Dermal Filler Injections Research Articles

Clavicular Contouring with a Novel Subperiosteal Filler Injection Technique: A Single-Case Study.

Injectable cosmetic procedures are increasingly popular among beauty seekers as rapid technology and material advancements making it easier to achieve desired results through minimal trauma. The technique of subperiosteal injection, which is not yet introduced to the field of medical esthetics, may achieve more satisfying results. This study confirms the possibility of subperiosteal injection of dermal filler, using the clavicle area as the validation region, and has been validated by ultrasound examinations. This novel injection technique combining sharp and cannula successfully achieves subperiosteal filling injections, aiming to shape clear contours by utilizing subperiosteal filling and addressing the displacement issues of conventionally injected dermal filler, thereby achieving long-term reliable results. The new technique involves linear limited subperiosteal dissection using a cannula, followed by further expansion of the periosteum through injection pressure to complete the injection of dermal filler and retain it beneath the periosteum. The conclusion drawn from clinical observation and ultrasound validation confirms that the dermal filler is indeed injected at the subperiosteal level and provides very stable support. The results at the 6-month follow-up remain ideal. This subperiosteal injection technique is easy to practice and conductive to promotion. In terms of results, it achieves long-term stable outcomes that traditional injection methods cannot achieve. Although the clavicle area was used as the validation region, this technique can also be applied to many conventional facial injection sites. 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 https://www.springer.com/00266 .

Quantitative Assessment of New Frontiers in Dermatochalasis and Periorbital Hyperpigmentation Treatment: The Role of Cross-Linked Porcine Collagen.

Collagen dermal fillers have shown efficacy in addressing age-related changes in facial appearance. However, their potential in rejuvenating the periorbital region remains unexplored. The aim of this study was to evaluate the effectiveness, clinical safety, and patient satisfaction associated with the utilization of collagen dermal fillers in individuals with dermatochalasis and periorbital hyperpigmentation. This study was reviewed and approved by the institutional review board of China Medical University Hospital (IRB No. CMUH107-REC2-157). Adults diagnosed with dermatochalasis or periorbital hyperpigmentation received periorbital injections of a sterile cross-linked highly-purified specific antigen free porcine dermal collagen (FACIALGAIN® Collagen Implant with Lidocaine, Sunmax Biotechnology Co. Ltd., Taipei, Taiwan) and were assessed for hydration, elasticity, pigmentation index, redness index, lightness value, and density with the DermaLab® Combo Multiparameter Skin Analysis System (Cortex Technology, Hadsund, Denmark) and Cutometer® Dual MPA 580 (Courage+Khazaka electronic GmbH, Köln, Germany). Data was collected prior to injection and at 1 week, 4 weeks, and 12 weeks after injection. Patient satisfaction on volume augmentation, decrease in hyperpigmentation, persistence, and overall satisfaction were also recorded. A total of 12 samples each were recruited for dermatochalasis and periorbital hyperpigmentation. For dermatochalasis subjects, hydration of the periorbital tissue significantly increased at week 1 and 4 (p = 0.011 and p = 0.015). Elasticity decreased by week 4 and persisted until week 12 (p = 0.001 and 0.014). For periorbital hyperpigmentation patients, lightness value increased significantly starting week 1 (p = 0.016), tapering off at week 12. Elasticity decreased by week 4 and persisted until week 12 (p = 0.002 and p = 0.002). Median overall patient satisfaction was 4 out of 5 for the dermatochalasis group and 4.5 out of 5 for the periorbital hyperpigmentation group, with a mild but insignificant decrease by week 12. DermaLab® Combo and Cutometer® Dual MPA 580 are considered effective methods for evaluating patients undergoing dermal filler injections. The utilization of cross-linked porcine collagen dermal filler injections can serve as a minimally invasive approach to enhance skin laxity in dermatochalasis and address discoloration in periorbital hyperpigmentation. However, it is important to note that regular treatments may be necessary to sustain the desired outcomes. 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/0026 .

Delayed Hypersensitivity Reaction to Dermal Fillers Following mRNA COVID-19 Vaccination

Dear Editor, I wish to bring attention to a potential delayed immune reaction associated with dermal fillers in the context of mRNA COVID-19 vaccines. While severe vaccine reactions remain uncommon, the widespread administration of mRNA vaccines and the prevalent use of dermal fillers necessitate a closer examination of their possible interactions. We recently encountered a 59-year-old female patient who developed persistent facial swelling months after receiving the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine. Notably, the patient had a history of dermal filler injections, predominantly hyaluronic acid, administered three to four years prior. Despite various therapeutic interventions, including antihistamines, corticosteroids, and ACE inhibitors, she experienced recurrent episodes of swelling. Ultrasound assessment revealed the absence of residual filler material, leading us to consider an immune-mediated response potentially triggered by the mRNA vaccine. This case highlights the importance of further research into the interaction between mRNA COVID-19 vaccines and dermal fillers. It suggests that individuals with a history of dermal fillers may be susceptible to delayed inflammatory reactions post-vaccination. Clinicians should be aware of this potential adverse event, particularly when evaluating patients with unexplained facial swelling following vaccination.

Advancements in lip augmentation: A scoping review exploring novel techniques.

Lip augmentation is among the most popular cosmetic procedures done today. Advancements in trustworthy techniques have made it feasible to alter the visual characteristics of the lips through the utilization of various injectable substances and surgical procedures. However, there is a lack of standardization in these techniques. The purpose of this review is to focus on novel dermal filler injection and surgical techniques for lip augmentation. We did a scoping review of the literature using PubMed, Embase, and the Google Scholar database to identify all original articles published up to June 2023, assessing new techniques that focus on lip augmentation. In our review, only two studies out of seven included studies were surgical whereas the other five studies were non-surgical. This suggests that injection of dermal fillers is currently the most opted technique performed. This review suggests that incorporating perioral rejuvenation into the plan for lower facial surgery can help to complete the youthful look sought by patients. Injectable fillers provide excellent but short-term benefits and additional options such as Modified upper lip lift and French kiss techniques exist that offer the patient permanent improvements at a low cost.

Three-Dimensional Computed Tomography Scanning Study of the Superior Labial Artery in Chinese Individuals for Assessing Filler Injection Safety.

Lip filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. The aim of this study was to investigate the anatomy of the superior labial artery (SLA) and provide precise topographic information for dermal filler injection into the lips. Computed tomography (CT) scans of 52 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3D images of the SLA described by a coordinate system based on the bilateral external auditory canal and the left orbit. This study aimed to classify the SLA in the Han Chinese population, measure its diameter at specific points, and determine the thickness of the lip at those points. Ultimately, we utilized a thermal imaging technique to illustrate the course and depth of the SLA within the lip. The objective of this study was to provide safe guidance for clinical injections. In this study, the SLA was successfully identified in all cadavers. The mean overall diameter of the superior labial arteries was 1.36±0.28 mm. The superior labial artery showed a general course from deep to shallow with an average depth of 5.68±1.68 mm from the oral commissure to the midline. There are anatomical differences in the superior labial arteries among Chinese people. Furthermore, 3D CT images can digitally elucidate the exact positions of the superior labial artery via a coordinate system, improving the safety of upper lip filler injections in clinical settings. 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 .

Rare and novel complications of botulinum neurotoxin type A and dermal filler injections

Botulinum neurotoxin type A (BoNTA) and filler injection procedures usually provide predicted outcomes with a low incidence of complications. Most of the complications after these procedures have been extensively discussed. In this study, we report on these injectables’ less well-known, recently reported, and novel complications and attempt to clarify the underlying mechanisms. Counterfeit or mishandled BoNTA has been associated with botulism. BoNTA has been linked to uncommon complications, including morphea-like lesions, nontuberculous mycobacterial infections, vascular occlusion, and pseudoaneurysm of the superficial temporal artery. Unusual complications from filler injection include nonscarring alopecia, intraoral necrosis, nontuberculous mycobacterial infections, xanthelasma-like reactions, intracranial perforation, and pneumosinus dilatans. Post-BoNTA injection nodules and filler infection from bone destruction due to cocaine use are new complications. These complications pose a challenge for diagnosis and treatment. This publication aims to assist in promptly identifying and managing these rare and novel complications when necessary.

Understanding cosmetic consumers: exploring consumption patterns and predictors through a cross-sectional survey

BackgroundPrevious reports have provided (some) demographics of the cosmetic consumer; however, findings are not unequivocal. This relates to differences in the studies’ categorizations, samples, and contextual factors.MethodsEmploying a cross-sectional survey design, which was disseminated by 11 cosmetic clinics and consumer platforms in the Netherlands, this study provides a clear overview of a total of 734 Dutch cosmetic consumers’ (a) demographic characteristics; (b) motivations for undergoing a range of specific cosmetic procedures; (c) cosmetic procedure frequency, i.e., how frequently they undergo particular procedures; and (d) frequency of, and motivations for, switching clinics. Relations between cosmetic consumers’ demographics, motivations for cosmetic procedures, and different procedures chosen were also established.ResultsThere is no unequivocal characterization of ‘the’ cosmetic consumer in the Netherlands, although they mostly identified as heterosexual women from Dutch descent with relatively high educational attainment levels and a high income. Some regional differences in terms of cosmetic procedure engagement were observed. Motivations for cosmetic procedure engagement were multifaceted, and responses varied between open- and closed-ended questions. Few relations between predictors and (a selection of) cosmetic procedures proved significant. (Higher) age and high educational attainment positively correlated with undergoing botulinum toxin injections and eyelid corrections. Gender and daily use of highly visual social media positively correlated with undergoing dermal filler injections. Lastly, lower-educated consumers were significantly more likely to have breast enlargements than higher-educated consumers.ConclusionsThis study provides a comprehensive overview of the demographic characteristics and motivations of a varied sample of cosmetic consumers, and the types and quantities of cosmetic procedures they undergo. In terms of demographics, we can conclude that there is no unequivocal characterization of ‘the’ cosmetic consumer in the Netherlands, although she frequently identifies as a heterosexual female of Dutch descent.Level of EvidenceNot gradable

A Prospective, Randomized, Double-Blind, Split-Face, Comparative Study to Evaluate the Efficacy and Safety of DKL23 and Juvéderm Volift for Correcting Moderate-to-Severe Nasolabial Folds.

Hyaluronic acid dermal fillers are used for multiple indications, including wrinkle correction and restoration of volume/fullness. The aim of this study was to compare the efficacy and safety of 2 hyaluronic acid products for correcting moderate to severe nasolabial folds (NLFs). A prospective, randomized, double-blind, split-face study was undertaken. The subjects' left and right NLFs were randomly allocated for treatment with DKL23 or Juvéderm Volift. Follow-up was conducted at 1, 3, 6, and 9 months. The changes from baseline on the Wrinkle Severity Rating Scale and the Global Aesthetics Improvement Scale were evaluated. Posttreatment adverse events (AEs) were recorded. Forty-eight women (median age, 57.0 years) with Type I to VI skin were enrolled. Both treatments showed statistically significant improvement (P < .0001) in NLFs according to the Wrinkle Severity Rating Scale score from baseline to each of the time points assessed. The improvement in NLFs was maintained until the end of the study (9 months). Furthermore, the change from baseline to each of the time points assessed was similar between DKL23 and Juvéderm Volift. Investigator- and subject-rated Global Aesthetics Improvement Scale scores showed similar rates of improvement (indicated by the sum of responses of improved, much improved, or very much improved) between the 2 products. The AEs reported in the study were in line with previous and expected experience after injection of hyaluronic acid dermal fillers. The types of AEs, their rates, intensity, and duration were comparable between the 2 products. DKL23 improved NLF severity from baseline and for up to 9 months, and the results were comparable to the improvement shown by Juvéderm Volift. Treatment was safe and well tolerated.

A cross-sectional analysis of TikTok's most popular dermal filler videos.

Dermal filler injections pose serious risks when administered by untrained individuals or when food and drug administration (FDA) guidelines are not adhered to. This issue may potentially be compounded by a growing reliance on social media platforms for health information. Our objective was to analyze the quality of health information in videos published on dermal filler on TikTok. We searched three hashtags, #filler (2.4 billion views), #dermalfiller (132.8 million views), and #fillersinjection (137.0 million views) and assessed the top videos returned by TikTok's algorithm that met inclusion criteria. The quality of health information was evaluated using the DISCERN instrument, a validated tool that uses a 1 to 5 scale to assess consumer health information. Videos received a mean DISCERN score of 1.64 (SD 0.33), indicating significantly low quality. 7% of the videos promoted non-FDA-approved uses of filler. Notably, videos posted by physician assistants or physicians received the highest mean scores (1.92 and 1.72) as well as videos categorized as educational (1.99). Dermatologists should be aware of the high viewership of low-quality TikTok videos on dermal filler. Dermatologists shall, therefore, understand the importance of their role in providing education to patients on this topic.

Fillers impacting follicles: the emerging complication of filler-induced alopecia.

Filler-induced alopecia is a transient alopecia characterized by localized hair loss and often attributed to vascular compromise following dermal filler injections in facial regions. Although an uncommon phenomenon, the rising incidence of filler-induced alopecia underscores the importance of understanding and managing this condition. We performed an extensive PubMed review of articles reporting filler-induced alopecia and summarizing the implicated filler types, injection areas, hair loss patterns, symptom onset, course progression, treatments, and prognosis. Hyaluronic acid injections were the most implicated in filler-induced alopecia cases, with calcium hydroxylapatite and autologous fat less frequently associated. No cases involved other dermal filler types. Although recovery times varied depending on the treatment, hyaluronidase (HAase) injections rapidly restored near-normal hair density within 3-4 months. Minoxidil and platelet-rich plasma play a more minor role in restoring hair growth but may be used as adjuncts with HAase to facilitate hair growth. Finally, alternative interventions like intralesional triamcinolone, warm compresses, and nitroglycerin warrant exploration, given limited robust clinical data. Our study promotes awareness of filler-induced alopecia's rising incidence and offers practical insights and evidence-based recommendations for effective management. By equipping dermatologists with this knowledge, our aim is to improve patient outcomes and reduce adverse events in filler-based procedures.

Management of visual complications of dermal filler injections

Injectable cosmetic fillers have dramatically risen in popularity in recent years. However, as the use of such fillers has become more common, there have been many reports of vision loss secondary to misplaced filler embolizing to the ophthalmic artery, resulting in ocular ischemia. Currently, there are no randomized control trials or widely validated clinical guidelines that dictate how injectors should manage ischemic complications of filler embolism. This review aims to explain the possible mechanisms by which a cosmetic filler embolus can occlude the ophthalmic artery and describe the types of treatments that have been attempted thus far. Additionally, this article uniquely delineates a possible stroke-like protocol that can be implemented in order to restore perfusion and recover vision after such ischemic complications have occurred.

Causes and management of sight threatening complications of dermal filler injections: A review.

Injectable dermal fillers continue to increase in popularity in aesthetic medicine. Although rare, vision loss secondary to filler injections is a devastating complication associated with a poor visual prognosis. The mechanism for vision loss is thought to be related to retrograde embolization of the dermal filler from peripheral vessels in the face into the ophthalmic arterial system. Early recognition and prompt management are essential if vision is to be salvaged. The use of retrobulbar hyaluronidase is still contentious, however when administered by a specialist, this treatment gives the best chance at visual recovery and should be considered for all cases.

(216) Efficacy of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement

Abstract Introduction There has been renewed public and professional interest in the topic of cosmetic penile girth enhancement. Hyaluronic acid (HA) injections have been proposed as a safer alternative to surgical options, however limited data exist regarding efficacy. Objective The purpose of our study was to evaluate average girth changes and related metrics in men undergoing penile girth enhancement with sequential administration of HA dermal filler at a single site. Methods We performed a retrospective review of men who underwent penile girth enhancement with HA from May 17, 2022 to April 28, 2023. Results 155 men underwent penile girth enhancement with HA filler and were instructed to follow a strict post-injection protocol. On average, men experienced a 0.633 cm increase in girth per treatment receiving an average of 12.5 total syringes over 2.2 treatments. Ultimately, all men receiving multiple treatments experienced an average girth increase of 1.8 cm as measured prior to their final treatment. 23 men who received 4 treatments or more experienced an average girth increase of 2.952 cm as measured prior to their final treatment. Of the 155 men treated, 19 (12.3%) required cosmetic correction with either hyaluronidase or abobotulinumtoxinA. Conclusions Our study suggests that injection of HA dermal filler is an effective option for men desiring non-surgical penile girth enhancement. Further studies are needed to better characterize outcomes and optimal treatment protocols. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.

(051) Safety of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement

Abstract Introduction Limited data exist regarding safety of penile girth enhancement treatments. Reported options for girth enhancement include injections of autologous fat, liquid silicone, hyaluronic acid (HA), or polymethyl-methacrylate, grafting with dermal fat, porcine dermal acellular matrix, or acellular collagen matrix, and surgical placement of a silicone implant. Objective The purpose of our study was to retrospectively evaluate safety in a cohort of men undergoing penile girth enhancement with HA dermal filler at a single site by reporting on post-procedure complications. Methods We performed a retrospective review of men who underwent penile girth enhancement with HA dermal filler from August 2020 through April 2023. Results 471 men underwent penile girth enhancement with HA dermal filler. Two patients experienced injection site infections related to non-compliance post treatment with infection resolution after completing a course of oral antibiotic. One patient reported urinary tract infection symptoms shortly after HA dermal filler procedure and subsequently underwent additional filler injections without recurrence of urinary symptoms. One patient underwent reversal with hyaluronidase after his initial treatment. Three patients developed granulomas which were completely resolved with a single treatment of hyaluronidase. All three of these patients underwent additional HA injections without granuloma formation. Three patients experienced priapism treated without long term sequelae when intracavernosal injection (ICI) therapy was used for tumescence at time of filler injection. Once ICI was no longer used, no patients reported priapism. No patients reported erectile dysfunction or loss of sensitivity. Conclusions Our study suggests that injection of HA dermal filler may be a safe option for men interested in penile girth enhancement. While rare complications may occur, our research suggests they are easily treatable in the outpatient setting without long term sequelae. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.

A Cross-Sectional Survey on Pain Management in Dermal Filler Injections from Physicians' and Patients' Perspectives.

Hyaluronic acid (HA) dermal fillers injection is a common procedure in patients with cosmetic needs. Concomitant pain is a major complaint among patients undergoing HA filler injections. Relevant research is limited and there is no consensus on pain management of dermal filler injection. To assist physicians in determining a more appropriate treatment approach, and to better provide treatment suggestions. A nationwide (China) cross-sectional survey was conducted using questionnaires designed for physicians and patients, respectively. A total of 62 semi-structured questionnaires were administered to aesthetic physicians via face-to-face interview, whereas 123 online-based questionnaires were collected from patients who have ever undergone HA treatment. The collected questionnaire information was analyzed using descriptive statistics and content analysis. 42 (67.74%) physicians observed that over 50% of their patients were concerned about pain during injection. 101 (82.11%) of patients were concerned about impending pain ≥5 points (a total score is 10) before injection. For preferred pain relief modalities, 48 (77.42%) physicians would choose a hyaluronic acid dermal filler with lidocaine, and 82 (66.67%) patients would choose anesthetic-containing products. 59 (95.16%) physicians who injected lidocaine-containing hyaluronic acid found patients had a comfortable treatment experience. Pain management during hyaluronic acid dermal fillers injection is important from both perspectives of physicians and patients. This survey showed that compared with other analgesic methods, lidocaine-containing hyaluronic acid has offered a more satisfying experience. It also provides insights to physicians and patients in pain management. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Personalized Protocol for Facial Rejuvenation Using Two Soft Hyaluronic Acid Fillers With High Cohesivity.

Minimally invasive injectable dermal fillers are one of the most commonly used aesthetic treatments for facial soft tissue restoration. Different formulations may be used simultaneously to target multiple areas of concern. Due to differences in their rheological properties that directly impact the recommended injection technique and overall result, the formulations in the Aliaxin® line are each designed to target different soft facial tissues. This case series addresses two potential treatment approaches and a combination approach specifically developed to achieve harmony and promote a full but soft facial appearance. To reach this goal, we used two different formulations: Aliaxin® Shape and Restore (ASR) and Aliaxin® Global Performance (AGP). Four patients, 35-55years received treatments with ASR, AGP, or both products. Utilizing the two protocols simultaneously achieved targeted support, lift, and volume, along with effective full facial softening and an authentic aesthetic outcome.

Complications after breast augmentation with dermal fillers containing copolyamide: A systematic review

BackgroundDermal fillers containing copolyamide are used for breast augmentation and are marketed under different labels, such as Aquafilling, Los Deline, Aqualift, and Activegel. In recent years, the number of publications reporting complications after use of these fillers has increased. MethodsThrough a computerized search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of published studies on complications, treatment options, and radiological findings related to breast augmentation with dermal fillers containing copolyamide was performed. Publications between January 1, 2007, and January 23, 2023, were included. Retrieved studies were screened for inclusion and quality assessment. The Joanna Briggs checklist for case reports and the Strengthening the Reporting of Observational Studies in Epidemiology checklist for cross-sectional studies were used. ResultsSixteen studies met the inclusion criteria: 14 case reports and 2 retrospective cohort studies, including 196 women and 333 complications. Long-term complications (≥30 days after surgery) were described in 15 studies. The most commonly reported complications were nodules in the breast (130 patients), pain (92 patients), inflammation and/or infection (43 patients), breast deformities (35 patients), and migration of the filler to the pectoralis muscle, abdominal wall, thoracic wall, pubic area, back, or upper extremity (27 patients). The median time between injection of the dermal filler and any complication was 18 months, and the majority of patients with complications required surgical intervention. ConclusionGiven the reports of severe complications months to years after injection of dermal fillers containing copolyamide and the lack of studies evaluating long-term safety, our interpretation is that dermal fillers containing copolyamide should not be used for breast augmentation.

Evolving Forehead Augmentation: A Five-step Approach with High G Prime Hyaluronic Acid.

Achieving effective upper-face rejuvenation through forehead augmentation is essential; however, complications such as vascular occlusion leading to skin necrosis or vision loss can occur. The complex forehead anatomy, characterized by ligaments and septa, often results in uneven outcomes with dermal filler treatment. The learning curve for successful forehead augmentation was longer than that anticipated. Herein, we present a specialized program for clinicians to expedite the learning process. This study explores a five-step technique for forehead augmentation using high elastic (G prime) hyaluronic acid fillers. We enrolled 10 Asian female participants with no history of dermal filler injections, surgery, or nonsurgical forehead procedures. All participants provided written informed consent, and their progress was assessed using photography and the Global Aesthetic Improvement Scale. Immediate post-treatment Global Aesthetic Improvement Scale ratings averaged 3.0 ± 0.0, decreasing to 2.5 ± 0.5 at 6 months, and 1.8 ± 0.6 at 12 months. Mild tenderness (10%), temporary swelling (30%), and a rapid recovery period underscored the safety and reliability of our approach. Importantly, no adverse vascular events were observed. Our five-step injection technique utilizing high-G prime hyaluronic acid leverages a profound understanding of the forehead anatomy, systematic methodology, and dynamic potential of advanced fillers. By implementing this paradigm, plastic and reconstructive surgeons can increase the standards of forehead augmentation and consistently achieve harmonious and effective results.

Facial Contouring after Permanent Filler Removal with Combined Facelift and Fat Grafting: A Case Series

Background: Aesthetic procedures for addressing aging range from simple injection of dermal fillers to facelift surgery. The last few decades have witnessed the development of diverse techniques to minimize facial wrinkles, volumize the face, and restore a youthful appearance. For example, fillers are a group of compounds used for cosmetic and reconstructive purposes, especially related to the face. Therefore, this study aimed to demonstrate specific cases where problematic dermal fillers were evacuated in combination with facelift procedures and fat grafting. It therefore demonstrates means to manage and treat permanent filler complications with a multidisciplinary evidence-based approach to achieve functional and cosmetic outcomes. Methods: Between January 2020 and August 2022, 50 patients were subjected to drainage of permanent dermal filler followed by facelift and fat grafting with a minimum 6-month follow-up recorded. Results: A total of 50 female patients between 30 and 56 years of age underwent permanent dermal filler removal in conjunction with facelift and fat grafting. The surgery was successful in all cases, but four cases of seroma and four cases of facial mandibular nerve neuropraxia, five cases of scar hypertrophy, two cases of wound infection and one case of pixie ear deformity were encountered during the follow-up. Conclusion: In this study, we present the characteristics of combining facelift and fat grafting procedures after surgical drainage of permanent dermal fillers to achieve aesthetically favorable results.

Laser Speckle Contrast Imaging Guides Needling Treatment of Vascular Complications from Dermal Fillers.

Although laser Doppler imaging (LDI) accurately delineates a hypoperfused area to help target hyaluronidase treatment, laser speckle contrast imaging (LSCI) is more appropriate for assessing microvascular hemodynamics and has greater reproducibility than LDI. This study investigated the use of LSCI in the evaluation and treatment of six patients who developed vascular complications after facial dermal filler injections. The areas of vascular occlusion were accurately defined in real time by LSCI and were more precise than visual inspections or photographic evidence for guiding needling and hyaluronidase treatment. All patients had achieved satisfactory outcomes as early as Day 2 of treatment and no procedure-related complications were reported after a median follow-up of 9.5 (7-37) days. LSCI accurately and noninvasively delineated vascular occlusions in real time among patients experiencing complications of facial dermal filler injections. Moreover, LSCI was more accurate than visual and photographic evaluations. Clinicians can use LSCI to reliably follow-up therapeutic outcomes after salvage interventions for vascular occlusions. 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 .