The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature.
Bachour Y,Kadouch J A,Niessen F B
Aesthetic plastic surgery
BACKGROUND:Late inflammatory reactions (LIRs) are the most challenging complications after filler use. The immune system plays a prominent role in its etiology, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for LIRs. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of LIRs. METHODS:We undertook a systematic literature review focused on immunological factors and microbiota in relation to LIRs after filler use. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE and the Cochrane databases were searched from inception up to August 2019. Included studies were assessed for the following variables: subject characteristics, number of patients, primary indication for filler injection, implant type/amount and injection site, type of complication, follow-up or injection duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors. RESULTS:Data on immunological factors and bacterial contamination were retrieved from 21 included studies. Notably, the presence of histocytes, giant cells and Staphylococcus epidermidis within biopsies were often associated with LIRs. CONCLUSION:This review provides a clear overview of the immunological factors associated with LIRs and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with LIRs has been provided. Follow-up research may result in clinical recommendations to prevent LIRs. LEVEL OF EVIDENCE III:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors- www.springer.com/00266. .
10.1007/s00266-021-02306-3
Cerebral Embolism as a Result of Facial Filler Injections: A Literature Review.
Aesthetic surgery journal
BACKGROUND:With the growth in the popularity of facial filler injections, increased numbers of severe adverse events, such as cerebral embolism, have been reported. OBJECTIVES:The aim of this article was to summarize the clinical manifestations and proposed mechanisms of filler-induced cerebral embolism (FICE). METHODS:A literature review was performed with the search keywords "filler injection," "hyaluronic acid," "fat graft," "cerebral infarction," "cerebral embolism," "stroke," "cerebrovascular infarction," "disorders of consciousness," and "hemiplegia." RESULTS:Among the 43 cases of FICE enrolled from 35 articles, 37 patients were female, and 6 were male. Twenty-nine of these patients had received fat grafting, and 12 hyaluronic acid injection. Most FICE patients had been injected in the glabella, followed by the temporal, forehead, and nasal areas. Among 30 patients injected under local anesthesia, 43.33% presented with neurologic symptoms during the procedure. The main symptoms were consciousness disorders and hemiplegia. Most of the embolization sites were in the middle cerebral artery, followed by frontal lobe infarction and anterior cerebral artery infarction. Three patients developed cerebral hemorrhage after embolism. Twenty-six patients presented with newly acquired vision loss. The management for FICE cases included embolectomy, thrombolysis, decompressive craniectomy, antiplatelet/anticoagulant therapy, and symptomatic and nutritional treatment. Nearly half of the patients recovered or exhibited improved neurologic manifestations but not visual loss. Five patients died. CONCLUSIONS:FICE is a severe complication following facial filler injection. Careful prevention, timely identification, and treatment are crucial to decreasing the morbidity and mortality of FICE. LEVEL OF EVIDENCE: 4:
10.1093/asj/sjab193
Complication of Soft Tissue Fillers: Prevention and Management Review.
Galadari Hassan,Krompouzos George,Kassir Martin,Gupta Mrinal,Wollina Uwe,Katsambas Andreas,Lotti Torello,Jafferany Mohammad,Navarini Alexander A,Vasconcelos Berg Roberta,Grabbe Stephan,Goldust Mohamad
Journal of drugs in dermatology : JDD
The use of dermal fillers has increased manifold over the past decade, which has been attributed to the ever-increasing need of the population for being young. Fillers have become quite popular both among patients and treating physicians due to their quick and quite predictable results. Filler injection is a safe procedure in the hands of an experienced provider using appropriate technique. Nevertheless, various adverse effects to fillers have been reported that range from mild injection site complications, such as pain and bruising, to severe complications, like tissue necrosis, retinal artery occlusion, and infections. The esthetic provider should be aware of and be able to quickly recognize such complications, and be confident in managing them. In this article we highlight the various adverse effects noted with the use of fillers and discuss prevention and management. J Drugs Dermatol. 2020;19(9):829-832. doi:10.36849/JDD.2020.5084.
10.36849/JDD.2020.10.36849/JDD.2020.5084
Complications Following Self-Administration of Hyaluronic Acid Fillers: Literature Review.
Rauso Raffaele,Nicoletti Giovanni Francesco,Zerbinati Nicola,Lo Giudice Giorgio,Fragola Romolo,Tartaro Gianpaolo
Clinical, cosmetic and investigational dermatology
The purpose of the present study is to review published literature regarding complications following self-administration of hyaluronic acid (HA) filler. The following keywords were searched in Pubmed and Cochrane database: filler AND self injection, hyaluronic acid AND self injection; filler AND self administration; hyaluronic acid AND self administration. Two authors performed title and abstract eligibility assessment independently. Gray literature and all articles cited in the included papers were also screened and their reference lists were examined to identify other potentially pertinent studies. Non-English papers were excluded. A total of 4 complications following self injection of HA were identified. Conversely, after performing a general search through the Google Internet search engine, with the item "self-injection of hyaluronic acid filler", there were 604,000 hits. The number of articles reporting complications after the self administration of HA is few. Despite that internet searches on the same topic shows that self-administration of HA fillers is a widely discussed phenomenon in several on-line forums. The present review suggests that complications after self-injection of HA are an under-reported phenomenon.
10.2147/CCID.S276959
Application of Nonsurgical Modalities in Improving Facial Aging.
International journal of dentistry
OBJECTIVE:This review aims to summarize different kinds of applications of minimally invasive surgery in improving facial aging to provide a comprehensive and accurate introduction on the issue of esthetic treatment of facial skin. . In the twentieth century, facial rejuvenation has become a new beauty trend. Facial cosmetology has entered a period of antiaging and rejuvenation therapies and microplastic surgery. The pursuit of beauty has promoted the development of minimally invasive plastic surgery. This review introduces the possible causes of facial aging and its related topics with a focus on facial injectable drugs, such as botulinum toxin, main filler materials (hyaluronic acid, calcium hydroxyapatite, poly L-lactic acid, collagen, autologous fat, and polymethyl methacrylate), and some current antiwrinkle technologies, such as thread lift and radiofrequency rhytidectomy. CONCLUSIONS:Despite the difference in mechanisms of action, each technique can address facial aging involving the loss of collagen, displacement and enlargement of fat, and muscle relaxation. Combinations of these treatments can provide patients with reasonable, comprehensive, and personalized treatment plans.
10.1155/2022/8332631
Complications of botulinum toxin and fillers: A narrative review.
Kassir Martin,Gupta Mrinal,Galadari Hassan,Kroumpouzos George,Katsambas Andreas,Lotti Torello,Vojvodic Aleksandra,Grabbe Stephan,Juchems Eva,Goldust Mohamad
Journal of cosmetic dermatology
BACKGROUND:Cosmetic surgery and esthetic procedures have become a billion dollar industry owing to the ever-growing demand of the population to stay young. The injectable treatments including fillers and botulinum toxin have become highly popular because of their quick, predictable and lasting results in the management of facial wrinkles and rejuvenation. Although these treatment modalities are relatively safe, they are associated with certain side effects. AIMS:In this review, we will focus on the complications of fillers and botulinum toxin. PATIENTS/METHODS:The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review. RESULTS:Brow ptosis and asymmetry are common adverse effects of botulinum toxin while the most common adverse effects associated with fillers are the local injection related effects manifesting as erythema, edema, pain, and ecchymosis. CONCLUSION:It is important that the treating physician is well verse with the various fillers and botulinum toxin complications and their management as some of the complications can be severely debilitating.
10.1111/jocd.13266
An Overview of Soft Tissue Fillers for Cosmetic Dermatology: From Filling to Regenerative Medicine.
Cassuto Daniel,Bellia Gilberto,Schiraldi Chiara
Clinical, cosmetic and investigational dermatology
Hyaluronic acid (HA)-based injectable filling agents are at the forefront of the current demand for noninvasive dermatological procedures for the correction of age-related soft tissue defects. The present review aims to summarize currently available HA-based products and critically appraise their differences in rheological nature and clinical application. Linear HA (LHA) gels may be supplemented with amino acids, lipoic acid, vitamins, nucleosides, or minerals for synergistic antiaging and antioxidant benefits (polycomponent LHA). HA hydrogels can be generated via chemical or physical crosslinking, which increases their elasticity and decreases viscosity. The performance of crosslinked fillers depends on HA concentration, degree of crosslinking, elastic modulus, cohesivity, and type of crosslinking agent employed. PEG-crosslinked LHA displays improved elasticity and resistance to degradation, and lower swelling rates as compared to BDDE-crosslinked LHA. Physical crosslinking stabilizes HA hydrogels without employing exogenous chemical compounds or altering hyaluronans' natural molecular structure. Thermally stabilized hybrid cooperative HA complexes (HCC) are a formulation of high- and low-molecular-weight (H-HA and L-HA) hyaluronans, achieving high HA concentration, low viscosity with optimal tissue diffusion, and a duration comparable to weakly cross-linked gel. Our critical analysis evidences the importance of understanding different fillers' properties to assist physicians in selecting the most appropriate filler for specific uses and for predictable and sustainable results.
10.2147/CCID.S276676