Cosmetic Injections Research Articles

Delayed Diagnosis of Mycobacterium marinum Infections Associated With Cosmetic Injections

Delayed Diagnosis of Mycobacterium marinum Infections Associated With Cosmetic Injections

Pyomyositis Caused by Disseminated Nocardia brasiliensis in a Patient With Goodpasture Disease

Nontuberculous mycobacteria (NTM) may cause skin and soft tissue infections. Frequently, these are related to contaminated environmental sources and/or inappropriate disinfection of instruments (including reuse of single use devices). Reports of skin and soft tissue infections caused by NTM have been described in the setting of cosmetic procedures (especially those performed by unlicensed and/or untrained practitioners). Injection-related NTM infections rarely involve Mycobacterium marinum. We report 2 cases of Mycobacterium marinum facial ulcers after “filler” injections by an unlicensed practitioner at a local “spa.” Lack of suspicion of NTM association led to delayed diagnosis and extensive local destruction. We aim to increase education regarding NTM-related infections resulting from cosmetic injections and increase public vigilance regarding the appropriate setting and personnel performing these procedures.

Blindness following Cosmetic Injections of the Face

Blindness following Cosmetic Injections of the Face

Nocardia cyriacigeorgica Infections Attributable to Unlicensed Cosmetic Procedures--An Emerging Public Health Problem?

We describe an outbreak of Nocardia cyriacigeorgica soft-tissue infections attributable to unlicensed cosmetic injections and the first report using multilocus sequence typing sequence data for determining Nocardia strain relatedness in an outbreak. All 8 cases identified had a common source exposure and required hospitalization, surgical debridement, and prolonged antimicrobial therapy.

Blindness following Cosmetic Injections of the Face

Complications following facial cosmetic injections have recently heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence for the prevention and treatment of this serious eye injury. The authors included in the study only the cases in which blindness was a direct consequence of a cosmetic injection procedure of the face. Twenty-nine articles describing 32 patients were identified. In 15 patients, blindness occurred after injections of adipose tissue; in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate, hyaluronic acid, and calcium hydroxyapatite. Some precautions may minimize the risk of embolization of filler into the ophthalmic artery following facial cosmetic injections. Intravascular placement of the needle or cannula should be demonstrated by aspiration before injection and should be further prevented by application of local vasoconstrictor. Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas when possible. Low-pressure injections with the release of the least amount of substance possible should be considered safer than bolus injections. The total volume of filler injected during the entire treatment session should be limited, and injections into pretraumatized tissues should be avoided. Actually, no safe, feasible, and reliable treatment exists for iatrogenic retinal embolism. Nonetheless, therapy should theoretically be directed to lowering intraocular pressure to dislodge the embolus into more peripheral vessels of the retinal circulation, increasing retinal perfusion and oxygen delivery to hypoxic tissues. Risk, V.

Investigating the Efficacy of Vibration Anesthesia to Reduce Pain From Cosmetic Botulinum Toxin Injections

Many analgesic modalities have been employed with limited success to alleviate the pain associated with botulinum toxin type A (BTX-A) injections. Vibration is an effective method of reducing pain during facial cosmetic injections, but it has not been previously studied in the context of clinical cosmetic procedures. The authors evaluate the safety and efficacy of vibration-assisted anesthesia for reducing pain associated with BTX-A injections. In this prospective study, 50 patients received BTX-A injections for cosmetic rhytid reduction. Injections were given in a split-face design that was randomly assigned. A vibration stimulus was coadministered with BTX-A injections on one side, while the other side of each patient's face received BTX-A injections alone. Patients completed a questionnaire immediately posttreatment and were contacted for follow-up three to four weeks later. Patients reported less injection pain on the vibration-treated half of the face as compared to the control side (an average of 1.3 vs 2.4 on a five-point scale; P = .000). Overall, 86% of patients preferred to receive vibration with their next BTX-A treatment. There was no significant difference between first-time and repeat BTX-A patients in terms of preference for vibration. Five of 50 patients experienced transient side effects perceived to be associated with vibration, including tingling teeth, increased bruising, and headaches. Of the patients who did not request vibration with subsequent BTX-A injections, none cited decreased BTX-A efficacy as the reason for their preference. Vibration is a safe and effective means of reducing patient discomfort during BTX-A injections for cosmetic rhytid reduction and may have applications in other cosmetic procedures.

Acute Right Ventricular Failure Following Cosmetic Injection of Silicone

INTRODUCTION: Reports of adverse events resulting from the injection of silicone for cosmetic purposes have been increasing in the scientific literature and popular media, emphasizing the importance of diagnostic consideration, disease recognition and understanding of pathophysiology. Here we present a previously unreported cardiopulmonary manifestation of systemic silicone embolization.

Subcutaneous Corn Oil Injections, Fat Embolization Syndrome, and Death

An unlicensed practitioner performing subcutaneous injections of large volumes of corn oil caused the death of one of her clients and life-threatening neurologic complications of a second client from systemic fat embolism. Several additional clients also came forward to report other serious complications they had suffered from similar procedures. The clinicopathologic and investigative findings from these cases are described. In both instances of fat embolization, the diagnosis was overlooked by hospital staff because of insufficient or misleading clinical history. The local and systemic pathologic manifestations of corn oil injections in 1 victim who died several days later from multiple organ failure are described. The clinical history and course of another who survived after 8 days of hospitalization are also presented. Similarities with complications from other forms of cosmetic oil injections are discussed. Laboratory analyses applied to confirm the nature of the injected oil and the course of criminal prosecution are also described.

The History of Injectable Facial Fillers

In an attempt to maintain a youthful appearance or to reconstruct facial deformities, physicians have greeted new technologies with excitement. In the late 1800 s, shortly after the invention of the syringe, chemical agents were used for facial augmentation. Unfortunately, history has taught us that new technologies must be used with care, because complications can occur, sometimes many years after initial treatment. The first injectable filling agent was paraffin, whose use was abandoned after complications of migration, embolization, and granuloma formation were described. More recently, silicone use was banned by the U.S. Food and Drug Administration (FDA) because of similar complications. In 1981, bovine collagen was the first agent to be approved by the FDA for cosmetic injection. Since its approval, dozens of injectable filling agents have been developed, and many are already FDA approved for cosmetic use. This article will review the highlights of the evolution of facial filling agents.

Reduction of Pain and Anxiety Prior to Botulinum Toxin Injections With a New Topical Anesthetic Method

To evaluate the safety and efficacy of vapocoolants (topical skin refrigerants) to induce skin anesthesia and relieve patient anxiety and pain prior to cosmetic botulinum injections. A paired (split-face) design was used in 52 patients where patient side (left vs. right) was randomized to receive either vapocoolant spray or no treatment control to test the study hypothesis of better anesthetic efficacy of vapocoolant spray versus no treatment control. A pain and anxiety questionnaire was administered before, during, and after the injections. A considerable percentage of patients either expected pain (35% of naïve patients expected moderate pain) or had experienced pain from their prior treatment (35% had experienced moderate pain). Among naïve patients, 15% had moderate or severe anxiety and among experienced patients, 31% had moderate anxiety. Pain was a factor in delaying the scheduling of cosmetic botulinum toxin treatments in 19% of naïve patients and 31% of experienced patients. Pain reported from actual injections was higher than what was anticipated prior to treatment. There was a significant reduction in pain at injection sites treated with vapocoolant (p < 0.001, paired t test). Overall, 67% of all patients reported that the vapocoolant method had less pain than no anesthesia and 54% preferred vapocoolant for their next treatment. Overall, 6% of all patients would schedule their next botulinum toxin treatment sooner if vapocoolant were available. Vapocoolants represent a safe and effective means to reduce patient discomfort and anxiety before and during botulinum toxin type A treatments for glabellar area indications.

CT features of foreign body granulomas after cosmetic paraffin injection in the cervicofacial area

Cosmetic injection of paraffin into cervicofacial tissues has been practiced in the past, especially in Asia, resulting in foreign body granuloma (paraffinoma). The purpose of this study was to describe the computed tomography (CT) findings of cervicofacial paraffinomas. CT images of 5 patients (4 women and 1 man; age range, 54-80 years; mean age, 67.6 years), who had received direct paraffin injections into cervicofacial tissues, were reviewed retrospectively. The lesions were bilateral and located in the subcutaneous fat layer of the cheek (n = 5), buccal space (n = 2), periorbital area (n = 1), periauricular area (n = 1), neck (n = 1), and nose (n = 1). The predominant CT features were speckled mass formation (n = 3), fat-density nodule (n = 5), high-density nodule (n = 5), nodular calcification (n = 5), and rim calcification (n = 4). Paraffinomas in the cervicofacial region have specific CT features that are distinct from other soft tissue masses.

Reply re: “Thyroid Eye Disease Presenting After Cosmetic Botulinum Toxin Injections”

Reply re: “Thyroid Eye Disease Presenting After Cosmetic Botulinum Toxin Injections”

Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists

Wait times for both routine and urgent dermatology appointments typically exceed 3 to 4 weeks. Many factors affecting physician workforce adequacy and patient access have been explored, but little is known about the impact of increasing numbers of doctors offering cosmetic services. We sought to evaluate access to dermatologists for patients requesting cosmetic services. Scripted patient telephone calls were made to 898 dermatologists in 12 metropolitan areas to assess wait times for an appointment to receive cosmetic botulinum toxin injections. The areas chosen were surveyed completely, and respondents represented about one tenth of practicing dermatologists in the United States. The methodology was identical to that used in a previous study of wait times for evaluation of a changing mole (a possible indicator of malignancy). Half of dermatologist respondents (455, 50.7%) offered appointments for botulinum toxin injections, and the median wait time was 8 days. Acceptance rates and wait times varied greatly by geographic area (range of median wait times 6.0-32.5 days), with dermatologists in Miami, Fla, and Orange County, California, most likely to provide a botulinum toxin appointment with a short wait time. Many dermatologists (241, 27%) employed physician extenders, and 39% of these extenders also offered appointments for botulinum toxin injections (median wait time 6 days). In comparison with a previous study showing median wait times of 26 days for evaluation of a changing mole in these communities, wait times for cosmetic injections were significantly shorter (P < .001). The metropolitan areas surveyed contain no highly rural areas and do not represent a random sample of all US dermatology practice sites. The cosmetic and medical studies were not conducted concurrently, but were carried out in the same metropolitan areas. Patients seeking a cosmetic botulinum toxin injection have more rapid access to dermatologists than has been previously reported for patients seeking urgent consultation for a changing mole. This study cannot differentiate between many possible explanations for the observed differences in wait times. Because physicians in many other specialties with physician shortages are also offering cosmetic services, further studies are needed to assess the broader policy implications of these findings.

Botulism in 4 Adults Following Cosmetic Injections With an Unlicensed, Highly Concentrated Botulinum Preparation

Botulism in 4 Adults Following Cosmetic Injections With an Unlicensed, Highly Concentrated Botulinum Preparation

Botulism in 4 Adults Following Cosmetic Injections With an Unlicensed, Highly Concentrated Botulinum Preparation

Botulism is a potentially lethal paralytic disease caused primarily by toxins of the anaerobic, spore-forming bacterium Clostridium botulinum. Although botulinum toxin A is available by prescription for cosmetic and therapeutic use, no cases of botulism with detectable serum toxin have previously been attributed to cosmetic or therapeutic botulinum toxin injections. On November 27, 2004, 4 suspected botulism case-patients with a link to cosmetic botulinum toxin injections were reported to the Centers for Disease Control and Prevention. To investigate the clinical, epidemiological, and laboratory aspects of 4 suspected cases of iatrogenic botulism. Case series on 4 botulism case-patients. Clinical characteristics of the 4 case-patients, epidemiological associations, and mouse bioassay neutralization test results from case-patient specimens and a toxin sample. Clinical characteristics of the 4 case-patients were consistent with those of naturally occurring botulism. All case-patients had been injected with a highly concentrated, unlicensed preparation of botulinum toxin A and may have received doses 2857 times the estimated human lethal dose by injection. Pretreatment serum toxin levels in 3 of the 4 case-patients were equivalent to 21 to 43 times the estimated human lethal dose; pretreatment serum from the fourth epidemiologically linked case-patient was not available. A 100-microg vial of toxin taken from the same manufacturer's lot as toxin administered to the case-patients contained a toxin amount sufficient to kill approximately 14,286 adults by injection if disseminated evenly. These laboratory-confirmed cases of botulism demonstrate that clinical use of unlicensed botulinum toxin A can result in severe, life-threatening illness. Further education and regulation are needed to prevent the inappropriate marketing, sale, and clinical use of unlicensed botulinum toxin products.

Diplopia Associated With the Cosmetic Use of Botulinum Toxin A for Facial Rejuvenation

We report three cases in which cosmetic injections of botulinum toxin A around the eye caused diplopia. Diplopia was due to inferior oblique paresis, which was bilateral in two cases. We suggest that consent for periocular botulinum toxin procedures should include a warning about diplopia.

Comprehensive Glabellar Anatomy for the Cosmetic Surgeon

Introduction: The purpose of this study was to clarify controversies in motor innervation to the glabellar muscles in order to create a comprehensive guide of anatomic relationships within the glabella for the cosmetic surgeon performing surgery or injections in this aesthetic region. Methods: Microdissection was performed on 28 sides of 14 preserved cadaver heads and 10 sides of 5 fresh-frozen cadaver heads. Dissection proceeded anterograde from the main trunk of the facial nerve to its terminal branches in the glabellar muscles. Measurements were made with calipers to record the locations of the motor nerve entry into the corresponding muscle and the locations of the sensory nerves, vessels, and orbital landmarks. Results: The temporal branch of the facial nerve did not terminate after supplying the posterolateral transverse corrugator muscle but continued medially to innervate the oblique head of the corrugator muscle, entering 4 mm inferior to the superior edge (range 2–6.5 mm). This pattern was identified in 26 of 38 dissections (68.4%). In 74% of specimens, a small artery coursed with the nerve toward the corrugator muscle that should be anticipated to avoid bleeding. In 4 specimens (10.5%), the temporal facial nerve supplied a branch to the depressor supercilii, which continued to enter the posterior surface of the procerus muscle. In the remaining specimens, the small terminal branches were lost after entering the oblique corrugator muscle. The supratrochlear nerve exited between, rather than lateral to, the 2 heads of the corrugator supercilii muscle near the muscle origin before dividing into 2–3 branches and measured 17 mm from midline. A sensory branch entered the procerus muscle 5 mm inferior to the motor nerve entering the muscle. The supraorbital notch and foramen was 26 mm from midline. Prominent angular vessels were located between the heads of the corrugator supercilii muscle and between the heads of the depressor supercilii muscle. Conclusions: With a thorough understanding of the anatomic relationships of the muscles to their associated innervation and vascular supply, complications such as prolonged paresthesia or dysesthesia from sensory nerve injury, eyebrow asymmetry from motor nerve damage, traumatic neuromas, and visual loss from vascular emboli from cosmetic injections may be avoided.

Aesthetic oculoplastic surgery.

Important concepts and advances continue to evolve in the field of aesthetic oculoplastic surgery. A keen interest in aesthetics exists, both on the part of the youth-oriented, aging baby-boomer population and on the part of many physicians and surgeons in a variety of different specialities. This review article highlights recent, important developments regarding cosmetic Botox injections for lines of facial expression, laser facial-resurfacing techniques, endoscopic and updated browlift techniques, lower-lid blepharoplasty with suborbicularis oculi fat lift, and subcutaneous Gore-Tex implants for treatment of deep facial rhytids. Because of the space limitations of this review, it is not possible to include a thorough step-by-step description of all surgical techniques. Rather, important concepts, references, and updates are emphasized. The information presented should be of interest to readers of varying levels of expertise.

Danger in performing MR imaging on women who have tattooed eyeliner or similar types of permanent cosmetic injections.

Danger in performing MR imaging on women who have tattooed eyeliner or similar types of permanent cosmetic injections.

Devastating Granulomata of the Lower Extremities Resulting from Cosmetic Injection of Adulturated Liquid Silicone

Granick, Mark S. M.D.; Solomon, Mark P. M.D.; Mosely, Linda H. M.D.; McGrath, Mary H. M.D. Author Information