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Ryu HJ, Kim BY, Ryu SI, Kim NY, Ko JY, Ro YS, Kim IH, Kim JE. "New classification of late and delayed complications after dermal filler: Localized or Generalized?". J COSMET LASER THER 2021; 22:244-252. [PMID: 33957852 DOI: 10.1080/14764172.2021.1922703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: As filler injections have become very common procedures worldwide, the number of complications has increased. However, there is a lack of systematized studies and precise classification of late and delayed complications. This study aimed to suggest new and reliable classifications and to characterize the clinical manifestations of late and delayed complications after filler injections.Methods: This retrospective study analyzed patients and suggested a new classification of delayed adverse effects related to filler injection. Several demographic and clinical findings were analyzed. Patients were classified into two types according to their clinical presentation: Type I (Localized) or Type II (Generalized).Results: Twenty-five patients were evaluated during a clinically active adverse event suspected to be related to fillers. The most common injected filler substance was hyaluronic acid (HA, 68.8%). 76% of the patients were classified with Localized complications. In the Generalized complications group, systemic symptoms were more common (p=0.002), the treatment response was poor (p=0.010), and fewer patients showed complete remission (p=0.007) than in the Localized complications group.Conclusions: We propose a simple new classification method for late and delayed complications after dermal filler: Localized and Generalized. We expect that this new classification could help provide appropriate treatment and predict patient prognosis.
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Affiliation(s)
- Hwa Jung Ryu
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Bo Young Kim
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Sook In Ryu
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Na Young Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Il-Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, Korea University, Ansan, Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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Heo JW, Kim BK. Paraffinoma induced bilateral preauricular cheek skin defects. Arch Craniofac Surg 2018; 19:227-230. [PMID: 29969847 PMCID: PMC6177678 DOI: 10.7181/acfs.2018.01865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/09/2018] [Indexed: 11/11/2022] Open
Abstract
“Paraffinoma” is a well-recognized complication of paraffin oil injection into various body parts for an aesthetic purpose. After a variable latency phase, paraffinoma can present as a wide range of clinical symptoms. This paper is a case report of surgical excision of the paraffinoma and subsequent reconstruction of the associated skin defect on bilateral preauricular cheeks, manifesting 50 years after a primary injection.
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Affiliation(s)
- Jae-Woo Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Baek Kyu Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Abstract
Plastic surgeons have been performing operations to improve the aesthetic aspect of the breast for centuries. Throughout ancient times, great controversy produced many theories of how breast cancer occurred and the best treatment. Because of beliefs that closure of mastectomy sites could conceal tumor recurrence, breast reconstruction did not gain wide acceptance until the mid-1900s. Today, plastic surgeons have a variety of techniques to reconstruct the breast. The first autologous muscle flap for breast reconstruction was the latissimus dorsi myocutaneous flap, described in 1896 by Iginio Tansini. The introduction of Carl Hartrampf's transverse rectus abdominis myocutaneous flap and Robert J. Allen's deep inferior epigastric perforator flap have also provided excellent reconstructive options. With regard to augmentation, Vincenz Czerny attempted to enhance a woman's breast in 1895 with implantation of a lumbar lipoma. Soon after, surgeons used paraffin injections and polyvinylic alcohol sponge implantation, which yielded disastrous results. In 1961, Thomas Cronin and Frank Gerow promoted the first silicone implant, paving the way for today's silicone and saline prototypes. Although reduction mammaplasty techniques had originated centuries earlier than mastopexy methods, the advancements of both have largely paralleled one another. In 1949, the Wise pattern was introduced to preoperatively plan safer and predictable outcomes in breast reductions. Efforts to minimize scars were achieved with Claude Lassus' introduction and Madeleine Lejour's subsequent modification of the vertical scar mammaplasty. In hopes of fostering an understanding of current post-mastectomy procedures and instilling passion for innovating future techniques, we provide a near-complete, surgically focused historical account of the primary contributors to breast reconstruction.
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Chung SI, You YC, Kim KY, Yang WY, Kwon SM, Kang SY. Single-stage reconstruction of skin-involving nasal paraffinoma with pericraniosubgaleal flap. Aesthetic Plast Surg 2012; 36:374-81. [PMID: 21964745 DOI: 10.1007/s00266-011-9815-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 07/17/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The removal of a paraffinoma over the nasal bridge may result in thinning and even loss of involved skin as well as a saddle nose deformity. For nasal reconstruction, a variety of techniques using a free graft of autogenous tissue such as fascia, dermofat, or cartilage have been used, either in immediate, single-stage or in delayed, multiphase treatment. However, such reconstructions can be challenging largely due to absorption of the grafted tissue and poor blood supply to the surrounding nasal tissue infiltrated with paraffin. This article reports the successful clinical outcomes of immediate, single-stage reconstructions by wrapping a pericraniosubgaleal flap over the nasal implant after removing a paraffinoma. METHODS Eleven patients with a paraffinoma showing a palpable lump, redness, or telangiectasia over the nasal skin were treated between November 1998 and March 2011. The mean follow-up period was 20.1 months. As much of the paraffinoma as possible was removed via a bidirectional approach (open rhinoplasty and frontal hairline incision), and the resulting deformity was reconstructed simultaneously using a pericraniosubgaleal flap and turning it over the sculpted nasal implant (ePTFE; GORE-TEX(®) in nine cases and silicone in two cases). RESULTS Nine patients (81.8%) were treated successfully without complications and were satisfied with their results. However, the other two patients complained of incomplete removal of the paraffinoma requiring additional removal. Telangiectasia over the nose improved in four out of six patients after surgery. CONCLUSION Nasal reconstruction using a pericraniosubgaleal flap is one of the most reliable surgical options for treating skin-involving nasal paraffinomas. The advantage of such a method is that a well-vascularized and durable flap, which is resistant to infection, is wrapped over the sculpted nasal implant in a single step. It also reinforces the thinned skin, which makes it easier to form various shapes, producing excellent cosmetic results. Finally, it can also serve as a tolerable graft bed in the case of overlying skin loss.
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Hasegawa T, Yukawa K, Suzuki M, Komiya T, Watanabe K. A case of eyelid paraffinoma that developed after endoscopic sinus surgery. Auris Nasus Larynx 2011; 38:538-42. [PMID: 21211917 DOI: 10.1016/j.anl.2010.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 09/18/2010] [Accepted: 09/24/2010] [Indexed: 11/28/2022]
Abstract
Paraffin has been used as a liquid prosthesis for medical purposes, and is still the base material in some ointments. However, it sometimes causes foreign-body reaction resulting in paraffinoma. We present a case of paraffinoma in a 64-year-old woman, which occurred in the eyelid after endoscopic sinus surgery for chronic sinusitis. During surgery, a small perforation developed in the left lamina papyracea, and therefore tetracycline ointment gauze was inserted. Two days after discharge, her left eyelid became swollen. The result of an open biopsy was paraffinoma. Total resection of the tumor was performed, and at the time of writing there has been no recurrence for 1 year after surgery.
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Affiliation(s)
- Tatsuya Hasegawa
- Department of Otolaryngology, Tokyo Medical University, Shinjuku-ku, Japan
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Kannan R, Sankar T, Ward D. The disaster of DIY breast augmentation. J Plast Reconstr Aesthet Surg 2010; 63:e100-1. [DOI: 10.1016/j.bjps.2009.01.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 01/25/2009] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
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Foreign body granulomas after all injectable dermal fillers: part 2. Treatment options. Plast Reconstr Surg 2009; 123:1864-1873. [PMID: 19483588 DOI: 10.1097/prs.0b013e3181858f4f] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Foreign body granulomas occur at certain rates with all injectable dermal fillers. They have to be distinguished from early implant nodules, which usually appear 2 to 4 weeks after injection. In general, foreign body granulomas appear after a latent period of several months at all injected sites at the same time. If diagnosed early and treated correctly, they can be diminished within a few weeks. The treatment of choice of this hyperactive granulation tissue is the intralesional injection of corticosteroid crystals (triamcinolone, betamethasone, or prednisolone), which may be repeated in 4-week cycles until the right dose is found. To lower the risk of skin atrophy, corticosteroids can be combined with antimitotic drugs such as 5-fluorouracil and pulsed lasers. Because foreign body granulomas grow fingerlike into the surrounding tissue, surgical excision should be the last option. Surgery or drainage is indicated to treat normal lumps and cystic foreign body granulomas with little tissue ingrowth. In most patients, a foreign body granuloma is a single event during a lifetime, often triggered by a systemic bacterial infection.
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Glicenstein J. Les premiers « fillers », vaseline et paraffine. Du miracle à la catastrophe. ANN CHIR PLAST ESTH 2007; 52:157-61. [PMID: 16860452 DOI: 10.1016/j.anplas.2006.05.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 05/31/2006] [Indexed: 11/20/2022]
Abstract
In 1899, Robert Gersuny, an austrian surgeon from Vienna, injected a mineral oil (vaseline) to correct the absence of a testicle in a patient who was castrated for tuberculous epididymitis. The immediate success of the operation encouraged him to use vaseline as filler for soft tissue defects. The principle of the technique consisted in the injection of a product that becomes semi liquid by heating but it solidifies when it gets colder. It remains stable and inert in the human body. Eckstein used paraffin instead because the melting temperature is too high (65 degrees ) to soften after the injection. The technique provoked enthusiasm. It was used for the cure of palatal and urinary fistulae, hernia but mainly in cosmetic indications: filling of face wrinkles, cheeks, front and breast augmentation as well as the penis and especially nasal defects. Although serious complications were reported, it remained popular for the first 20 years of the 20th century. Unfortunately even with initial good results, secondary or late severe complications appeared due to the dispersion of paraffin. There was formation of nodules, the paraffinomas that were very difficult to remove. The sequelae of paraffin injections were observed for several years.
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Di Benedetto G, Pierangeli M, Scalise A, Bertani A. Paraffin oil injection in the body: an obsolete and destructive procedure. Ann Plast Surg 2002; 49:391-6. [PMID: 12370645 DOI: 10.1097/00000637-200210000-00010] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Injection of foreign materials, such as paraffin oil, is an old and obsolete procedure. The authors describe previous uses for this procedure that had been used since the 19th century and the treatment of patients affected by such a disease.
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Affiliation(s)
- Giovanni Di Benedetto
- Department of Plastic and Reconstructive Surgery, Ancona University School of Medicine, Piazza Capelli 1, I-60121 Ancona, Italy
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Abstract
BACKGROUND Factitious disease involving the breast is unusual. The rarely reported cases of this entity have been encountered in middle-aged women. In general, factitious disease can be distinguished on clinical and/or psychological grounds from self-induced disorders seen in malingerers and among those demonstrating Munchausen's syndrome. METHODS We report herein a male patient displaying factitious disease of the breast due to injection of a high viscosity liquid plastic material. RESULTS Establishment of the proper diagnosis was greatly delayed due to a lack of suspicion of this entity. Only direct confrontation of the patient with the biopsy results (lipogranulomatosis) led to a reluctant and then only partial admission of the self-induced nature of this patient's illness. CONCLUSION The clinician should remain vigilant for factitious disease when confronted with chronic or recurrent lesions of a bizarre or atypical morphology. Any body site can be involved, including the breast. Management is difficult and is best accomplished in conjunction with an appropriate mental health professional. Continued dramatic surgical interventions are contraindicated.
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Affiliation(s)
- T Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
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Mehendale FV, Sommerlad BC. Paraffinoma--a complication of Jelonet packs following rhinoplasty. BRITISH JOURNAL OF PLASTIC SURGERY 2001; 54:179-80. [PMID: 11207137 DOI: 10.1054/bjps.2000.3495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Montgomery PQ, Khan JI, Feakins R, Nield DV. Paraffinoma revisited: a post-operative condition following rhinoplasty nasal packing. J Laryngol Otol 1996; 110:785-6. [PMID: 8869618 DOI: 10.1017/s0022215100134966] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Paraffin impregnated tulle is frequently used as a post-operative dressing after surgical repair of wounds, on skin-donor sites and in packing of tissue cavities. Historically, paraffin has been injected into various sites of the body and paraffinoma is a well-described complication. Despite this, nasal packing with paraffin gauze is still common after rhinoplasty. We report a case of paraffinoma occurring after rhinoplasty and discuss the avoidance of this rare but serious complication and suggest silicon mesh as an alternative dressing.
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Affiliation(s)
- P Q Montgomery
- Department of Otolaryngology, St Bartholomew's Hospital, London, UK
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Matton G, Anseeuw A, De Keyser F. The history of injectable biomaterials and the biology of collagen. Aesthetic Plast Surg 1985; 9:133-40. [PMID: 3895848 DOI: 10.1007/bf01570345] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors discuss the history and use of injections of paraffin, silicone, and collagen for soft-tissue contouring. The structure and uses of collagen are described with particular reference to Zyderm Collagen Implant, a highly purified bovine collagen.
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Kay SP, Saad MN. Paraffinoma of the male breast: a case report. BRITISH JOURNAL OF PLASTIC SURGERY 1983; 36:522-3. [PMID: 6626837 DOI: 10.1016/0007-1226(83)90144-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case of paraffinoma of the male breast is reported following injections of paraffin in a male transexual.
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van der Waal I. Paraffinoma of the face: a diagnostic and therapeutic problem. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1974; 38:675-80. [PMID: 4612433 DOI: 10.1016/0030-4220(74)90384-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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