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Han HS, Kim BR, Kim M, Na JI, Seo SB, Huh CH, Shin JW. Needleless laser injector versus needle injection for skin enhancement and rejuvenation effect of dermal filler. Lasers Surg Med 2023; 55:809-816. [PMID: 37632290 DOI: 10.1002/lsm.23719] [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: 03/15/2023] [Revised: 07/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND AND OBJECTIVES A needleless laser-induced microjet injector is a novel transdermal drug delivery system that can rapidly inject a very small and precise drug dose into the skin with minimal pain and downtime. In this study, we aimed to compare the laser-induced microjet injection versus needle injection of polylactic acid/hyaluronic acid filler for skin enhancement and rejuvenation. PATIENTS AND METHODS A 24-week prospective, single-center, assessor-blinded, randomized, split-face study was conducted. The enrolled patients underwent one treatment session of dermal filler injection using a laser-induced microjet injector on one half of the face or a traditional needle injection on the other half of the face. Evaluation was conducted at baseline before treatment and at 4, 12, and 24 weeks after treatment. RESULTS A single treatment of filler injection with a laser-induced microjet injector resulted in similar improvements in skin hydration and elasticity as a single treatment of filler injection by using manual needle injection, with reduced pain, side effects, and decreased treatment time. CONCLUSIONS Laser-induced microjet injector enabled not only the application of a controlled dose and filler depth but also even distribution, improved clinical efficacy, reduced pain and side effects, and sufficient time for clinicians to perform treatment.
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Affiliation(s)
- Hye Sung Han
- Department of Dermatology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Gyeonggi-do, Korea
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Minjae Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Im Na
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | | | - Chang-Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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2
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Diwan Z, Trikha S, Etemad-Shahidi S, Parrish N, Rennie C. Evaluation of Current Literature on Complications Secondary to Lip Augmentation Following Dermal Filler Injection. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:26-33. [PMID: 37560504 PMCID: PMC10409513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND The current popularity of dermal filler treatments as an alternative to invasive surgical cosmetic procedures has led to an increase in filler-related complications. Lip filler treatments are among the most sought-after injectable treatments and a thorough understanding of the complications of lip filler injections, and their management, is essential for any practitioner. OBJECTIVE The aim of this review is to evaluate the current literature on complications secondary to lip augmentation following non-permanent dermal fillers. METHODS A thorough MEDLINE literature search of keywords, including lip filler, augmentation, injection, filler, dermal filler, and complications, was completed to collate cases of complications secondary to lip filler injections. RESULTS Of our 53 cases that were studied, 82 complications were reported. Our review and evaluation of these cases showed that HA filler was most commonly used in this region, alone or in combination with other soft tissue fillers. The majority of complications resulted from HA involvement, however its frequency of use likely accounts for this. Across all three filler types, the most common complication was nodule formation. Other complications, such as migration, discoloration and herpetic outbreaks, have been linked with filler placement in the lip area. CONCLUSION It is clear that filler treatments carry a variety of risks, thus it becomes of utmost importance to truly understand the product we are working with, its properties, its associated risks, and how to manage those risks. We have to ensure that patients are adequately informed about the risks associated, and understand what those risks entail.
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Affiliation(s)
- Zoya Diwan
- Dr. Diwan is the President of Academic Aesthetics Mastermind Group and the Medical Director at Trikwan Aesthetics in London, United Kingdom
| | - Sanjay Trikha
- Dr. Trikha is the Vice President of Academic Aesthetics Mastermind Group and the Director at Trikwan Aesthetics in London, United Kingdom
| | - Sepideh Etemad-Shahidi
- Dr. Etemad-Shahidi is a member at Academic Aesthetics Mastermind Group and a Practitioner at Medicetics in London, United Kingdom
| | - Nina Parrish
- Ms. Parrish is a member of the Academic Aesthetics Mastermind Group and Trikwan Aesthetics in London, United Kingdom
| | - Christopher Rennie
- Dr. Rennie is a member of the Academic Aesthetics Mastermind Group and a Director at Romsey Medical Aesthetics in Winchester, United Kingdom
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Alli N, Murdoch M, Meer S. Delayed adverse reaction to a natural dermal filler mimicking salivary gland neoplasia. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:97. [PMID: 35431534 PMCID: PMC8996220 DOI: 10.1186/s42269-022-00791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cosmetic dermal fillers are a sought-after procedure globally. However, despite the safety claims of filler materials by the manufacturers, adverse reactions still occur. CASE PRESENTATION This case report is of a 66-year-old female who presented with a late-onset complication of a hyaluronic acid dermal filler that clinically mimicked a salivary gland neoplasm. The patient presented with firm peri-oral swellings of short duration that clinically mimicked a pleomorphic adenoma and mucoepidermoid carcinoma. The diagnosis was that of a foreign-body granulomatous response to dermal fillers. Although other mimics of a similar nature are reported a knowledgeable clinician, careful choice of filler material, knowledge of the product, thorough pre-procedural history taking and post-procedural patient follow-up can drastically minimize a possible misdiagnosis. The reaction was treated with a combination of hyaluronidase, betamethasone and 5-flurouracil intra-lesional injections monthly for 11 consecutive months, with total clinical resolution. CONCLUSIONS Patient education of the procedure, product name and the possibility of an adverse reaction occurring, even years later or at a site distant to the initial site of placement, is vital. Further, we review the recent reported adverse association of the new mRNA COVID-19 vaccines and dermal filler placement.
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Affiliation(s)
- Nasreen Alli
- KwaMashu Community Health Centre, Durban, KwaZulu Natal South Africa
| | | | - Shabnum Meer
- Department of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, WITS, Private Bag 3, Johannesburg, 2050 South Africa
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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] [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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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] [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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6
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Hypersensitivity Caused by Cosmetic Injection: Systematic Review and Case Report. Aesthetic Plast Surg 2021; 45:263-272. [PMID: 32206863 DOI: 10.1007/s00266-020-01684-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/08/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Botulinum toxin injection, micro-needling injection, and filler injection are the most widely used non-surgical facial cosmetic treatments. Hypersensitivity reactions associated with injections have not received sufficient attention due to their low incidence rates. The authors tried to summarize the characteristics of the hypersensitivity caused by cosmetic injections and helped to improve the diagnosis and treatment. METHODS A comprehensive search of the PubMed database to September 2019 was performed. Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, injection information (injected material, trade name, location of injection, symptoms of allergy, time of onset), diagnostic examination, treatment, and prognosis. RESULTS A total of 14 articles (57 patients) were included. There were 3 patients receiving botulinum toxin injection, 3 patients receiving micro-needling injection, and 46 patients receiving hyaluronic acid injection. Five patients were injected with collagen, polyacrylamide, paraffin, alkyl-imide or hyaluronidase, separately. The symptoms were redness, swelling, itching or induration at the injection site. The diagnosis and treatment methods vary greatly depending on the injection fillers. Removing the injected filler is the primary treatment. CONCLUSION Although hypersensitivity reaction is a relatively uncommon adverse event, more practice guidelines and research on diagnosis and treatment are demanded to help improve the outcomes. 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 .
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7
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Tharwat M, Al-Hawas A. Ultrasound detection of cosmic filler injection of lips in camel beauty pageants: first report in veterinary medicine. Trop Anim Health Prod 2021; 53:53. [PMID: 33387053 DOI: 10.1007/s11250-020-02551-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
This study was carried out in Saudi Arabia during the events of the 4th King Abdulaziz Camel Festival, Saudi Arabia. It was designed to describe the most frequent locations of injected cosmetic fillers in the head region as well as the ultrasound features of the injected material. Apparently healthy camels (Camelus dromedarius) (n = 11,626) were thoroughly examined for injection of cosmetic fillers in the head region. In parallel, 30 non-injected camels were used as controls. The lips of camels suspected of having been injected with fillers were subjected to high-resolution ultrasound examination. Of the 11,626 camels, 58 were found to have been injected with cosmetic fillers, 45 in the upper lip and 13 in both the upper and lower lip. None of the injected camels had a history of recent illness. In addition, in all the injected camels, no dermal lip lesions were seen by the naked eye. Swelling of the upper and/or lower lips was visually inspected and palpated by hand in 52 of the camels. Drooping and swinging of the injected lips were observed in all injected camels. Hardness was detected in the tip of the upper lips of 26 of the injected camels and multiple hard nodules were palpated in the injected lips of 44 camels. Swelling of the edges of the upper and lower lips was detected in 41 of the injected camels. Ultrasonographic features of the injected lips are described in detail. Blood samples were collected from both groups. In none of the injected camels did the hemato-biochemical profiles differ significantly than the control group. In conclusion, results clearly indicate the usefulness and convenience of ultrasound as a diagnostic tool to locate the presence of injected fillers and to help monitor the extension and complications of the deposits.
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Affiliation(s)
- Mohamed Tharwat
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, P. O. Box 6622, Buraidah, 51452, Saudi Arabia. .,Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt.
| | - Abdulla Al-Hawas
- Veterinary Teaching Hospital, Qassim University, P. O. Box 6622, Buraidah, 51452, Saudi Arabia
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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] [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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Thanasarnaksorn W, Puttacharoenlarp P, Boonchoo K, Suwanchinda A. Case Report: The role of intradermal micro-droplet hyaluronic acid injection in the correction of filler nodules complication. Dermatol Ther 2020; 33:e14315. [PMID: 32951305 DOI: 10.1111/dth.14315] [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: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
Filler injection has been widely used as a non-surgical intervention for skin rejuvenation and augmentation for the past decade. Hyaluronic acid (HA) is considered the most common treated material with high safety profile. Various mechanisms, including promoting collagen synthesis are postulated the efficacy of this powerful skin rejuvenation. The greater number of its used, the more complications were seen. Among the non-vascular complications from filler injection, the most frequent one is nodule formation. It could occur as early or late onset even with HA injection. One of the causes of these nodule formation is from poor injection technique leading to visible skin beads and lumps. The current treatments of these filler side effects mainly aim to remove or reduce excessive or displaced filler product. To the best of our knowledge, there has been no report of using the intradermal injection of the micro-droplet HA to correct filler nodule and simultaneously revitalize the skin quality. This novel treatment technique could be a safe alternative for nodule formation correction.
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Affiliation(s)
- Wilai Thanasarnaksorn
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Doctor Younger Clinic, Bangkok, Thailand
| | - Puttida Puttacharoenlarp
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanjana Boonchoo
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Atchima Suwanchinda
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Dermatology, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
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10
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Wang HC, Wang Y, Long X, Wang X. Mandibular osteomyelitis after hyaluronic acid injection. J Cosmet Dermatol 2020; 20:457-459. [PMID: 32592232 DOI: 10.1111/jocd.13575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/26/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mandibular osteomyelitis after filler injection is extremely rare. AIMS We reported a case of mandibular osteomyelitis after hyaluronic acid injection. PATIENTS A 33-year-old woman received 1 mL hyaluronic acid injection on her chin 1 year ago, after which her chin kept swelling and painful, and gradually ulcerated with pus flowing out. She received antibiotics, debridement procedures, negative pressure wound therapy, and hyperbaric oxygen therapy without symptoms improved. Cone-beam computed tomography scan showed local bone destruction, sequestrum formation, and tissue calcification on the right mandible body. The patient was diagnosed with mandibular osteomyelitis and received local curettage for the removal of necrotized bone. RESULTS Literature search found no case reports on mandibular osteomyelitis after filler injection so far. CONCLUSION Minimizing the risk of contamination and infection is strictly required during the filler injection process. Once the patient shows signs of incurable mandibular infection postoperation, clinicians should consider the possibility of osteomyelitis.
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Affiliation(s)
- Hayson Chenyu Wang
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Yunting Wang
- Department of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Long
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojun Wang
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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11
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Wang C, Sun T, Yu N, Wang X. Herpes reactivation after the injection of hyaluronic acid dermal filler: A case report and review of literature. Medicine (Baltimore) 2020; 99:e20394. [PMID: 32541459 PMCID: PMC7302668 DOI: 10.1097/md.0000000000020394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Hyaluronic acid injections is relatively safe with little risk of complications. Although herpes reactivation after the injection of hyaluronic acid is rare, it produces quite a huge pressure and panic on patients. Quite a lot cosmetic practitioners have no awareness of preventing, diagnosing, and giving correct treatment in time due to lack of experience. PATIENT CONCERNS A 24-year-old woman presented with erythema, crusted papules, pain and swelling on the nose after receiving the injection of hyaluronic acid. A swab of the discharge fluid was obtained for bacterial and viral culture, showing positive for herpes simplex virus. DIAGNOSIS The patient was diagnosed as herpes reactivation after the injection of hyaluronic acid. INTERVENTIONS The patient underwent antiviral therapy with acyclovir 400 mg, 3 times daily for seven days. OUTCOMES After a week of antiviral treatment, the clinical signs improved. CONCLUSION Herpes reactivation after the injection of hyaluronic acid is quite rare but needed sufficient attention of cosmetic practitioners to make the proper diagnosis, prevention and treatment.
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Affiliation(s)
- Chenyu Wang
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Tianyu Sun
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Nanze Yu
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiaojun Wang
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
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12
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Philipp-Dormston WG, Goodman GJ, De Boulle K, Swift A, Delorenzi C, Jones D, Heydenrych I, Trindade De Almeida A, Batniji RK. Global Approaches to the Prevention and Management of Delayed-onset Adverse Reactions with Hyaluronic Acid-based Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2730. [PMID: 32440404 PMCID: PMC7209845 DOI: 10.1097/gox.0000000000002730] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed-onset adverse reactions to hyaluronic acid (HA) fillers are uncommon but have received increased attention, particularly with regard to late-onset nodules. Globally, there is a need for comprehensive prevention and management strategies. METHODS Experts with clinical practices in diverse regions of the world and extensive experience in managing complications related to HA fillers convened to propose and evaluate approaches to prevent delayed-onset adverse reactions after HA filler administration and manage late-onset nodules. RESULTS The expert panel agreed to define delayed-onset adverse reactions as those presenting more than 4 weeks posttreatment, with swelling, induration, and nodulation being the most common clinical signs. The panel recommended 5 general key approaches for the prevention of delayed-onset reactions (patient selection, anatomic location of injection/product selection, aseptic technique, injection procedure/filler, and posttreatment care). Strategies recommended for managing late-onset nodules included oral antibiotics, oral steroids, nonsteroidal anti-inflammatory drugs if needed, hyaluronidase for noninflammatory nodules (recognizing the limitations and regional availability of this treatment), intralesional antibiotics, intralesional immunosuppressive drugs such as steroids and fluorouracil, and surgical excision as a last resort. The panel noted that late-onset nodules may vary in both clinical presentation and etiology, making them challenging to address or prevent, and stressed individualized treatment based on clinical presentation. Regional differences in aseptic protocols, antibiotic selection, and steroid formulations were described. CONCLUSION Insights from global experts on approaches to prevent and manage delayed-onset adverse reactions following HA filler administration, including late-onset nodules, support clinicians worldwide in optimizing patient outcomes and safety.
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Affiliation(s)
- Wolfgang G. Philipp-Dormston
- From the Department of Dermatology, Witten/Herdecke University, Witten, Germany
- Klinik Links vom Rhein, Cologne, Germany
| | - Greg J. Goodman
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Derek Jones
- Skin Care and Laser Physicians of Beverly Hills, Beverly Hills, Calif
| | - Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Cape Town, South Africa
- Stellenbosch University, Cape Town, South Africa
| | - Ada Trindade De Almeida
- Clinica de Dermatologia, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
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13
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Aframian DJ, Keshet N, Nadler C, Zadik Y, Vered M. Minor salivary glands: Clinical, histological and immunohistochemical features of common and less common pathologies. Acta Histochem 2019; 121:151451. [PMID: 31653464 DOI: 10.1016/j.acthis.2019.151451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hundreds of minor salivary glands (MiSGs) are scattered in the oral cavity located at the submucosa layer. Beside their role in the oral cavity lubrication and immunity defence system, MiSGs are beneficial tissue source for diagnosing oral and non-oral related diseases. The advantage of MiSGs as a diagnostic tool reside on their fairly simple excisional procedure on one hand and negligible impact of the normal secretion capability of the salivary gland system on the other hand. The review focuses on pathologies related to developmental, reactive, metabolic, inflammatory and immunologic conditions, Iatrogenic causes and other undefined causes.
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Affiliation(s)
- Doron J Aframian
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Naama Keshet
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Chen Nadler
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yehuda Zadik
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel; Department of Oral Medicine, The Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Marilena Vered
- Dept. Oral Pathology, Oral Medicine and Oral Radiology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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14
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Hirth J. Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature. Hum Vaccin Immunother 2018; 15:146-155. [PMID: 30148974 DOI: 10.1080/21645515.2018.1512453] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Human papillomavirus (HPV) is a common sexually transmitted infection which is the cause of several cancers, including cervical cancer, and genital warts. Although cervical cancer can be prevented through screening, this cancer persists in the US. More recently, HPV vaccination has the potential to decrease the burden of HPV-related disease among young HPV-unexposed adolescents. Several initiatives aimed to encourage HPV vaccination have been adopted. Unfortunately, uptake of the HPV vaccine remains modest, despite evidence that vaccine-type HPV prevalence is decreasing as a result of HPV vaccination. Further, geographic disparities in vaccination uptake across different US regions and by race/ethnicity may contribute to continuing disparities in HPV-related cancers. More data are needed to evaluate impact of HPV vaccination on HPV prevalence in smaller geographic areas. Further, more information is needed on the impact of individual vaccination programs and policy on population level vaccination and HPV prevalence.
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Affiliation(s)
- Jacqueline Hirth
- a Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston, TX , USA
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15
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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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16
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Alcântara CEP, Noronha MS, Cunha JF, Flores IL, Mesquita RA. Granulomatous reaction to hyaluronic acid filler material in oral and perioral region: A case report and review of literature. J Cosmet Dermatol 2017; 17:578-583. [DOI: 10.1111/jocd.12374] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mariana S Noronha
- Faculdade de Odontologia; Departamento de Clínica, Patologia e Cirurgia Odontológicas; Universidade Federal de Minas Gerais; Belo Horizonte MG Brazil
| | - Joanna F Cunha
- Faculdade de Odontologia; Departamento de Clínica, Patologia e Cirurgia Odontológicas; Universidade Federal de Minas Gerais; Belo Horizonte MG Brazil
| | - Isadora L Flores
- Departamento de Odontologia; Universidade Federal de Juiz de Fora; Governador Valadares MG Brazil
| | - Ricardo A Mesquita
- Faculdade de Odontologia; Departamento de Clínica, Patologia e Cirurgia Odontológicas; Universidade Federal de Minas Gerais; Belo Horizonte MG Brazil
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17
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The Hyaluronic Acid Fillers: Current Understanding of the Tissue Device Interface. Facial Plast Surg Clin North Am 2016; 23:423-32. [PMID: 26505539 DOI: 10.1016/j.fsc.2015.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The article is a detailed update regarding cosmetic injectable fillers, specifically focusing on hyaluronic acid fillers. Hyaluronic acid-injectable fillers are used extensively for soft tissue volumizing and contouring. Many different hyaluronic acid-injectable fillers are available on the market and differ in terms of hyaluronic acid concentration, particle size, cross-linking density, requisite needle size, duration, stiffness, hydration, presence of lidocaine, type of cross-linking technology, and cost. Hyaluronic acid is a natural component of many soft tissues, is identical across species minimizing immunogenicity has been linked to wound healing and skin regeneration, and is currently actively being studied for tissue engineering purposes. The biomechanical and biochemical effects of HA on the local microenvironment of the injected site are key to its success as a soft tissue filler. Knowledge of the tissue-device interface will help guide the facial practitioner and lead to optimal outcomes for patients.
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18
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Late-Onset Adverse Reactions Related to Hyaluronic Acid Dermal Filler for Aesthetic Soft Tissue Augmentation. J Craniofac Surg 2015; 26:782-4. [DOI: 10.1097/scs.0000000000001358] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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19
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Bitterman-Deutsch O, Kogan L, Nasser F. Delayed immune mediated adverse effects to hyaluronic Acid fillers: report of five cases and review of the literature. Dermatol Reports 2015; 7:5851. [PMID: 25918619 PMCID: PMC4387334 DOI: 10.4081/dr.2015.5851] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022] Open
Abstract
Hyaluronic acid (HA) fillers in cosmetic medicine have been considered relatively safe, though fillers used in European countries and throughout the world are not necessarily approved by the Food and Drug Administration. As their use continues to expand worldwide, physicians in a wide range of medical specialties are authorized to perform HA injections, including general medicine practitioners and even dentists. An increasing number of reports have appeared regarding side effects to these products. It is now known that reactions to Hyaluronic acid are related not only to technical faults of the injections, but also to immune responses, including delayed hypersensitivity and granulomatous reactions. Herein, we describe five cases treated by a variety of treatment modalities, all with delayed reactions to different brands of hyaluronic acid fillers. As there is currently no standardization of treatment options of adverse effects, these cases accentuate the debate regarding the approach to the individual patient and the possible need for pre-testing in patients with an atopic tendency.
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Affiliation(s)
- Ora Bitterman-Deutsch
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed
- Dermatology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Leonid Kogan
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed
- Department of Plastic Surgery, Galilee Medical Center, Nahariya, Israel
| | - Faris Nasser
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed
- Department of Internal Medicine E, Galilee Medical Center, Nahariya, Israel
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20
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Friedrich RE, Zustin J. Paraffinoma of lips and oral mucosa: Case report and brief review of the literature. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY 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] [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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21
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de Vries CGJCA, Geertsma RE. Clinical data on injectable tissue fillers: a review. Expert Rev Med Devices 2013; 10:835-53. [PMID: 24164663 DOI: 10.1586/17434440.2013.839211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment with injectable tissue fillers for aesthetic purposes is increasingly popular. In parallel with this success, questions related to the safety of these treatments and the products involved are being raised more prominently. To gain insight in the safety aspects of injectable tissue fillers, we performed a literature review to collect studies reporting clinical data of injectable tissue fillers. We found several case reports where serious complications after more than three years are described. However, there are only a limited number of well-defined prospective clinical studies available with follow-up periods longer than three years. Furthermore, causes of complications, that is, treatment or product related, are often not specified in literature. Considering the intended functional period of fillers in combination with the known occurrence of long-term complications, there is a need for well-defined prospective clinical studies. In order to be able to discriminate between product failure (a product safety issue) or application methodology (a physician expertise or training issue), better identification of observed complications and whether they are product or treatment related, is needed. For the safe use of the fillers it is important that treatment with injectable tissue fillers is performed by a trained physician, who knows the product specifications and its applications.
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Affiliation(s)
- Claudette G J C A de Vries
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, NL-3720 BA Bilthoven, The Netherlands
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22
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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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23
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BOSCOLO-RIZZO P, DEL MISTRO A, BUSSU F, LUPATO V, BABOCI L, ALMADORI G, DA MOSTO M, PALUDETTI G. New insights into human papillomavirus-associated head and neck squamous cell carcinoma. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2013; 33:77-87. [PMID: 23853396 PMCID: PMC3665382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/07/2013] [Indexed: 11/05/2022]
Abstract
Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is an entity with peculiar clinical and molecular characteristics, which mainly arises from the reticulated epithelium lining the crypts of the palatine tonsils and the base of the tongue. The only head and neck site with a definite etiological association between persistent high-risk (HR) HPV infection and development of SCC is the oropharynx. HPV-positive malignancies represent 5-20% of all HNSCCs and 40-90% of those arising from the oropharynx, with widely variable rates depending on the geographic area, population, relative prevalence of environment-related SCC and detection assay. HPV-16 is by far the most common HR HPV genotype detected in oropharyngeal SCC (OPSCC), and the only definitely carcinogenic genotype for the head and neck region. Patients with HPV-induced OPSCC are more likely to be middle-aged white men, non-smokers, non-drinkers or mild to moderate drinkers, with higher socioeconomic status and better performance status than subjects with HPV-unrelated SCC. HPV-induced HNSCCs are often described as non-keratinizing, poorly differentiated or basaloid carcinomas, and are diagnosed in earlier T-category with a trend for a more advanced N-category, with cystic degeneration, than the HPV-unrelated carcinomas. HPV positivity is associated with better response to treatment and modality-independent survival benefit. Treatment selection in HPV-related oropharyngeal carcinoma is becoming a critical issue, and although there is no evidence from randomized, controlled trials to support a treatment de-escalation in HPV-positive SCC, some investigators argue that intensive combined modality strategies may represent an overtreatment.
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Affiliation(s)
- P. BOSCOLO-RIZZO
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - A. DEL MISTRO
- Immunology and Diagnostic Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - F. BUSSU
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - V. LUPATO
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - L. BABOCI
- Immunology and Diagnostic Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - G. ALMADORI
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - M.C. DA MOSTO
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - G. PALUDETTI
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
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