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Massidda E, Ciampa S, Iozzo I, Emanuele E, Minoretti P. Real-World Outcomes of Lip Augmentation Using a Hyaluronic Acid-Based Filler With Low 1,4-Butanediol Diglycidyl Ether Content: A Prospective, Open-Label, Multicenter, Post-marketing Study. Cureus 2024; 16:e53513. [PMID: 38439998 PMCID: PMC10911686 DOI: 10.7759/cureus.53513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Background 1,4-butanediol diglycidyl ether (BDDE) is the most common cross-linker used to produce hyaluronic acid (HA)-based dermal fillers. However, BDDE may have cytotoxic and potentially mutagenic effects, raising safety concerns. Consequently, manufacturers are developing new HA filler formulations with reduced BDDE levels to mitigate potential biological risks. Here, we sought to evaluate the clinical outcomes of lip augmentation performed using an HA-based filler with a reduced BDDE content (Agex Fill Volume®; Biodue SpA, Barberino Tavarnelle, Italy) in a real-world clinical setting. Methods This was a prospective, open-label, multicenter, post-marketing study conducted over six months. Thirty adult subjects (29 women and one man) who desired a ≥1-point improvement on the validated Lip Fullness Scale 2 (LFS2) were enrolled. The primary efficacy endpoint was the post-procedural increase in the investigator-reported LFS2 compared to baseline. Other endpoints included self-perceived happiness assessed using the Happiness Measure Scale (HMS) and safety. Results Of the study participants, 73% (22/30) demonstrated an improvement of at least one point in their LFS2 scores immediately after treatment compared to baseline, thus qualifying as responders. Six months later, the responder rate, based on LFS2 scores, remained steady at 66.7% (20/30). Importantly, these aesthetic improvements were consistently associated with a positive impact on subject-reported HMS, with a significant difference (p < 0.001) between post-treatment and baseline scores. All adverse events (AEs) reported after treatment were mild. Conclusions Agex Fill Volume®, a HA filler with low BDDE content, provides a safe and effective option for enhancing lip volume in real-world aesthetic settings.
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Affiliation(s)
- Enrico Massidda
- Dermatology, Italian Society of Aesthetic Medicine, Cagliari, ITA
| | - Sonia Ciampa
- Dermatology, Poliambulatorio Rimedical, Santarcangelo di Romagna, ITA
| | - Ivano Iozzo
- Dermatology, Iozzo Antonucci Medical Center, Bologna, ITA
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Trinh LN, McGuigan KC, Gupta A. Delayed Granulomas as a Complication Secondary to Lip Augmentation with Dermal Fillers: A Systematic Review. Surg J (N Y) 2022; 8:e69-e79. [PMID: 35252562 PMCID: PMC8894086 DOI: 10.1055/s-0042-1743524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction
Lip augmentation with dermal filler is rising in popularity. There are generally minimal side effects that are mild and transient. However, long-term complications may occur and include lumps, bumps, nodules, or granulomas. To better understand this uncommon but challenging outcome, we aim to perform a thorough systematic review of the published literature related to nodule or granuloma formation after cosmetic soft tissue augmentation of the lips.
Methods
A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in April 2021 and included PubMed, ScienceDirect, Embase, Google Scholar, and Cochrane databases. The Medical Subject Headings (MeSH) terms used included the following terms: “lip filler,” “hyaluronic acid,” “lip injection,” “lip augmentation,” “silicone,” “poly-L-lactic acid,” “calcium hydroxyapatite,” “polymethylmethacrylate,” “complications,” “reaction,” “granuloma,” and “nodule.” All studies were reviewed by two independent reviewers. Any discrepancies were resolved by a third reviewer.
Results
The initial search for filler-related nodules or granulomas yielded 2,954 articles and 28 were included in the final analysis containing 66 individual cases of lip nodules. All but one patient was female. The mean age was 50 years. Nodules presented on average 35.2 months or 2.9 years after initial treatment. Thirty-seven nodules underwent histological analysis, the majority of which identified the presence of a foreign-body granuloma. Silicone was the most reported filler used followed by hyaluronic acid. Most cases resolved following multiple treatments including oral antibiotics or steroids followed by surgical excision.
Conclusion
Understanding the sequelae of lip augmentation with filler products allows clinicians to provide safe and effective treatment. Nodules that present months to years following dermal treatment may represent a foreign-body granuloma. A combination of oral antibiotics, intralesional or oral steroids, and surgical excision successfully treated the majority of cases in our study.
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Affiliation(s)
- Lily Nguyen Trinh
- Department of Otolarynology- Head and Neck Surgery, School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Institution, Boston, Massachusetts
| | - Kelly Christine McGuigan
- Department of Otolarynology- Head and Neck Surgery, School of Medicine, Kimmel Medical College, Thomas Jefferson University Sidney, Philadelphia, Pennsylvania
| | - Amar Gupta
- Department of Otolaryngology - Head and Neck Surgery, Facial Plastic Surgery, Los Angeles, California
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Goel A, Rai K. A minimalistic approach for effective lip augmentation-A case report. J Cosmet Dermatol 2021; 21:2426-2428. [PMID: 34510690 DOI: 10.1111/jocd.14444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/13/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lip augmentation using dermal fillers is a widely performed procedure, which gives immediate and gratifying results. However, the cost associated with it is a major concern and reservation for a lot of patients. An innovative minimalistic technique can be used to enhance the lips using minimal amount of filler to provide maximum results, especially in aging lips. Though a simple and effective method, this technique has not yet gained popularity worldwide. AIM To present a case demonstrating a new and innovative technique for lip augmentation as a part of lower face rejuvenation. METHOD A 55-year-old female patient underwent augmentation of lips using the described technique. Since she had a limited budget, treatment was planned to rejuvenate her face in just 1 ml of filler. Areas on the face which would give maximum impact with minimal amount of filler were treated. Treatment was done using Juvederm Ultra Plus XC (JUVX+ ; 24 mg/ml) dermal filler. RESULTS Using this technique, we were able to demonstrate that a small quantity of filler when used suitably with an understanding of the areas of concern could provide an impact on the overall rejuvenation. CONCLUSION The described technique is an effective method of lip enhancement with minimal cost, especially in aging patients. Skillful application of a suitable injection technique is required to achieve a desired esthetic outcome.
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Affiliation(s)
| | - Kritika Rai
- Oral and Maxillofacial Surgery, Berkowits Hair and Skin Clinic, New Delhi, India
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Abstract
INTRODUCTION Soft tissue filler augmentation has become increasingly popular due to its perceived ease and impressive results. Unfortunately, although the results are impressive, so are the reported complications. This article describes complications specific to peri-oral soft tissue filler injection and then discusses evidence-based, anatomic prevention and treatment guidelines. AREAS COVERED The authors aimed at providing an overview of the complications associated with peri-oral soft tissue filler. Hyaluronic Acid (H.A) fillers may have devastating complications which are oft undisclosed or published. This narrative review aims to describe the various complications and provide preventative strategies. EXPERT OPINION Given the paucity of prospective, randomized clinical trials on the subject and in light of complication underreporting, the authors believe that efficacy and safety literature on the subject is lacking. Injectors must rely on the one strength which exists in the lip literature to date, that is anatomy. The basis of all successful injections is a mandatory understanding of normal as well as variations of vital structures in an area, combined with meticulous injection techniques, deposition of small aliquots of product and the ability to recognize unwanted adverse events early enough to act on them.
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Affiliation(s)
- Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
| | - Arthur Swift
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada.,Westmount Institute of Plastic Surgery, Montreal, QC, Canada
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Andreas Nikolis
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada.,Erevna Innovations Inc, Montreal, Quebec, Canada
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Czumbel LM, Farkasdi S, Gede N, Mikó A, Csupor D, Lukács A, Gaál V, Kiss S, Hegyi P, Varga G. Hyaluronic Acid Is an Effective Dermal Filler for Lip Augmentation: A Meta-Analysis. Front Surg 2021; 8:681028. [PMID: 34422892 PMCID: PMC8377277 DOI: 10.3389/fsurg.2021.681028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/09/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction: The lips and the mouth play an indispensable role in vocalization, mastication and face aesthetics. Various noxious factors may alter and destruct the original structure, and appearance of the lips and the anatomical area surrounding the mouth. The application of hyaluronic acid (HA) may serve as a safe method for lip regeneration. Although a number of studies exist for HA effectiveness and safety, its beneficial effect is not well-established. Aim: The present meta-analysis and systematic review was performed to investigate the effectiveness of HA on lip augmentation. We also investigated the types and nature of adverse effects (AEs) of HA application. Methods: We reported our meta-analysis in accordance with the PRISMA Statement. PROSPERO protocol registration: CRD42018102899. We performed the systematic literature search in CENTRAL, Embase, and MEDLINE. Randomized controlled trials, cohort studies, case series and case reports were included. The untransformed proportion (random-effects, DerSimonian-Laird method) of responder rate to HA injection was calculated. For treatment related AEs descriptive statistics were used. Results: The systematic literature search yielded 32 eligible records for descriptive statistics and 10 records for quantitative synthesis. The results indicated that the overall estimate of responders (percentage of subjects with increased lip fullness by one point or higher) was 91% (ES = 0.91, 95% CI:0.85-0.96) 2 months after injection. The rate of responders was 74% (ES = 0.74, 95% CI:0.66-0.82) and 46% (ES = 0.46, 95% CI:0.28-0.65) after 6 and 12 months, respectively. We included 1,496 participants for estimating the event rates of AEs. The most frequent treatment-related AEs were tenderness (88.8%), injection site swelling (74.3%) and bruising (39.5%). Rare AEs included foreign body granulomas (0.6%), herpes labialis (0.6%) and angioedema (0.3%). Conclusion: Our meta-analysis revealed that lip augmentation with injectable HA is an efficient method for increasing lip fullness for at least up to 6 months after augmentation. Moreover, we found that most AEs of HA treatment were mild or moderate, but a small number of serious adverse effects were also found. In conclusion, further well-designed RCTs are still needed to make the presently available evidence stronger.
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Affiliation(s)
- László Márk Czumbel
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Sándor Farkasdi
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Mikó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dezső Csupor
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Anita Lukács
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Valéria Gaál
- Department of Ophthalmology, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Varga
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
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Goel A, Rai K. Male lip filler-Aesthetic enhancement is not just limited to females: A case report. J Cosmet Dermatol 2021; 20:3173-3176. [PMID: 34197689 DOI: 10.1111/jocd.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/30/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lips play an important role in facial aesthetics. Hyaluronic acid fillers have been widely used for lip augmentation in females but very few men seek this treatment due to the fear of feminization of lips. However, there are very few case reports published for correction of lips using fillers in men. AIM To assess the effectiveness of hyaluronic acid dermal fillers for enhancement of lips in males. METHOD A 52-year-old male underwent two sessions of treatment for inturned lips. In the first session, 2 ml hyaluronic acid dermal filler (Juvederm Ultra Plus-JUP) with 27G × 8 mm needle via bolus and retrograde linear thread technique was used. Assessment of lips was done after one week. Second session of treatment was done after 30 months of first treatment with 1 ml of filler. RESULTS Injection of filler not only led to a significant improvement in vermillion show, but also improved the overall facial appearance. The results of this treatment were long lasting and even after 30 months from the first treatment the patients' vermillion body still showed ten per cent improvement from the original. CONCLUSION Dermal lip filler treatment in men can be a very satisfying and rewarding procedure. Its awareness should be spread afar to increase its acceptability.
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Affiliation(s)
| | - Kritika Rai
- Berkowits Hair and Skin Clinic, New Delhi, India
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7
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Shome D, Shah RA, Gowda D, Vadera S, Kumar V, Raj M, Atif A, Doshi K, Vekaria M, Pathak M, Kapoor R. A prospective, open-label, multicentric, single-arm, post-marketing clinical study to evaluate effectiveness and safety of Cross-Linked Sodium Hyaluronate 24mg with Lidocaine 3mg Injection in subjects undergoing treatment for facial wrinkles and lip augmentation. J Cosmet Dermatol 2021; 20:2472-2479. [PMID: 34021962 DOI: 10.1111/jocd.14249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyaluronic acid (HA) fillers are quite commonly used since several years for soft tissue augmentation. AIM The purpose of this study was to evaluate primarily the safety and secondarily the clinical effectiveness of Cross-Linked Sodium Hyaluronate 24 mg with Lidocaine 3 mg (Jeunesso 24L) injection, in subjects undergoing treatment for facial wrinkles and lip augmentation. METHOD Patients between the age groups of 18 and 75 years, who were seeking soft tissue augmentation treatment on the face and with wrinkle severity score (WSS) ≥2 for bilateral Nasolabial Folds (NLF), were included in the study. The appropriate quantity of the filler was injected at the treatment site. Clinical efficacy assessments were conducted independently at 3 and 6 months after baseline. Clinical efficacy was assessed using Wrinkle Severity Rating Scale (WSRS) and a Global Aesthetic Improvement Scale (GAIS). RESULTS The mean pain score was found to be 2.57 ± 2.06 immediately after injection which was reduced to 0.1 ± 0.675 at 15 min and this further subsided to "No Pain" in any of the participants at 60 min post the injection. WSRS mean score before treatment was 2.76, which were significantly reduced to 2.14, at 3 months. Majority of participants found an improvement in the marionette line severity. Also, significant improvements were seen in the perioral and lip areas. The Study filler was well-tolerated and no side effects were reported. CONCLUSION The study indicates that this particular filler, HA+L, is useful for cosmetic improvements in the nasolabial folds and for enhancement of the lips.
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Affiliation(s)
- Debraj Shome
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | | | - Dinesh Gowda
- Hairline Diagnostics & Healthcare Pvt Ltd, Bengaluru, India
| | - Sapna Vadera
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | - Vaibhav Kumar
- Clinical Research Coordinator, The Esthetic Clinics, Mumbai, India.,Faculty, TPCT's Terna Dental College, India
| | - Manish Raj
- Smile Designers Multispeciality Dental Hospital, Prayagraj, India
| | - Ali Atif
- Department of Oral and Maxillofacial Surgery, King George Medical College, Lucknow, India
| | - Komal Doshi
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | | | | | - Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery, The Esthetic Clinics, Mumbai, India
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8
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Abstract
Administration of hyaluronic acid (HA) filler for aesthetic lip augmentation is a routine and common procedure with a low rate of adverse reactions. This case report documents an extremely rare complication of lip augmentation with HA leading to the development of lymphangiomas. Lymphangiomas are uncommon hamartomas of the lymphatic system. Although usually congenital, they can be acquired due to trauma, inflammation, or lymphatic blockage. They may be in the deep or superficial tissues, with superficial forms being either lymphangioma circumscriptum or acquired lymphangioma, also referred to as lymphangiectasia. Acquired lymphangiomas are typically formed by blockage of lymphatic drainage leading to dilation of the lymphatic channels. The diagnosis in our case report is acquired lymphangioma. A 27-year-old female presented with a two-year history of linear swellings in her upper lip. These lumps followed the line where HA filler had been injected four years earlier. Hyaluronidase had previously been used unsuccessfully to remove these lumps. The patient was treated with surgery to excise the lesions. Five masses were excised, and histopathological analysis displayed the presence of variably ectatic lacunae, lined by cells with CD34 expression, a lymph-vascular-endothelial marker. There were also scattered macrophages with CD68 expression in the interstices. These are typical features of a lymphangioma. The patient was satisfied with the excellent aesthetic and functional outcome. To our knowledge this is the first case of a lymphangioma following HA lip augmentation. Although rare, this complication can have aesthetic implications for the patient which may require further treatment or surgery to correct.
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Affiliation(s)
- James Wege
- Oral and Maxillofacial Surgery, Castle Hill Hospital, Hull, GBR
| | - Mohammed Anabtawi
- Oral and Maxillofacial Surgery, Chesterfield Royal Hospital, Chesterfield, GBR
| | - Mike A Blackwell
- Oral and Maxillofacial Surgery, Leeds General Infirmary, Leeds, GBR
| | - Alan Patterson
- Oral and Maxillofacial Surgery, Rotherham National Health Service Foundation Trust, Rotherham, GBR
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9
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Walker L, Cetto R. Lip Augmentation Using Hyaluronic Acid Filler and a 4-mm Needle: A Safer, More Natural, and Predictable Approach. J Clin Aesthet Dermatol 2021; 14:E61-E63. [PMID: 33584970 PMCID: PMC7869814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clinicians employ several techniques to augment lips with hyaluronic acid (HA) filler. To the best of our knowledge, however, no previous study has documented the use of a 4-mm 30-gauge needle in this context. This paper describes the anatomical rationale behind and practical application of such a needle applied very superficially in the vermillion border during lip augmentation. Using a 4-mm 30-gauge needle facilitates precise HA placement into the safer subcutaneous plane of the lip and lowers the pressure needed to extrude the filler, which might optimize patient comfort. This technique aims to increase the safety and predictability of lip augmentation with HA fillers. Credit is owed to Dr. Jean Louis Sebagh, who provided the inspiration to use the described needle for this evidence-based technique.
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Affiliation(s)
- Lee Walker
- Dr. Walker is with BCity Clinics in Liverpool, England
- Dr. Cetto is with Clinic One Point Six in London, England
| | - Raul Cetto
- Dr. Walker is with BCity Clinics in Liverpool, England
- Dr. Cetto is with Clinic One Point Six in London, England
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10
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Li Y, Chong Y, Yu N, Dong R, Long X. The use of botulinum toxin A in upper lip augmentation. J Cosmet Dermatol 2020; 20:71-74. [PMID: 32969573 DOI: 10.1111/jocd.13731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Full lips are beauty standards. Botulinum toxin A (BTA) paralyzes the orbicularis oris muscle to achieve the eversion of the lip, and thus makes the lip look plump. AIMS This study presents three cases of BTA injection to the lip and evaluates the possible changes in the labial morphology and the lip surface area. METHODS Three patients received a total of 4U BTA injection at the vermilion border of the upper lip. Vectra® H1 3D imaging system was used to capture 3D photographs of the lips before injection and two weeks after injection. Eight linear distances and the upper lip surface area were measured. Anthropometric measurements before and after injection were compared. RESULTS Patients displayed a larger upper vermillion height (P = .038) and a smaller cutaneous upper lip height (P = .024). There was a trend for a larger upper lip surface area, but not statistically significant (P = .109). Symptoms of slight perioral muscular palsy and mouth incompetence lasted about one month in three patients. CONCLUSION BTA helps to enlarge the upper lip and shorten the philtrum. The BTA injection can be an option for lip enhancement with caution.
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Affiliation(s)
- Yunzhu Li
- Department of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuming Chong
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Ruijia Dong
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
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11
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Caldas Pozuelo C, Domínguez De Dios J, Mota Rojas X. Multiple oral granulomatous nodules to hyaluronic acid filler. J Cosmet Dermatol 2020; 19:3453-3455. [PMID: 32979892 DOI: 10.1111/jocd.13734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/06/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
A 74-year-old Caucasian woman presented with a 2-week history of multiple nodules in both lips and perioral region that caused her mild discomfort while eating. The patient reported hyaluronic acid infiltration on both lips 5 months prior to presentation. The examination revealed multiple, well-defined, millimetric, and firm nodules on both lips and oral mucosa. An excisional biopsy of one of the nodules was performed under local anesthesia. Histopathological analysis demonstrated acute eosinophilic inflammation, fibrosis, and granulomas on mucoid material, positive for colloidal iron stain and Alcian blue stain, alongside a minor salivary gland showed mild atrophy, fibrosis, and fat infiltration. Enhancement of the aged lip using hyaluronic acid, to restore the bulkiness and elasticity that have been lost with age, is very common. Nevertheless, soft tissue fillers are used in a wide age range. Hyaluronic acid represents 78% of the dermal filler injections in the United States, been the second most popular nonsurgical cosmetic procedure after botulinum toxin injection. Foreign body granulomatous reaction is a rare delayed complication that has been well documented elsewhere and it has been associated with poor injection technique. Although it also has been related to hypersensitivity reactions that may be caused by impurities developed during the bacterial fermentation process, treatment of granulomatous reactions with hyaluronidase is recommended.
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Affiliation(s)
| | | | - Xenia Mota Rojas
- Department of Otolaryngology, Hospital Álvaro Cunqueiro, Vigo, Spain
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Scarano A, Puglia F, Cassese R, Mordente I, Amore R, Ferraro G, Sbarbati A, Lo Russo F, Greco Lucchina A, Amuso D. Hyaluronic acid fillers in lip augmentation procedure: a clinical and histological study. J BIOL REG HOMEOS AG 2019; 33:103-108. DENTAL SUPPLEMENT. [PMID: 32425030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Several approaches have been proposed for soft tissue augmentation using injectable materials for lip and soft-tissue augmentation due to their physical and biological properties. Hyaluronic acid represents a natural component of the connective tissues, related to wound healing and skin regeneration. The aim of this research was to investigate the clinical and histological effectiveness of cross-linked hyaluronic acid for lip augmentation. A total of 8 patients were treated for lip augmentation with a clinical follow up of 60 days. After this period a histological evaluation was performed to evaluate the healing of the treated regions. The healing phase reported no inflammatory response, tissue contractions and no local flogistic evidence in the treated areas, where the filling volume appeared maintained. The 60 days histological evaluation showed evidence of filler resorption with few infiltrated inflammatory cells. The clinical and histological findings suggested that cross-linked hyaluronic acid represents a safe and effective tool for lip augmentation.
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Affiliation(s)
- A Scarano
- Dean Master Program in Aesthetic Medicine Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - F Puglia
- University of Palermo, Master of Techniques of Aesthetic Medicine and Wellness, Palermo, Italy
| | - R Cassese
- University of Palermo, Master of Techniques of Aesthetic Medicine and Wellness, Palermo, Italy
| | - I Mordente
- Master Course in Aesthetic Medicine, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Italy
| | - R Amore
- Master Course in Aesthetic Medicine, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Italy
| | - G Ferraro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - A Sbarbati
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - F Lo Russo
- Department of Neurosciences, Biomedicine and Movement Sciences, Anatomy and Histology Section, University of Verona, School of Medicine, Verona, Italy
| | - A Greco Lucchina
- Research Laboratory in Regenerative Medicine and Tissue Engineering Saint Camillus International University of Health Sciences, Rome, Italy
| | - D Amuso
- Master course in Aesthetic Medicine, Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Italy
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13
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Ehsani AH, Ansari MS, Ghanadan A, Mehdizade Rayeni N, Noormohammad Poor P, Ansari M. Serious complication as a result of lip augmentation with vitamin E. J Cosmet Dermatol 2019; 18:1632-1634. [PMID: 30924223 DOI: 10.1111/jocd.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/12/2019] [Indexed: 11/28/2022]
Abstract
Nowadays lip augmentation with FDA-approved fillers is becoming popular. However, because of financial concerns many patients seek for unregistered materials. Here, we report two cases who use vitamin E for lip augmentation. They experience severe infiltration and discharge less than one month after injection. Biopsy revealed lipogranuloma formation. They were treated with incision and drainage, antibiotic, and corticosteroids. Although these complications are usually difficult to treat, the patients had good clinical response and no recurrence in 5-month follow-up.
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Affiliation(s)
- Amir Hooshang Ehsani
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Sadat Ansari
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghanadan
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehdizade Rayeni
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Noormohammad Poor
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Ansari
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kollipara R, Walker B, Sturgeon A. Lip Measurements and Preferences in Asians and Hispanics: A Brief Review. J Clin Aesthet Dermatol 2017; 10:19-21. [PMID: 29399256 PMCID: PMC5774906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: Most literature regarding lip augmentation refers to Caucasian anthropometric measurements, but ethnic differences affect facial dimensions and the evaluation of beauty. Specifically with regard to Asians and Hispanics, dermatology does not have much literature on the subject. This review investigates the differences in lip measurements and preferences of Asians and Hispanics compared with those of Caucasians. Design: A literature search of other fields, including plastic surgery, maxillofacial surgery, orthodontics, and forensic anthropology, was conducted, and relevant articles were selected that applied to the discussion of lip measurements and preferences in Asians and Hispanics. Results: Lip measurements do appear to differ between Asians, Hispanics, and Caucasians, and ethnic background appears to influence lip preferences. Conclusions: It is inappropriate to use Caucasian measurements and generalizations in lip preferences when determining what is "ideal" when aesthetically augmenting lips among Asians and Hispanics. Ultimately, it is important to take into account the goals, anatomy, and ethnic background of each individual patient before performing lip augmentation.
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Affiliation(s)
- Ramya Kollipara
- Dr. Kollipara is a dermatology resident, Ms. Walker is a student
- Dr. Sturgeon is Assistant Professor of Dermatology at Texas Tech University Health Sciences Center in Lubbock, Texas
| | - Bridget Walker
- Dr. Kollipara is a dermatology resident, Ms. Walker is a student
- Dr. Sturgeon is Assistant Professor of Dermatology at Texas Tech University Health Sciences Center in Lubbock, Texas
| | - Ashley Sturgeon
- Dr. Kollipara is a dermatology resident, Ms. Walker is a student
- Dr. Sturgeon is Assistant Professor of Dermatology at Texas Tech University Health Sciences Center in Lubbock, Texas
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Yazdanparast T, Samadi A, Hasanzadeh H, Nasrollahi SA, Firooz A, Kashani MN. Assessment of the Efficacy and Safety of Hyaluronic Acid Gel Injection in the Restoration of Fullness of the Upper Lips. J Cutan Aesthet Surg 2017; 10:101-105. [PMID: 28852297 PMCID: PMC5561704 DOI: 10.4103/jcas.jcas_115_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM Lips have a significant role in face aesthetic perception, and lip augmentation is one of the most commonly requested aesthetic procedures. Non-permanent dermal fillers, such as hyaluronic acid (HA), are used for augmenting the lips. This article presents the results of Phase II, before - after designed study, assessing the safety and efficacy of a soft tissue HA filler, for upper lip augmentation. MATERIALS AND METHODS Investigators treated 10 healthy adult women 28-45 years old, using a single injection of Hyamax Kiss soft tissue HA filler (a product from Hyamed Laboratories, Switzerland) for upper lip augmentation. The primary efficacy endpoint was an increase in lip fullness at least one grade on Medicis Lip Fullness Scale at 2, 12 and 24 weeks post-treatment. Furthermore, the effectiveness and durability of filler were assessed using a 5-point Investigator's Global Assessment (IGA). Adverse events and volunteers' satisfaction were reported using visual analog scale. RESULTS Response to treatment (as defined above) after 2, 12 and 24 weeks were observed in 80%, 70% and 80% of patients, respectively. No statistical difference was found in response to treatment rate between follow-up visits (P = 0.83). The mean value of IGA score in weeks 2, 12 and 24 were 3.4 ± 0.96, 3.3 ± 0.67 and 3.3 ± 0.67, respectively. The study subjects were almost all satisfied with their lip improvement. Reported adverse effects were temporary and mostly mild in severity. CONCLUSION Soft tissue HA filler tested in this study was well tolerated, efficient and durable when used for upper lip augmentation.
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Affiliation(s)
- Taraneh Yazdanparast
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.,Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Air Pollution, Health and Occupational Diseases Research Unit, Tehran, Iran
| | - Aniseh Samadi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hournaz Hasanzadeh
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Ahmad Nasrollahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Nassiri Kashani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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16
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Kamouna B, Darlenski R, Kazandjieva J, Balabanova M, Dourmishev L, Negentsova Z, Etugov D, Mirchevska B, Tsankov N. Complications of injected vitamin E as a filler for lip augmentation: case series and therapeutic approach. Dermatol Ther 2015; 28:94-7. [PMID: 25649466 DOI: 10.1111/dth.12203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The strive for proficient cosmetic facial appearance is growing in the past decades. Fillers for tissue augmentation are gaining wide popularity. Uncertified products based on oleic solutions are applied by untrained staff, thus growing the risk for certain complications such as infections, allergic and irritant contact dermatitis, and lipogranuloma formation. We present a series of three cases lipogranuloma after liquid vitamin E injection for lip augmentation. In all cases, painful edema at the injected area followed the procedure. The patients were presented with erythema, firm indurations of the lips and the perioral skin, and tenderness. Histological examination of skin biopsies showed round-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with a lipogranuloma. In this paper, we propose a protocol for treatment of this specific complication with systemic corticosteroids and a broad spectrum antibiotics.
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Affiliation(s)
- Ban Kamouna
- Department of Dermatology and Venereology, Medical Faculty-Sofia, Sofia, Bulgaria
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17
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Friedrich RE, Zustin J. Paraffinoma of lips and oral mucosa: Case report and brief review of the literature. GMS Interdiscip Plast Reconstr Surg DGPW 2014; 3:Doc05. [PMID: 26504716 PMCID: PMC4582499 DOI: 10.3205/iprs000046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interstitial application of paraffin in plastic and reconstructive surgery is obsolete due to the development of permanent and extensive foreign body granulomas at the site of application. These granulomas can cause severe physical impairment and develop their own prognostic worth. Furthermore, the disperse oil droplets are not a locally stable suspension. Therefore, the desired aesthetic aspect can get lost in the course of a potential dislocation of the suspension. In addition, the interstitial confluence of non-resorbable droplets to larger oil drops causes palpable and sometimes visible indurations of the skin, the correlate of chronic inflammation. This case report describes the efforts undertaken to release the patient at least temporarily from her paraffin granulomas and to improve her appearance. The relevant literature is briefly discussed. Furthermore, we present some immunohistochemical findings to specify the foreign body reaction associated with paraffin injections into connective tissues.
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Affiliation(s)
- Reinhard E Friedrich
- Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Germany
| | - Jozef Zustin
- Gerhard-Domagk-Institute of Pathology, Westfälische Wilhelms University, Münster, Germany
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18
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Abstract
Instances of perioral and labial foreign body reactions to a variety of injectable dermal fillers were selected from the oral and maxillofacial pathology and dermatopathology archives at Pacific Pathology Laboratory of San Diego with the objective being to engender a compilation of histopathologic characteristics that allow the pathologist to identify the inciting materials. All cases of foreign body reactions located in the lips and perioral regions were reviewed by four pathologists, retaining those cases with a history of injection lip augmentation as well as those with histologic features previously documented to represent dermal filler substances. In selected cases, Alcian blue pH 2.5 with and without hyaluronidase pretreatment was performed. Immunohistochemical markers for macrophages (CD 68), adipocytes (S-100) and keratinocytes (AE1/AE2) were undertaken. All instances presented as single or multiple submucosal plaques, nodules or swellings. Natural polymers including collagen, hyaluronate, hydroxyapatite, poly-L-lactate and synthetic polymers including carboxymethyl cellulose, dimethylpolysiloxane, and polyethyl methacrylate induce histologically unique features that allow for their identification. Host histopathologic responses included nodule without foreign body reaction, nodule with chronic inflammation, granuloma with epithelioid histiocytic and multinucleated giant cell reaction. Dermal filler foreign body host reactions in conjunction with the morphology of the foreign materials themselves are unique and can be differentiated from one another microscopically.
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Affiliation(s)
- Roy Eversole
- Oral Pathology Diagnostic Services, San Diego, CA 92123 USA
| | - Khahn Tran
- Pacific Pathology Laboratory, San Diego, CA 92123 USA
| | - Doyle Hansen
- Pacific Pathology Laboratory, San Diego, CA 92123 USA
| | - John Campbell
- Pacific Pathology Laboratory, San Diego, CA 92123 USA
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