Reply: Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect.

Abstract

We thank Drs. Hua and Wei for the interest in our article entitled “Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect.”1 The authors pointed out that Cohen et al.2 recommend microfat for injections in the superficial layer, according to our practice. In contrast to what we do, Cohen et al. suggest millifat for injections in the deep layer. Of note, in our procedures, the surface area and the layer of lipofilling are different. We would like to highlight the fact that Cohen et al.2 considered the use of regenerative cells in facial rejuvenation where aging is responsible for histologic changes but the structural anatomy of the superficial and deep layers is preserved. Patients in our study came to our attention with facial filler–related complications. They suffered from episodes of acute inflammation and infection, with chronic reactions to the permanent filler. Several local steroid injections were often performed to treat these diseases with an increased risk of lipoatrophy. In these patients, scar tissue replaces the native tissue, with substantial modifications of the structural anatomy. Replacement of deep fat with scar and inflamed tissue makes it difficult to inject fat parcels of a large size. Moreover, the risk of fat necrosis and reabsorption eventually caused by large bolus grafting increases in these damaged tissues. Basically, facial rejuvenation and filler-induced complications have different anatomical and histological patterns that require different techniques of fat grafting. Because of the long-lasting inflammation, scar tissue formation, and filler removal with deep depressions, the amount of the injected graft in every area and the number of treatment sessions were increased in patients who underwent permanent filler removal compared with patients who simply want facial rejuvenation.1 In order to ensure an acceptable cosmetic appearance within a reasonable time, even if it requires 6 months or up to several years for a final outcome,3 most of the fat reabsorption can be appreciated in a period up to 4 months from the treatment. However, we evaluated the need for further treatment at 6 months.1 DISCLOSURE Neither of the authors has a conflict of interest to declare. Marta Starnoni, M.D.Clinical and Experimental Medicine PhD ProgramDivision of Plastic Surgery Giorgio De Santis, M.D.Division of Plastic SurgeryUniversity of Modena and Reggio EmiliaModena, Italy