12/2023]
Abstract
Facial aesthetic procedures have become increasingly popular and complex, making knowledge of facial anatomy crucial for achieving desired outcomes without complications. Some of the most common procedures include blepharoplasty, bichectomy, face-lifts, facial implants, thread lifting, and fillers. Blepharoplasty and bichectomy are surgical procedures that respectively aim to restore youthful contours to the periorbita and create a slimmer lower face by removing Bichat fat from the maxillofacial region. Facial implants are used for aesthetic augmentation of the skeletal structure and restoration of facial contour by using biomaterials or autogenous bone grafts. Face-lift surgeries involve incisions and removal of excess skin, and thread lifts involve less invasive procedures performed by inserting threads beneath the skin, with the aim to lift the skin and thus reduce wrinkles and sagging. Fillers improve wrinkles and loss of facial volume, with biologic types made from animal, human, or bacterial sources (such as hyaluronic acid), while synthetic fillers include substances such as paraffin, silicone, calcium hydroxyapatite, polymethylmethacrylate microspheres, polyacrylamide hydrogel, hydroxyethyl-ethyl methacrylate, and poly-l-lactic acid. Synthetic fillers can be classified as rapidly resorbable (<12 months), slowly resorbable (<24 months), or permanent. Imaging modalities such as US, CT, and MRI can help identify and analyze each type of facial aesthetic procedure or filler, as well as their possible complications such as foreign-body granuloma, noninflammatory nodule, late intermittent persistent edema, filler migration, infection, or complications after removal of the buccal fat pad. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center The online slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Andrea Meneses Soares de Sousa
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Angelo Chelotti Duarte
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Marcos Decnop
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Daniel de Faria Guimarães
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Carlos Alberto Ferreira Coelho Neto
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Maíra de Oliveira Sarpi
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Luis Gustavo Palhiari Duarte
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Soraia Ale Souza
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Larissa Freire Segato
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Julia Diva Zavariz
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Suresh K Mukherji
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
| | - Márcio Ricardo Taveira Garcia
- From the Department of Radiology, Head and Neck Section (A.M.S.d.S., M.D., C.A.F.C.N., M.d.O.S., L.G.P.D., S.A.S., J.D.Z., M.R.T.G.) and Neuroradiology Section (A.M.S.d.S.), Dasa/Alta Excelência Diagnóstica, Av Juruá 548, Alphaville, Barueri, São Paulo 06455-010 SP, Brazil; Department of Radiology, Neuroradiology Section, Irmandade da Santa Casa de Misericordia de Sao Paulo, São Paulo, Brazil (A.C.D., D.d.F.G.); Division of Head and Neck Imaging, Instituto Nacional do Cancer, Rio de Janeiro, Brazil (M.D.); Head and Neck Radiology Section, Universidade Federal de São Paulo, São Paulo, Brazil (S.A.S.); Head and Neck Radiology Section (S.A.S.) and Ultrasound Section (J.D.Z.), Universidade de São Paulo, São Paulo, Brazil; Department of Dermatology, Universidade de Brasília, Brasília, Brazil (L.F.S.); and Department of Radiology, ProScan Imaging, Cincinnati, Ohio (S.K.M.)
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7
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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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8
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An Update on the Clinical Efficacy and Safety of Collagen Injectables for Aesthetic and Regenerative Medicine Applications. Polymers (Basel) 2023; 15:polym15041020. [PMID: 36850304 PMCID: PMC9963981 DOI: 10.3390/polym15041020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Soft tissues diseases significantly affect patients quality of life and usually require targeted, costly and sometimes constant interventions. With the average lifetime increase, a proportional increase of age-related soft tissues diseases has been witnessed. Due to this, the last two decades have seen a tremendous demand for minimally invasive one-step resolutive procedures. Intensive scientific and industrial research has led to the recognition of injectable formulations as a new advantageous approach in the management of complex diseases that are challenging to treat with conventional strategies. Among them, collagen-based products are revealed to be one of the most promising among bioactive biomaterials-based formulations. Collagen is the most abundant structural protein of vertebrate connective tissues and, because of its structural and non-structural role, is one of the most widely used multifunctional biomaterials in the health-related sectors, including medical care and cosmetics. Indeed, collagen-based formulations are historically considered as the "gold standard" and from 1981 have been paving the way for the development of a new generation of fillers. A huge number of collagen-based injectable products have been approved worldwide for clinical use and have routinely been introduced in many clinical settings for both aesthetic and regenerative surgery. In this context, this review article aims to be an update on the clinical outcomes of approved collagen-based injectables for both aesthetic and regenerative medicine of the last 20 years with an in-depth focus on their safety and effectiveness for the treatment of diseases of the integumental, gastrointestinal, musculoskeletal, and urogenital apparatus.
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9
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Magacho-Vieira FN, Santana AP. Displacement of Hyaluronic Acid Dermal Filler Mimicking a Cutaneous Tumor: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:197-201. [PMID: 36711075 PMCID: PMC9882410 DOI: 10.2147/ccid.s398014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
There has been considerable growth in the number of cosmetic injectable procedures in recent years. Consequently, physicians in general are seeing a greater number of patients who have previously had cosmetic implants. These patients often fail to mention or do not admit to having had previous cosmetic procedures, conditions that should be noted in their medical histories. In this article, the authors report a rare case of hyaluronic acid filler displacement resulting from injection in the nasal radix region that had been administered 10 months prior, which the patient failed to mention. The filler migration mimicked facial tumors, entangling an otherwise easy case and it was only recognized with the use of dermatological ultrasound. This serves as a warning and a reminder to include complications from cosmetic procedures in diagnostic hypotheses. Physicians need to be vigilant, question their patients' medical histories, and be familiar with diagnostic imaging options. The presence of dermal fillers should always be considered in cutaneous tumor lesions, since they can last for months to years, or be present in locations distant from the site of application.
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Affiliation(s)
- Fabiano Nadson Magacho-Vieira
- Magacho Institute for Health Education, Fortaleza, CE, Brazil,Department of Clinical, Aesthetic and Surgical Dermatology, Batista Memorial Hospital, Fortaleza, CE, Brazil,Correspondence: Fabiano Nadson Magacho-Vieira, Clínica Magacho - Avenida Desembargador Moreira, 1300, Sala 1419 - Torre Norte, Fortaleza, CE, 60170-002, Brasil, Tel/Fax +55 85 3246 0829, Email
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10
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Soliman SB. Liquid silicone filler migration following illicit gluteal augmentation. Radiol Case Rep 2023; 18:984-990. [PMID: 36636483 PMCID: PMC9829554 DOI: 10.1016/j.radcr.2022.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
The illicit use of fillers has significantly increased, especially among transgender women (transwomen) attempting to fulfill unmet gender affirmation needs. We present a case of liquid silicone filler migration to the distal lateral thigh, multiple years following an illicit gluteal augmentation, and mimicking a neoplasm. Initial clinical and imaging findings were inconclusive necessitating advanced imaging, an orthopedic oncology surgical consultation, and finally an ultrasound-guided biopsy. Knowledge of the increasing use of fillers, their complications, and imaging findings is critical as these patients commonly choose not to disclose this history. A radiologist suggesting this diagnosis may assist the clinician, who is often unaware of this history which could help prevent unnecessary imaging and invasive procedures.
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11
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Lee C, Choi YJ, Jeon KJ, Choi SH, Han SS. Imaging feature of cosmetic fillers in cone-beam computed tomography and its dental consideration. Head Face Med 2022; 18:24. [PMID: 35804349 PMCID: PMC9264564 DOI: 10.1186/s13005-022-00327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background As the application of cone-beam computed tomography (CBCT) in head and neck area increases for dental treatment purposes, cosmetic filler materials are incidentally observed. Since the materials are very diverse, unnecessary referrals or additional examination may be performed when clinicians are unfamiliar with the imaging findings. Thus, this study aimed to introduce the imaging characteristics of cosmetic fillers and grafts shown in dental CBCT with dental considerations that the clinician should be aware of. Methods CBCT obtained for dental purpose presenting cosmetic material were selected. The location of the material was identified as buccal, retroantral, parotid space, nose, zygoma, and symphysis. The material was classified as single or multiple, and grouped according to morphology: speckle, round, eggshell, linear, and amorphous. The radiopacity was classified as similar to soft tissue, between soft and hard tissue, similar to hard tissue, and metal. Results Twenty-one patients were reviewed, and all patients were female with mean age of 50.5 years. The buccal space was the most frequent location for multiple filler materials. The symphysis was the next frequent location and only single material were shown in this location. Cases having multiple filler showed diverse shapes while all single materials showed round shape. Fillers showing radiopacity of hard tissue were similar to diseases producing soft tissue calcifications. Metal-density material distributed in spaces induced white and dark streak artifacts in the CBCT image. All single materials presented radiopacity between soft and hard tissue and attached to the bone surface causing mandibular bone resorption. Conclusions Cosmetic materials displayed various imaging features in CBCT acquired during dental procedure. Clinicians should consider that cosmetic material may cause mandibular bone resorption and imaging artifacts on CBCT. Knowledge of the imaging characteristics of cosmetic fillers may help correct diagnosis.
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Affiliation(s)
- Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Korea
| | - Yoon Joo Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Korea
| | - Kug Jin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Korea
| | - Seong Ho Choi
- Department of Periodontology, Yonsei University College of Dentistry, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu Seoul, Korea.
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Kalmanson OA, Misch ES, Terella A. Hyaluronic acid fillers may be longer-lasting than previously described: A case report of delayed filler-associated facial cellulitis. JPRAS Open 2022; 33:37-41. [PMID: 35722166 PMCID: PMC9198373 DOI: 10.1016/j.jpra.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022] Open
Abstract
Hyaluronic acid-based filler is the most popular injectable augmentation preparation due to its efficacy and safety compared to other injection fillers. The complication of infected filler is known, but it is unknown exactly how long filler persists prior to reabsorption. A case was presented of filler-exacerbated facial cellulitis that occurred 2.5 years after hyaluronic acid-based filler administration. The presence of residual filler was confirmed with magnetic resonance imaging, suggesting that hyaluronic acid-based fillers may persist longer than previously thought and act as a reservoir for regional bacterial infections refractory to antibiotics.
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13
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Pierce C, Ginat DT. Postsurgical and Postradiation Findings in the Head and Neck Imaging. Neuroimaging Clin N Am 2022; 32:299-313. [DOI: 10.1016/j.nic.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Usmani S, Al-Turkait D, Al-Kandari F, Ahmed N. 18F-FDG PET Uptake in the Scalp After Platelet-Rich Plasma Therapy. Clin Nucl Med 2022; 47:e43-e44. [PMID: 34034312 DOI: 10.1097/rlu.0000000000003707] [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: 11/26/2022]
Abstract
ABSTRACT 18F-FDG PET/CT has been found useful for the detection of the source of infection/inflammation in the body. Platelet-rich plasma is a new treatment modality in which plasma is injected subdermally or intradermally for potential hair regrowth into the scalp. We report a case of 43-year-old woman with right breast cancer who underwent surgery, chemotherapy, and radiotherapy 2 years ago and is currently on hormonal therapy. 18F-FDG PET/CT demonstrate incidental findings of increased FDG avidity in the scalp after platelet-rich plasma therapy.
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Affiliation(s)
- Sharjeel Usmani
- From the Department of Nuclear Medicine, Kuwait Cancer Control Centre
| | - Dalal Al-Turkait
- Department of Nuclear Medicine, Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
| | | | - Najeeb Ahmed
- Jack Brignall PET-CT Centre, Castle Hill Hospital, Cottingham, United Kingdom
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15
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Lim T, Frank K, Hadjab B. Target-Specific Sandwich Technique: Facial rejuvenation leveraging CPM technology. J Cosmet Dermatol 2021; 21:207-219. [PMID: 34255904 DOI: 10.1111/jocd.14342] [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: 04/27/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Injectable rejuvenation treatments used in Caucasians might not always suit Asians as the visible signs of aging manifest differently, underscoring a need for Asian-specific strategies that correct underlying structural deficiencies and cumulative age-related changes. The presented Target-Specific Sandwich Technique (TSST) aims to simultaneously restore, rejuvenate, and enhance faces through the distribution of minute amounts of different fillers with different rheologies, using a minimal number of entry points in strategic facial areas and different soft tissue layers in Asians. A total of 14 patients underwent the presented TSST and were subsequently assessed for satisfaction with the treatment and the outcome of the treatment. With 3 cc of fillers, patients experienced a rejuvenated appearance with brow support, brow ridge softening, less severe nasolabial folds, and corrected tear trough hollows. Fillers in the lateral canthal and mandibular angles lifted mouth corners, improved submandibular jowls, and defined the lower face. Although the prejowl sulcus received minimal filler, it appeared subtler, relaxed, and had fewer lines visible while smiling. Overall, patients appeared less tense, rejuvenated, and had improved light reflection and firmer skin. These were due to tissues being supported upward and laterally by fillers in areas of bone resorption-induced volume loss.
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Abramo AC, Sgarbi R, Kim CY, Bastos PA. Effectiveness and Long-Acting of the Hyaluronic Acid Injected into the Nasolabial Fold Measured Through Magnetic Resonance Imaging. Aesthetic Plast Surg 2021; 45:1221-1230. [PMID: 33230693 DOI: 10.1007/s00266-020-02050-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND MRI analyzed quantitatively the HA injected into the NLF subcutaneous fat to correlate the gel diffusion and degradation with the morphological changes of the NLF appearance for twelve months. Measurements of the gel diffusion and degradation were taken by MRI as parameters to assess the clinical efficacy and long-acting of the HA in NLF rejuvenation. METHOD HA was applied into the superficial compartment of the subcutaneous fat of twenty NLFs. Each NLF received three injection points, from the nasal ala toward the oral commissure, 1.0-1.5 cm distant from each other, according to the NLF length. A bolus injection technique without retrograde backflow applied per injection point 0.15-0.20 ml of HA for moderate. NLF and 0.20-0.25 ml for severe NLF. Patients were evaluated through MRI and clinically twenty-four hours, one month and twelve months after the HA application. RESULTS MRI, in T2-weighted, displayed the gel as a dense, spindle-shaped nodule as pattern of the gel diffusion, measuring its largest longitudinal and transverse axes. Twenty-four hours after HA application the longitudinal axis measured 1.79 cm, after one month 2.33 cm and at month twelve 0.91 cm. The transverse axis measured 0.92 cm at 24 hours, 1.13 cm after one month and 0.47 cm at month twelve. CONCLUSION Despite reduction in size and denseness of the spindle-shaped nodule, the small amount of gel presenting into the subcutaneous fat after twelve months of the application evidenced the HA efficacy and long-acting in NLF rejuvenation. 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)
- Antonio Carlos Abramo
- Post-Graduate Course of the ACA-Institute of Assistance in Plastic Surgery of São Paulo, Division of Plastic Surgery, General Hospital São Rafael, endorsed by the Brazilian Society of Plastic Surgery and Brazilian Medical Association, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil.
| | - Romulo Sgarbi
- Post-Graduate Course of the ACA-Institute of Assistance in Plastic Surgery of São Paulo, Division of Plastic Surgery, General Hospital São Rafael, endorsed by the Brazilian Society of Plastic Surgery and Brazilian Medical Association, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil
| | - Clara Young Kim
- Post-Graduate Course of the ACA-Institute of Assistance in Plastic Surgery of São Paulo, Division of Plastic Surgery, General Hospital São Rafael, endorsed by the Brazilian Society of Plastic Surgery and Brazilian Medical Association, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil
| | - Paulo Armon Bastos
- Post-Graduate Course of the ACA-Institute of Assistance in Plastic Surgery of São Paulo, Division of Plastic Surgery, General Hospital São Rafael, endorsed by the Brazilian Society of Plastic Surgery and Brazilian Medical Association, Rua Afonso de Freitas, 641, São Paulo, SP, 04006-052, Brazil
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Penile girth augmentation by injectable fillers: a comprehensive review of imaging features and inflammatory complications. Abdom Radiol (NY) 2021; 46:1703-1717. [PMID: 33040174 DOI: 10.1007/s00261-020-02788-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
Despite the extensive controversy and debate of penile girth augmentation, high demands for such procedures are increasing. Penile inflammation is not common sequel after penile filler augmentation, but when it occurs, it has serious complications that sometimes necessitate emergency surgical intervention. Imaging with a variety of modalities, including ultrasonography, magnetic resonance imaging, and ascending urethrogrphy plays a paramount role in the detection and assessment of these conditions. Inflammatory conditions after penile girth augmentation using injectable fillers are ranging from local granuloma to penile abscess formation or diffuse cellulitis that may extend to the scrotum, perineum or deep pelvic organs. Rapid diagnosis and evaluation of extensions are important to avoid associated morbidity and permanent deformity. Our purpose is to provide a practical review of relevant penile anatomy, imaging appearance and injection technique of different types of subcutaneous fillers used in penile girth augmentation, and inflammatory complications that may occur after these procedures. Brief descriptions of patient clinical information and imaging features of inflammatory complications will be included and correlated in actual cases.
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Abdelmohsen MA. Injectable fillers: imaging features and related complications. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Injectable fillers are currently widely used in the clinical practice; there are many indications for injectable fillers including facial and gluteal rejuvenation, management of post-traumatic facial disfiguring, and pathological volumetric loss secondary to certain disease medications like human immune deficiency virus (HIV) medications.
Radiologists should be familiar with the specific imaging features of the injectable fillers, characteristic anatomical locations, and possible complications to avoid diagnostic pitfalls especially when incidentally discovered while imaging of other pathological process like neoplastic work up or granulomatous lesions follow-up.
Results
The study included 48 patients (45 females and 3 males): 44 patients with facial injectable fillers and four patients with pelvic injectable fillers.
Of the 48 patients, 37 patients showed unremarkable fillers features with normal morphological features and anatomical distribution, and eleven patients showed complications: six patients showed one complication, and five patients showed more than one complications.
Dedicated fillers imaging study was done in 22 patients, while in the other 26 patients, imaging was done for other reasons, and fillers were notified and documented.
Magnetic resonance imaging (MRI) was done for 46 patients; two patients were subjected to combine ultra-sonographic and CT examinations with no clinical indication for MRI study assessment.
Conclusion
Magnetic resonance imaging (MRI) is an effective tool for evaluation of facial and gluteal region fillers with delineation of their imaging features and related potential complications.
Differentiation between fillers and neoplastic or granulomatous lesions could be accurately done with MRI.
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Cunqueiro A, Gomes WA, Lee P, Dym RJ, Scheinfeld MH. CT of the Neck: Image Analysis and Reporting in the Emergency Setting. Radiographics 2019; 39:1760-1781. [PMID: 31589582 DOI: 10.1148/rg.2019190012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Interpreting findings seen at CT of the neck is challenging owing to the complex and nuanced anatomy of the neck, which contains multiple organ systems in a relatively small area. In the emergency department setting, CT is performed to investigate acute infectious or inflammatory symptoms and chronic processes. With few exceptions, neck CT should be performed with intravenous contrast material, which accentuates abnormally enhancing phlegmonous and neoplastic tissues and can be used to delineate any abscesses or necrotic areas. As part of the evaluation, the vascular structures and aerodigestive tract must be scrutinized, particularly for patency. Furthermore, although the patient may present because of symptoms that suggest non-life-threatening conditions involving structures such as the teeth or salivary glands, there may be serious implications for other areas, such as the orbits, brain, and spinal cord, that also may be revealed at the examination. With a focus on the emergency setting, the authors propose using an approach to interpreting neck CT findings whereby 12 areas are systematically evaluated and reported on: the cutaneous and subcutaneous soft tissues, aerodigestive tract and adjacent soft tissues, teeth and periodontal tissues, thyroid gland, salivary glands, lymph nodes, vascular structures, bony airspaces, cervical spine, orbits and imaged brain, lung apices, and superior mediastinum. The use of a systematic approach to interpreting neck CT findings is essential for identifying all salient findings, recognizing and synthesizing the implications of these findings to formulate the correct diagnosis, and reporting the findings and impressions in a complete, clear, and logical manner.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Alain Cunqueiro
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - William A Gomes
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Peter Lee
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - R Joshua Dym
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
| | - Meir H Scheinfeld
- From the Division of Emergency Radiology (M.H.S.), Department of Radiology (A.C., P.L.), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G.); and Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ (R.J.D.)
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21
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Parulan MAA, Sundar G, Lum JH, Ramachandran U. A case report on dermal filler-related periorbital granuloma formation. Orbit 2019; 38:169-172. [PMID: 29842814 DOI: 10.1080/01676830.2018.1477806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/13/2018] [Indexed: 06/08/2023]
Abstract
We report a case of a 49-year old East-Asian female who presented with delayed onset granuloma formation at the right medial lower eyelid area. The clinical and radiologic presentation with pathologic correlation following synthetic hyaluronic acid filler injection and its management are described along with a review of literature following dermal-filler injections types. Dermal-filler-related granuloma formation should be included in the differential diagnoses of periorbital inflammatory and mass lesions. It is recommended that clinicians who perform this procedure should discuss these risks and possible late complications with patients and provide them with the relevant product information of the injected filler for appropriate management should such early or late complications occur.
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Affiliation(s)
| | - Gangadhara Sundar
- a Ophthalmology Department , National University Health System (NUHS) , Singapore
| | - Jeffrey Hy Lum
- b Pathology Department , National University Health System (NUHS) , Singapore
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22
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Turner J, Mannion CJ. Cosmetic dentistry: Facial aesthetic treatments and clinical and radiological implications. Br Dent J 2018; 225:794-795. [PMID: 30412521 DOI: 10.1038/sj.bdj.2018.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J Turner
- Maxillofacial Surgery Department, by email
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23
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Kwon YE, An CH, Choi KS, Lee DH, An SY. Radiographic study of dermal fillers in the facial area: A series of 3 cases. Imaging Sci Dent 2018; 48:227-231. [PMID: 30276160 PMCID: PMC6148037 DOI: 10.5624/isd.2018.48.3.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/17/2017] [Accepted: 10/10/2017] [Indexed: 12/03/2022] Open
Abstract
In recent years, as interest in maintaining beauty and a youthful appearance has grown, filler procedures such as soft tissue augmentation have become more popular. These fillers are sometimes seen as radiopaque shadows on radiographic images, either due to the fillers themselves or because of secondary reactions; such findings may present a diagnostic challenge to dentists. The present report describes 3 cases of dermal fillers observed in panoramic and cone-beam computed tomographic (CBCT) images. All 3 elderly female patients had filler injected into their cheeks and chin area for cosmetic purposes decades ago. On panoramic images, multiple symmetric radiopacities were observed in the facial area; on CBCT, these calcifications were seen in the subcutaneous tissue in various shapes and with varying density. In conclusion, dentists should be aware of the imaging characteristics of dermal filler, and should be able to differentiate dermal filler from other pathological findings.
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Affiliation(s)
- Young-Eun Kwon
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Chang-Hyeon An
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Karp-Shik Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Du-Hyeong Lee
- Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Seo-Young An
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Korea
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24
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Haneke E. Adverse effects of fillers. Dermatol Ther 2018; 32:e12676. [PMID: 30187592 DOI: 10.1111/dth.12676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 06/27/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Filler injections belong to the most frequently performed noninvasive beautifying procedures. When done correctly they are generally well tolerated. However, a number of factors, such as poor filler quality, and particularly host as well as user dependent filler reactions may lead to unwanted effects. These may be early, late, or delayed events with characteristics for each of them. Temporary fillers almost invariably cause temporary side effects whereas those of permanent fillers may last forever. Some fillers are notorious for their poor safety profile; for example, silicone is banned in the European Union and the United States but nevertheless used by many practitioners and beauticians. Many fillers can be identified in histopathologic sections allowing specific measures to be instituted.
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Affiliation(s)
- Eckart Haneke
- Dermatology Practice Dermaticum, Freiburg, Germany.,Department of Dermatology, Inselspital, Universitätsspital Bern, Bern, Switzerland.,Centro Dermatol Epidermis, Instituto CUF, Porto, Portugal.,Department of Dermatology, University Hospital, Ghent, Belgium
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25
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Thaung C. Orbital pathology - Iatrogenic findings and artefacts. Saudi J Ophthalmol 2018; 32:17-22. [PMID: 29755266 PMCID: PMC5944018 DOI: 10.1016/j.sjopt.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/01/2018] [Accepted: 02/08/2018] [Indexed: 12/01/2022] Open
Abstract
The relationship between the ophthalmologist and ophthalmic pathologist is particularly important in orbital disease, as diagnosis is heavily dependent on correlation with clinical context. If the patient has previously had treatment to the orbit or an adjacent area, whether for the same or a different condition, tissue changes may occur which affect the histological appearance of any specimen taken. This article is an overview of therapeutic interventions which may cause either orbital pathology or an altered appearance of the tissue, either of which can pose a diagnostic challenge. The problem of artefact is also addressed as another factor which may alter the appearance of a specimen. It is hoped that the information provided in this brief review will help clinicians better evaluate what information may be relevant when submitting a specimen.
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26
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Savoia A, Onori N, Baldi A. Efficacy of Skinfill plus filler in the management of facial aging: a multicenter, post-marketing clinical study. BIOMEDICAL DERMATOLOGY 2018. [DOI: 10.1186/s41702-017-0019-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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27
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Mlosek RK, Skrzypek E, Skrzypek DM, Malinowska S. High‐frequency ultrasound‐based differentiation between nodular dermal filler deposits and foreign body granulomas. Skin Res Technol 2018; 24:417-422. [DOI: 10.1111/srt.12444] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- R. K. Mlosek
- Institute of Diagnostic ImagingMedical University of Warsaw Warsaw Poland
| | - E. Skrzypek
- Department of History of MedicineMedical University of Warsaw Warsaw Poland
| | - D. M. Skrzypek
- Department of Forensic MedicineMedical University of Warsaw Warsaw Poland
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28
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Costa ALF, Caliento R, da Rocha GBL, Gomes JPP, Mansmith AJC, de Freitas CF, Braz-Silva PH. Magnetic resonance imaging appearance of foreign-body granulomatous reactions to dermal cosmetic fillers. Imaging Sci Dent 2017; 47:281-284. [PMID: 29279829 PMCID: PMC5738512 DOI: 10.5624/isd.2017.47.4.281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/21/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022] Open
Abstract
Foreign body granulomas can develop after the injection of various cosmetic filling materials into the facial area to flatten wrinkles. Clinically, reactive lesions are easily mistaken for soft-tissue neoplasms or cysts. This report presents a case of foreign body granuloma in a 52-year-old female patient complaining of a painless swelling in the nasolabial region. Both clinical and histological features are described, underscoring the diagnostic role of magnetic resonance imaging findings.
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Affiliation(s)
- Andre Luiz Ferreira Costa
- Department of Radiology and Orthodontics, School of Dentistry, University City of Sao Paulo, Sao Paulo, Brazil
| | - Rubens Caliento
- Division of Oral and Maxillofacial Pathology, Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Glauber Bareia Liberato da Rocha
- Division of Oral and Maxillofacial Pathology, Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Joao Pedro Perez Gomes
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Claudio Froes de Freitas
- Department of Radiology and Orthodontics, School of Dentistry, University City of Sao Paulo, Sao Paulo, Brazil.,Division of Radiology, Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Henrique Braz-Silva
- Division of General Pathology, Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil.,Laboratory of Virology, Institute of Tropical Medicine of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
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29
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Wortsman X, Quezada N. Ultrasound Morphology of Polycaprolactone Filler. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2611-2615. [PMID: 28703420 DOI: 10.1002/jum.14327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Abstract
Nowadays, cosmetic fillers are widely used and the reports of complications are rising. Therefore, the possibility to detect and identify noninvasively new fillers can provide a potent tool for managing complications. The objective of this study was to assess the ultrasound morphology of polycaprolactone. First, polycaprolactone was injected into porcine skin and this sonographic morphology was prospectively compared with the one observed in patients injected with this filler. On sonography, polycaprolactone shows as hypoechoic deposits that present multiple bright hyperechoic spots with mini-comet-tail artifact. This morphology differs from the ultrasound appearance of other common fillers.
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Affiliation(s)
- Ximena Wortsman
- Institute for Diagnostic Imaging of the Skin and Soft Tissues, Santiago, Chile
- Department of Imaging, Clinica Servet, Santiago, Chile
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Natacha Quezada
- Department of Dermatology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
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30
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Lin DJ, Wong TT, Ciavarra GA, Kazam JK. Adventures and Misadventures in Plastic Surgery and Soft-Tissue Implants. Radiographics 2017; 37:2145-2163. [DOI: 10.1148/rg.2017170090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Dana J. Lin
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Tony T. Wong
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Gina A. Ciavarra
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
| | - Jonathan K. Kazam
- From the Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032 (D.J.L., T.T.W., J.K.K.); and the Department of Radiology, NYU Langone Medical Center–Hospital for Joint Diseases, New York, NY (G.A.C.)
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31
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Injectable facial fillers: imaging features, complications, and diagnostic pitfalls at MRI and PET CT. Insights Imaging 2017; 8:557-572. [PMID: 28980212 PMCID: PMC5707222 DOI: 10.1007/s13244-017-0575-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 01/31/2023] Open
Abstract
Injectable fillers are widely used for facial rejuvenation, correction of disabling volumetric fat loss in HIV-associated facial lipoatrophy, Romberg disease, and post-traumatic facial disfiguring. The purpose of this article is to acquaint the reader with the anatomy of facial fat compartments, as well as with the properties and key imaging features of commonly used facial fillers, filler-related complications, interpretation pitfalls, and dermatologic conditions mimicking filler-related complications. The distribution of facial fillers is characteristic and depends on the anatomy of the superficial fat compartments. Silicone has signature MRI features, calcium hydroxyapatite has characteristic calcifications, whereas other injectable fillers have overlapping imaging features. Most fillers (hyaluronic acid, collagen, and polyalkylimide-polyacrylamide hydrogels) have signal intensity patterns compatible with high water content. On PET-CT, most fillers show physiologic high FDG uptake, which should not be confounded with pathology. Abscess, cellulitis, non-inflammatory nodules, and foreign body granulomas are the most common filler-related complications, and imaging can help in the differential diagnosis. Diffusion weighted imaging helps in detecting a malignant lesion masked by injected facial fillers. Awareness of imaging features of facial fillers and their complications helps to avoid misinterpretation of MRI, and PET-CT scans and facilitates therapeutic decisions in unclear clinical cases. KEY POINTS • Facial fillers are common incidental findings on MRI and PET-CT scans. • They have a characteristic appearance and typical anatomic distribution • Although considered as safe, facial filler injections are associated with several complications • As they may mask malignancy, knowledge of typical imaging features is mandatory. • MRI is a problem-solving tool for unclear cases.
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32
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Koka S, Shah K, Mallya S. Dermal Filler Presenting as Lobular Radiopacities in an Edentulous Patient: A Clinical Report. J Prosthodont 2017; 26:670-671. [PMID: 28940797 DOI: 10.1111/jopr.12632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/30/2022] Open
Abstract
This clinical report describes the unusual appearance of radiopacities, lobular in nature, observed on a dental panoramic image of an edentulous patient. Upon questioning, the patient described a history of recently having hydroxylapatite-based dermal filler placed in her right and left cheeks to reduce wrinkles and enhance cosmetic appearance. The localization and shape of the radiopacities were consistent with the placement of the dermal filler.
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Affiliation(s)
- Sreenivas Koka
- Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA.,Department of Advanced Prosthodontics, Loma Linda University School of Dentistry, Loma Linda, CA.,Private Practice, Koka Dental Clinic, San Diego, CA
| | - Kumar Shah
- Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA
| | - Sanjay Mallya
- Department of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA
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33
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Kerscher M, Agsten K, Kravtsov M, Prager W. Effectiveness evaluation of two volumizing hyaluronic acid dermal fillers in a controlled, randomized, double-blind, split-face clinical study. Clin Cosmet Investig Dermatol 2017; 10:239-247. [PMID: 28721082 PMCID: PMC5498678 DOI: 10.2147/ccid.s135441] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Enhancement of the midface can be achieved with volumizing hyaluronic acid (HA) fillers. Objective The objective of this study was to compare the safety and effectiveness of Cohesive Polydensified Matrix® 26 mg/mL HA gel (CPM-26) and Vycross® 20 mg/ml HA gel (VYC-20) in a controlled, randomized, evaluator-blind, split-face clinical study. Patients and methods Subjects with moderate-to-severe malar volume loss on the Merz Aesthetics Scale (MAS) received CPM-26 on one side and VYC-20 on the contralateral side of the face. Effectiveness assessments were performed by blinded evaluators including photographic and live MAS ratings and live Global Aesthetic Improvement Scale (GAIS) ratings. Calculations of anatomical volume variations at month 3 (M3), month 6 (M6), month 12 (M12) and month 18 (M18) were also performed. Results Non-inferiority of CPM-26 versus VYC-20 was demonstrated at M3 (primary end point) based on MAS. GAIS rating showed that significantly more subjects had better improvement with CPM-26 than with VYC-20 at month 1, M3, M12 and M18 (p=0.0032, p=0.0074, p=0.0384 and p=0.0110, respectively). Standardized evaluation of volume variations from baseline to M3, M12 and M18 showed that CPM-26 created more volume augmentation at all time points, and the difference was significant at M3. Conclusion CPM-26 was non-inferior to VYC-20 based on MAS ratings at M3 and demonstrated a favorable safety and effectiveness profile for midfacial volume enhancement with results lasting up to M18.
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Affiliation(s)
| | | | | | - Welf Prager
- Prager & Partner Dermatologische Praxis, Hamburg, Germany
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34
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Delayed-Onset Edematous Foreign Body Granulomas 40 Years After Augmentation Rhinoplasty by Silicone Implant Combined with Liquid Silicone Injection. Aesthetic Plast Surg 2017; 41:637-640. [PMID: 28130558 DOI: 10.1007/s00266-017-0790-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
Abstract
Despite the widespread application of augmentation rhinoplasty in Asia, reports on the interaction between alloplastic implants and injectable filler are scarce. This paper reports on a patient with delayed-onset edematous foreign body granuloma that had been caused by augmentation rhinoplasty performed using a silicone implant in conjunction with a liquid silicone injection 40 years earlier. This is the longest reported duration between initial rhinoplasty and the exacerbation of foreign body granuloma. This case report also presents intraoperative findings pertaining to the interlocking structures between silicone implants and injected liquid silicone. LEVEL OF EVIDENCE V 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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35
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Delayed Superficial Migration of Retained Hyaluronic Acid Years Following Periocular Injection. Ophthalmic Plast Reconstr Surg 2017; 33:S116-S118. [DOI: 10.1097/iop.0000000000000434] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Ferneini EM, Beauvais D, Aronin SI. An Overview of Infections Associated With Soft Tissue Facial Fillers: Identification, Prevention, and Treatment. J Oral Maxillofac Surg 2016; 75:160-166. [PMID: 27717817 DOI: 10.1016/j.joms.2016.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to provide an overview of infections associated with facial soft tissue fillers. MATERIALS AND METHODS A literature review was performed which evaluated infections associated with facial soft tissue fillers. RESULTS Infection rates with soft tissue fillers are low and are estimated at 0.04 to 0.2%. Most of these infections arise when skin contaminants infiltrate the injection site at the time of injection. These infections can occur early, up to several days after treatment, or delayed, occurring weeks to years after treatment. Reactions vary based on the filler absorbability and duration. Early recognition and treatment are important factors in managing our cosmetic surgery patients. CONCLUSION Although facial fillers are safe and predictable, infections can still occur. Oral and maxillofacial surgeons need to be able to prevent, recognize, and properly manage infections related to these popular injections.
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Affiliation(s)
- Elie M Ferneini
- Medical Director, Beau Visage Med Spa, Cheshire; Private Practice, Greater Waterbury OMS, Cheshire; Assistant Clinical Professor, University of Connecticut, Cheshire, CT.
| | - Daniel Beauvais
- Resident, General Practice Residency, Saint Francis Hospital and Medical Center, Hartford, CT
| | - Steven I Aronin
- Chief, Section of Infectious Disease, Waterbury Hospital, Waterbury; Associate Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT
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37
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Tal S, Maresky HS, Bryan T, Ziv E, Klein D, Persitz A, Heller L. MRI in detecting facial cosmetic injectable fillers. Head Face Med 2016; 12:27. [PMID: 27595744 PMCID: PMC5011976 DOI: 10.1186/s13005-016-0124-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Despite being considered a non-invasive procedure, injections can cause adverse outcomes including infections, overfilling, asymmetry, foreign body granulomas, and reactions that lead to scarring. Complications may be associated with the procedure itself, the physician’s technique, and/or the type of agent injected. In these instances, it is important to be able locate and identify the substance used. This study investigated the viability of using MRI to correctly identify injected substances, their symmetry of distribution, and related complications. Methods Fourteen patients with suspected injectable filler complications were identified by our institution’s plastic surgery service. All subjects were scanned with MRI, using highly specific face-oriented sequences at high resolution with small field of view and thin slices across the axial and coronal planes by T1 Dixon non-contrast, T2 Dixon, and T1 Dixon after gadolinium injection. Two independent and blinded radiologists evaluated the images and reported (1) the likely injected substance, (2) symmetry, and (3) complications. These radiological results were compared against clinical data provided by the plastic surgery service. Results Ten patients (83 %) presented objective injectable complications: 4 had abscess, 4 granulomata, and 2 had allergic reactions to the injected substance. The Fleiss Kappa for inter-rater agreement on substances was 0.80. Asymmetry was identified in six patients (50 %) with a Kappa between radiology evaluators of 1. MRI characteristics of these common fillers are summarized in table form. Conclusions Given the growing awareness among referring physicians of the value of dedicated facial MRI, utilization of this imaging technique may lead to discovery of the injected substance’s true identity, evaluation of symmetry and/or complications.
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Affiliation(s)
- Sigal Tal
- Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,Department of Medical Imaging, Sackler Faculty of Medicine, Tel Aviv Universiy, Zeriffin, 70300, Israel
| | - Hillel S Maresky
- Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. .,Department of Medical Imaging, Sackler Faculty of Medicine, Tel Aviv Universiy, Zeriffin, 70300, Israel.
| | - Theodore Bryan
- Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ella Ziv
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Klein
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Persitz
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Heller
- Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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38
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Dubin I, Gelber M, Schattner A. Ageless beauty. Postgrad Med J 2016; 93:171. [PMID: 27514402 DOI: 10.1136/postgradmedj-2016-134213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/18/2016] [Accepted: 07/25/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Ina Dubin
- Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel.,Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Moshe Gelber
- Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel.,Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Ami Schattner
- Department of Medicine, Laniado Hospital, Sanz Medical Centre, Netanya, Israel.,Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel
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Singh M, Wang S, Yee RW, Larin KV. Optical coherence tomography as a tool for real-time visual feedback and biomechanical assessment of dermal filler injections: preliminary results in a pig skin model. Exp Dermatol 2016; 25:475-6. [PMID: 26910121 DOI: 10.1111/exd.12983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Manmohan Singh
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Shang Wang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Richard W Yee
- Department of Research, SeeFit Inc., Houston, TX, USA
| | - Kirill V Larin
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA.,Interdisciplinary Laboratory of Biophotonics, Tomsk State University, Tomsk, Russia
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Vachha BA, Ginat DT, Mallur P, Cunnane M, Moonis G. "Finding a Voice": Imaging Features after Phonosurgical Procedures for Vocal Fold Paralysis. AJNR Am J Neuroradiol 2016; 37:1574-80. [PMID: 27173367 DOI: 10.3174/ajnr.a4781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical restoration. In this article, both traditional and cutting-edge phonosurgical procedures targeting the symptoms resulting from vocal fold paralysis are reviewed, with emphasis on the characteristic imaging appearances of various injectable materials, implants, and augmentation procedures used in the treatment of vocal fold paralysis. In addition, complications of injection laryngoplasty and medialization laryngoplasty are illustrated. Familiarity with the expected imaging changes following treatment of vocal fold paralysis may prevent the misinterpretation of posttreatment changes as pathology. Identifying common complications related to injection laryngoplasty and localization of displaced implants is crucial in determining specific management in patients who have undergone phonosurgical procedures for the management of vocal fold paralysis.
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Affiliation(s)
- B A Vachha
- From the Department of Radiology (B.A.V.), Memorial Sloan Kettering Cancer Center, New York, New York Department of Radiology (B.A.V.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D T Ginat
- Department of Radiology (D.T.G.), University of Chicago, Chicago, Illinois
| | - P Mallur
- Department of Otology and Laryngology (P.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - M Cunnane
- Department of Radiology (M.C.), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - G Moonis
- Department of Radiology (G.M.), Columbia University Medical Center, New York, New York
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Abstract
Fillers belong to the most frequently used beautifying products. They are generally well tolerated, but any one of them may occasionally produce adverse side effects. Adverse effects usually last as long as the filler is in the skin, which means that short-lived fillers have short-term side effects and permanent fillers may induce life-long adverse effects. The main goal is to prevent them, however, this is not always possible. Utmost care has to be given to the prevention of infections and the injection technique has to be perfect. Treatment of adverse effects is often with hyaluronidase or steroid injections and in some cases together with 5-fluorouracil plus allopurinol orally. Histological examination of biopsy specimens often helps to identify the responsible filler allowing a specific treatment to be adapted.
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Affiliation(s)
- Eckart Haneke
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland, Europe; Department of Dermatology, Clinic Dermaticum, Freiburg, Germany, Europe; Centro de Dermatología Epidermis, Inst CUF, Porto, Portugal, Europe; Department of Dermatology, Ghent University Hospital, Gent, Belgium, Europe
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42
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Xiao X, Yu L, Dong Z, Mbelek R, Xu K, Lei C, Zhong W, Lu F, Xing M. Adipose stem cell-laden injectable thermosensitive hydrogel reconstructing depressed defects in rats: filler and scaffold. J Mater Chem B 2015; 3:5635-5644. [PMID: 32262534 DOI: 10.1039/c5tb00270b] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Facial depressed defects are a common cosmetic problem. Temporary fillers need to be re-injected frequently to maintain the desired outcomes. Here, the feasibility of a novel type of injectable hydrogel for persistent effect is demonstrated. We first useed agmatine to synthesize a poly(amidoamine) (PAA) to form a cell-attachable crosslinker and then the crosslinker was co-polymerized with N-isopropylacrylamide to obtain an injectable and temperature sensitive hydrogel. 1H NMR showed the successful synthesis of the crosslinker. In vitro tests, CCK-8 assay and live/dead viability test showed that the hydrogel was non-toxic to adipose-derived stem cells (ASCs). SEM images also confirmed that ASCs could adhere to the hydrogel. Then we constructed a novel depressed defect model in rats and injected four different fillers in the depressed defects: (1) the hydrogel with ASCs, (2) the hydrogel only, (3) hyaluronic acid, and (4) PBS. After 4 weeks, gross and histological analyses showed the defects in hydrogel, hydrogel + ASCs, and HA groups improved significantly and there were no significant differences among them. Significant differences in thickness from skin to muscle in the defect was found between the hydrogel + ASCs group and the other groups after 6 months. The hydrogels degraded completely in defects in both the hydrogel group and the hydrogel + ASCs group, and were filled with adipocytes and multilocular immature adipocytes. Immunohistochemical study using s-100 and perilipin staining revealed adipocyte differentiation in the defect sites. We also used green fluorescent protein (GFP)-ASCs for tracing and found that exogenous added ASCs were involved in adipogenesis. In conclusion, such a cell attachable thermosensitive hydrogel has definite potential not only as a filler but also as a scaffold, and has a persistent effect for small depressed defects. It might ultimately become a new material in plastic and reconstructive surgery.
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Affiliation(s)
- Xiaolian Xiao
- Department of Plastic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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43
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Becker M, Balagué N, Montet X, Calmy A, Salomon D, Toutous-Trellu L. Hyaluronic Acid Filler in HIV-Associated Facial Lipoatrophy: Evaluation of Tissue Distribution and Morphology with MRI. Dermatology 2015; 230:367-74. [PMID: 25870932 DOI: 10.1159/000379747] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This prospective observational study evaluated magnetic resonance imaging (MRI) findings of hyaluronic acid (HA) injections used for the correction of HIV-associated facial lipoatrophy. METHODS Ten consecutive males underwent subdermal HA injection (mean 1.3 ± 0.6 ml per side) and MRI examinations prior to and then 1, 6 and 12 months after injection. Two radiologists blinded to the clinical data assessed morphologic and quantitative changes. RESULTS MRI revealed HA deposition in the subdermal and deep fat compartments. A significant HA volume increase was observed 1 month after injection (mean increase 331%, p < 0.0001) as compared to the injected amount. No volume reduction occurred at 12 months (p = 0.9961). The measured bound water content did not change (p > 0.9991), whereas skin thickness and tissue vascularization increased during the first 6 months (p = 0.01). CONCLUSION Our data show that the cosmetic results of HA injections are caused by water binding in the deep facial fat and by a transient increase in vascularization and skin thickness.
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Affiliation(s)
- Minerva Becker
- Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
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44
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Imaging of Cosmetic Plastic Procedures and Implants in the Body and Their Potential Complications. AJR Am J Roentgenol 2015; 204:707-15. [DOI: 10.2214/ajr.14.13516] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pavicic T. Complete biodegradable nature of calcium hydroxylapatite after injection for malar enhancement: an MRI study. Clin Cosmet Investig Dermatol 2015; 8:19-25. [PMID: 25709485 PMCID: PMC4330000 DOI: 10.2147/ccid.s72878] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Radiesse® (Calcium hydroxylapatite [CaHA]) is a biocompatible, injectable gel for facial soft tissue augmentation. It is a completely biodegradable filler and this is well documented, but objective imaging methods to confirm this property are scarce. Methods We present a case report in which CaHA was injected into the midface of a 50-year-old woman for volume restoration and shaping of the cheek region. On the right side of the face, 1.6 mL CaHA was injected as several (5−7) small depots (0.1−0.2 mL) using a 28G 3/4 inch needle and the vertical supraperiosteal depot technique. On the contralateral side of the face, the subject received 1.6 mL CaHA over three entry points using a 27G 1 1/2 inch blunt cannula and the fanning technique. CaHA location and degradation were assessed using magnetic resonance imaging (MRI). Results CaHA appears as low-to-intermediate signal intensity on MRI images taken immediately after injection for malar enhancement with a symmetrical distribution. On MRI images taken 2.5 years after injection, no CaHA was visible but tissue volume remained increased, indicating a collagen-stimulating effect. The treatment was well tolerated. Conclusion In addition to producing long-lasting aesthetic and collagen-stimulating effects, MRI images confirm that CaHA is completely biodegradable with no product remaining 2.5 years after injection.
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Di Girolamo M, Mattei M, Signore A, Grippaudo FR. MRI in the evaluation of facial dermal fillers in normal and complicated cases. Eur Radiol 2014; 25:1431-42. [PMID: 25477273 DOI: 10.1007/s00330-014-3513-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/01/2014] [Accepted: 11/17/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To ascertain by MRI the presence of filler injected into facial soft tissue and characterize complications by contrast enhancement. METHODS Nineteen volunteers without complications were initially investigated to study the MRI features of facial fillers. We then studied another 26 patients with clinically diagnosed filler-related complications using contrast-enhanced MRI. TSE-T1-weighted, TSE-T2-weighted, fat-saturated TSE-T2-weighted, and TIRM axial and coronal scans were performed in all patients, and contrast-enhanced fat-suppressed TSE-T1-weighted scans were performed in complicated patients, who were then treated with antibiotics. Patients with soft-tissue enhancement and those without enhancement but who did not respond to therapy underwent skin biopsy. Fisher's exact test was used for statistical analysis. RESULTS MRI identified and quantified the extent of fillers. Contrast enhancement was detected in 9/26 patients, and skin biopsy consistently showed inflammatory granulomatous reaction, whereas in 5/17 patients without contrast enhancement, biopsy showed no granulomas. Fisher's exact test showed significant correlation (p < 0.001) between subcutaneous contrast enhancement and granulomatous reaction. Cervical lymph node enlargement (longitudinal axis >10 mm) was found in 16 complicated patients (65 %; levels IA/IB/IIA/IIB). CONCLUSIONS MRI is a useful non-invasive tool for anatomical localization of facial dermal filler; IV gadolinium administration is advised in complicated cases for characterization of granulomatous reaction. KEY POINTS • MRI is a non-invasive tool for facial dermal filler detection and localization. • MRI-criteria to evaluate complicated/non-complicated cases after facial dermal filler injections are defined. • Contrast-enhanced MRI detects subcutaneous inflammatory granulomatous reaction due to dermal filler. • 65 % patients with filler-related complications showed lymph-node enlargement versus 31.5 % without complications. • Lymph node enlargement involved cervical levels (IA/IB/IIA/IIB) that drained treated facial areas.
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Affiliation(s)
- Marco Di Girolamo
- Radiology Unit, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy,
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47
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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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48
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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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49
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Abstract
SUMMARY A wide variety of implants and grafts have been used for cosmetic facial surgery, including forehead, nose, cheek, lip, and chin augmentation. Some of the implant materials include silicone, expanded polytetrafluoroethylene (Gore-Tex), hydroxylapatite, and porous polyethylene (Medpor). Grafts include bone and cartilage, which can be prepared as "Turkish Delight" for rhinoplasty. Imaged facial implants and grafts can be encountered incidentally or purposely to evaluate complications. Many of these materials have distinct radiologic imaging features and should not be misinterpreted as pathology. Conversely, implant complications should be appropriately recognized by using a focused imaging approach. The purpose of this article was to review the different types of cosmetic facial implants and grafts with an emphasis on their expected and complicated radiologic imaging appearances.
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Affiliation(s)
- C J Schatz
- From Beverly Tower Wilshire Advanced Imaging, Beverly Hills California
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50
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Abstract
SUMMARY Cosmetic rhinoplasty encompasses a diverse group of procedures, including alteration of the radix, nasal dorsum, nasal tip, and nasal base; premaxillary augmentation; septoplasty; and combinations thereof. Similarly, many different types of grafts and alloplastic materials can be used in cosmetic rhinoplasty, such as cartilage, bone, silicone, porous polyethylene, expanded polytetrafluoroethylene, and calcium hydroxylapatite. Complications of rhinoplasty that can be observed on imaging include retained metallic surgical instrument fragments, infection, implant extrusion, nerve impingement by implants, nasal valve collapse, and implant deformity. Knowledge of the basic surgical procedures and potential complications of cosmetic rhinoplasty is important for adequately interpreting postoperative radiologic imaging studies.
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Affiliation(s)
- C J Schatz
- From the Department of Radiology (C.J.S.), Beverly Tower Wilshire Advanced Imaging, University of Southern California Keck School of Medicine, Los Angeles, California
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