Dermal Fillers Research Articles

Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication.

Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.

Using dermal filler to camouflage forehead osteoma: A case report.

AbstractObjectiveTo review the technique and outcomes of using dermal filler to camouflage forehead osteoma, providing a minimally invasive alternative to surgical excision.BackgroundForehead osteoma, commonly known as a forehead bump or bone spur, can be a cosmetic concern. Surgical excision, while effective, carries risks of scarring and postoperative complications. An innovative approach using dermal filler offers a potential solution.MethodsA hyaluronic acid‐based filler is injected into the deep subcutaneous plane over the bony prominence using a cannula. The fanning technique ensures even distribution of the filler. The procedure's safety, patient selection, and communication between the injector and patient are emphasized to achieve optimal results.ResultsThe technique provides immediate aesthetic improvement with results that can last up to 12 months, depending on the filler used. While generally safe, potential complications include infections, swelling, asymmetry, and lumpiness. Proper technique, patient selection, and good communication between the injector and patient are critical to achieving optimal outcomes.ConclusionUsing dermal filler to camouflage forehead osteoma is a minimally invasive alternative to surgical excision, offering immediate and long‐lasting results with minimal downtime and fewer risks. Further studies are needed to refine the technique and optimize outcomes.

"Autologous Breast Dermal Filler": A Novel Technique for Breast Reconstruction After Nipple- or Skin-Sparing Mastectomy in Pubertal Gigantomastia.

For females in puberty, mastectomy caused by pathological gigantomastia usually brings significant psychological problems. Appropriate immediate breast reconstruction method is necessary. The aim of this study is to present a novel method of breast reconstruction that requires neither implants nor donor-site sacrifice. All patients who were diagnosed with pathological gigantomastia and indicated for nipple-sparing or skin-sparing mastectomy (NSM or SSM) were selected. All extra skin was de-epithelialized, followed by NSM or SSM through a vertical incision on the lower pole of the breast. Then, a skin and dermal envelope in all directions was formed. Whether to preserve the nipple-areolar complex depended on its perfusion. The dermal flap was folded inward to serve as the "autologous dermal filler" and reconstruct the breast. A second surgery of inframammary fold elevation for larger projection was performed at least 6 months. Follow up for at least 1 year and record complications as well as pre- and postoperative BREAST-Q Scores. A total of 11 breasts were included. Four (36.4%) were NSM and seven (63.6%) were SSM. Nipple to sternal notch distance in NSM and SSM was 32.3±9.1cm and 35.1±4.4cm, respectively. No complications occurred, while one breast with NSM showed nipple upward displacement. The BREAST-Q indicated significant postoperative improvements in breast satisfaction (20.5 ± 11.3 vs 80.2 ± 10.4) and psychosocial well-being (23.4 ± 8.9 vs. 81.4 ± 11.3). Preliminary study demonstrated the efficacy and long-term safety of "autologous breast dermal filler." For adolescents, it is a less invasive autologous breast reconstruction method, or transitional plan for further adjustment in adulthood. 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 .

Tyndall, Rayleigh, Mei, and Raman scattering: Understanding their role in aesthetics.

The role of various light scattering phenomena in aesthetics and clinical practice is explored in this review. Four main types of light scattering, Tyndall, Rayleigh, Mie, and Raman, are discussed. Each type is explained in terms of its physical principles and its applications in aesthetic medicine. Tyndall scattering is relevant in understanding the blue appearance of certain dermal fillers. Rayleigh scattering contributes to skin tone perception and plays a role in certain laser treatments. Mie scattering is important in laser hair removal and the appearance of skin conditions like melasma. Raman scattering, while primarily used in research, shows promise for non-invasive skin analysis, personalized skincare, treatment monitoring, and early skin cancer detection. It is important to understand these scattering phenomena for optimizing light-based aesthetic procedures and developing effective treatments. Properly applying the appropriate scattering theory based on relative particle size is crucial in clinical aesthetic practice.

Investigating Facial Muscle Physiology Following Soft Tissue Filler Injections-A Surface-derived Electromyographic and Skin Vector Displacement Analytic Study.

The use of hyaluronic acid-based soft tissue fillers has often been reported to modulate the muscle, that is, to cause myomodulation. To our knowledge, there has been so far no scientific study investigating the potential of hyaluronic acid-based soft tissue fillers to modulate or actually alter the function of facial muscles. To further assess this three-dimensional (3D) surface imaging and electromyography (EMG)-based prospective study investigated the changes of facial muscle contraction after injection of strategically placed hyaluronic acid-based soft tissue fillers to assess the actual validity of the term myomodulation. A total of 13 subjects with a mean age of 37.8 years (12 females, 1 male) were injected according to a predefined injection protocol. Surface EMG and 3D surface imaging were performed prior to the injection and 5 days after the injection. The results showed no significant change in the strength of the muscles (measured in μV) after injection of hyaluronic acid-based soft tissue fillers. However, horizontal and vertical skin displacement upon contraction of the zygomaticus major muscle changed significantly between baseline and follow-up, with a mean horizontal skin displacement increase from 3.2 to 4.1 mm. Upon contraction of the depressor anguli oris muscle, the horizontal skin displacement did not change significantly (2.15 vs. 2.05 mm), while vertical skin displacement increased significantly from 2.9 to 4.3 mm. The modification of the surrounding tissue caused an alteration of the vectorial skin displacement upon contraction of the muscle. A potential explanation could be the increased distance between the origin and insertion of the muscle due to the material deposition in the proximity of the relevant facial muscles, leading to a change of contraction vector.

Stem Cell-Derived Extracellular Vesicle-Bearing Injectable Hydrogel for Collagen Generation in Dermis.

Despite the remarkable advances of dermal fillers that reduce wrinkles caused by dermis thickness reduction, they still lack effective hydrogel systems that stimulate collagen generation along with injection convenience. Here, we develop a stem cell-derived extracellular vesicle (EV)-bearing thermosensitive hydrogel (EVTS-Gel) for effective in vivo collagen generation. The TS-Gel undergoes sol-gel transition at 32.6 °C, as demonstrated by the storage and loss moduli crossover. Moreover, the TS-Gel and the EVTS-Gel have comparable rheological properties. Both hydrogels are injected in a sol state; hence, they require lower injection forces than conventional hydrogel-based dermal fillers. When locally administered to mouse skin, the TS-Gel extends the retention time of EVs by 2.23 times. Based on the nature of the controlled EV release, the EVTS-Gel significantly inhibits the dermis thickness reduction caused by aging compared to the bare EV treatment for 24 weeks. After a single treatment, the collagen layer thickness of the EVTS-Gel-treated dermis becomes 2.64-fold thicker than that of the bare EV-treated dermis. Notably, the collagen generation efficacy of the bare EV is poorer than that of the EVTS-Gel of a 10× lesser dose. Overall, the EVTS-Gel shows potential as an antiaging dermal filler for in vivo collagen generation.

Safe Zones for Facial Fillers: Anatomical Study of SubSMAS Spaces in Asians.

The study "Spaces of the Face for Filler Procedures: Identification of subSMAS Spaces Based on Anatomical Study" explores the anatomy of facial spaces crucial for safe and effective filler injections. By delineating the subSMAS (sub-superficial musculoaponeurotic system) spaces, this research highlights how these virtual compartments, bordered by fat, muscles, fascia, and ligaments, facilitate independent muscle movement and reduce the risk of damaging critical structures. The thicker and more robust skin of East Asians necessitates deeper filler injections, emphasizing the significance of accurately identifying these spaces. A cadaver study with dyed gelatin validated the existence and characteristics of these subSMAS spaces, confirming their safety for filler procedures. Key spaces, such as the subgalea-frontalis, interfascial and temporalis, and prezygomatic spaces, were examined, illustrating safe zones for injections. The findings underscore the importance of anatomical knowledge for enhancing facial aesthetics while minimizing complications. This study serves as a guide for clinicians to perform precise and safe filler injections, providing a foundation for further research on the dynamic interactions of these spaces and long-term outcomes.

Current understanding and future directions in diagnosis and treatment in breast asymmetry: a literature review

Breast asymmetry can be caused by hormonal fluctuations, surgery, or developmental abnormalities that result in disparities in the size, shape, or location of the breasts. When it comes to identifying and assessing asymmetry, diagnostic techniques such as mammography, ultrasonography, MRI, and 3D tomosynthesis provide clear advantages. To address both functional needs and aesthetic concerns, there are various treatment options available, including non-surgical techniques such as hormone therapy and fat grafting, as well as surgical techniques such as augmentation, reduction, and mastopexy. With the help of AI and machine learning, future advancements in imaging improve the accuracy of diagnoses, enabling customized treatment plans based on molecular and genetic profiles. The field is evolving due to advancements in minimally invasive, 3D-printed implants enabling customization, and regenerative therapies such as stem cell treatments, with the goal of optimizing outcomes while minimizing recovery time and complications. Non-surgical alternatives such as focused ultrasound and injectable fillers provide additional choices for patients preferring less invasive treatments. Holistic patient care integrates virtual reality for surgical planning and psychosocial support, ensuring comprehensive management of both physical and emotional aspects. Overall, ongoing innovations are poised to revolutionize breast asymmetry management, offering tailored solutions that improve patient outcomes and quality of life.

Ultrasound-guided hyaluronic acid filler injections for temporal augmentation: a case report of two patients

Ultrasound-guided hyaluronic acid filler injections for temporal augmentation: a case report of two patients

A comprehensive approach to skin rejuvenation with Neauvia smart combination therapy

Aesthetic medicine extends beyond just correction, evolving into prevention strategies for aging. This case study highlights the revolutionary potential of Neauvia dermal fillers in skin rejuvenation and enhancement. Unlike conventional hyaluronic acid fillers, Neauvia uses PEG (polyethylene glycol), a biocompatible polymer, ensuring exceptional durability and longevity. Moreover, its PEG-based formulation offers thermal stability, enabling synergistic use with energy-based devices like LaserMe. Through the SCT (Smart Combination Therapy) Protocol, combining Neauvia dermal fillers, Hydro Deluxe skin booster, and LaserMe, a comprehensive treatment approach is achieved. Illustrated through a case study of a 74-year-old female, this protocol demonstrates remarkable results in addressing volume loss, fine lines, and skin quality over three sessions. Neauvia's mission to redefine medical aesthetics emphasises synergy between technology and clinical efficacy, creating natural rejuvenation with minimal intervention. This approach signifies a model shift towards holistic aesthetic solutions, optimising outcomes with minimal filler volume and maximal skin regeneration.

The access and invasiveness-based classification of medical procedures to clarify non-invasive from different forms of minimally invasive and open surgery.

The rapid development of less invasive and traumatic medical procedures has resulted in a mixture of terms used to describe them, without any agreed definition for each. This is confusing to both medical professionals and patients and can lead to unrealistic patient expectations. The aim of this article is to show the current confused nomenclature and to suggest a new, simple classification based on access and invasiveness (AI) that can be applied to any medical procedure. We performed an online search for definitions for 'non-invasive', 'non-surgical', 'minimally invasive', 'minimal access', 'pinhole' and 'keyhole'. We then searched peer-reviewed medical papers (PRMPs) and patient facing websites (PFWs) for the following index procedures, to see which of the original 6 terms were used to describe them: transvaginal ultrasound, sclerotherapy for leg veins, botulinum toxin injections, dermal fillers, endovenous thermal ablation and laparoscopic gall bladder removal. We found a wide variety of definitions for each of the initial terms. In both PRMPs and PFWs, there were a variety of terms used for each index procedure (i.e.: transvaginal ultrasound, injections of sclerotherapy, botulinum toxin or dermal fillers being both 'non-invasive' and 'minimally invasive') showing confusion in the classification of procedures. We suggested the 'AI classification' based on access (A - none, B - natural orifice or C - penetrating an epithelial surface) and invasiveness (1 - none, 2 - surface damage, 3 - needle = <21G, 4 - cannula >21G but not a surgical trocar, 5 - surgical trocars or small incisions and 6 - incisions). The current confusion of terms used for procedures that are less invasive than the open surgical alternatives leads to confusion and possible false patient expectations. We have proposed an AI classification that can be applied easily to any procedure, giving a uniform classification for medical professionals and patients to understand.

A Prospective, Multicenter, Evaluator-Blinded, Randomized Study of Diluted Calcium Hydroxylapatite to Treat Decollete Wrinkles.

Calcium hydroxylapatite (CaHA) dermal filler is used for a variety of aesthetic treatments; however, the safety and effectiveness of diluted CaHA for the treatment of d&eacute;collet&eacute; wrinkles have not been established. To demonstrate the effectiveness and safety of diluted CaHA (Radiesse; 1:2 CaHA:saline) injection for the improvement of d&eacute;collet&eacute; wrinkles in females. Eligible females with moderate or severe ratings on the Merz Aesthetic Scale (MAS) Decollete Wrinkles - At Rest received up to 3 injection cycles of diluted CaHA either 8 weeks apart (3 injection cycles) or 16 weeks apart (2 injection cycles). Effectiveness was evaluated by improvement on the MAS. Adverse events were recorded over a 52 week period. Sixteen weeks after the last treatment, the response rate (1-point improvement or greater) on the MAS Decollete Wrinkles - At Rest was 73.5% (P&lt;0.0001; pooled sample) for all patients. The use of diluted CaHA in the decollete also demonstrated a favorable safety profile. Diluted CaHA is a safe and effective treatment for the improvement of decollete wrinkles in females.J Drugs Dermatol. 2024;23(7):551-556.&nbsp; doi:10.36849/JDD.8261.

Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation on Etiology, Prevention and Management.

Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactions. Hyaluronidase is not recommended as a first-line treatment for infections, which require drainage, bacterial culture, and antibiotic treatment. However, the board emphasizes the need for individualized evaluation and treatment in all cases.

Evaluation of Collagen Dermal Filler with Lidocaine for the Correction of Nasolabial Folds: A Randomized, Double-Blind, Multicenter Clinical Trial.

Porcine-based dermal injectable collagen is effective for nasolabial fold correction. In the present study, a new dermal injectable collagen, incorporating a novel cross-linking technology and premixed with lidocaine, was introduced. The study aimed to determine the efficacy of the new dermal injectable collagen in improving bilateral nasolabial fold wrinkles, and reducing pain during injection. This prospective, double-blind, multicenter, parallel-group, randomized trial enrolled participants with moderate-to-severe bilateral nasolabial fold wrinkles from February 2019 to March 2021. Participants were randomly assigned to the test group (new dermal injectable collagen with lidocaine featuring a novel cross-linking technology) or control group (traditionally cross-linked dermal injectable collagen with lidocaine). Participants were monitored for adverse events (AEs), and for pain using the Thermometer Pain Scale (TPS) and a visual analog scale (VAS). Efficacy was measured using the Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS). On the poor or better sides, the 2 groups exhibited a significant decrease in WSRS scores at 4, 12, 24, and 36 weeks after treatment, compared to baseline WSRS scores (all, p < 0.05). Compared to the control group, the test group had a greater decrease in WSRS score (poor or better sides) at 12, 24, 36, and 52 weeks after treatment (all, p < 0.05). A similar observation was also found in the WSRS response rate and GAIS score of the 2 groups. VAS and TPS scores were not significantly different between the 2 groups (p > 0.05), indicating that pain reduction was similar in the 2 groups. All AEs were anticipated AEs associated with facial aesthetic injections, and most recovered within 0 to 30 days without sequelae. There were no differences in AEs between the 2 groups (all, p > 0.05). The new dermal injectable collagen with lidocaine exhibited better efficacy for correcting nasolabial fold wrinkles compared to the control group. Both relieved pain and produced only transient and tolerable AEs.

Analysis of 4725 Cases of Gluteal Augmentation with Intramuscular Fillers: A Clinical Cohort Study.

In recent years, the aesthetic market has become more prominent for being not only a tool to correct unwanted features but also a social means for improving quality of life. The use of 30% polymethylmethacrylate (PMMA) as a gluteal filler has grown in popularity all over the world, being sought after by men and women for body remodeling because it provides a natural look as well as significant long-lasting results. A retrospective, multicenter study analyzed the medical records of 2801 patients who underwent a total of 4725 gluteal filler procedures between January 2009 and December 2021 at the different locations of Clínica Leger. The study protocol was approved by the Brazilian National Research Ethics Commission. The medical records of 2801 patients (2666 women and 135 men) who underwent 4725 gluteal filler injections were retrospectively analyzed. A total of 922,776 mL of PMMA was used (average = 329 mL/patient). The occurrence of 101 adverse events (2.1%) was observed, and no statistically significant relationship between the mean injected volume and the incidence of complications could be found. According to the data presented in this study, the use of PMMA injections with the appropriate volumes for aesthetic treatments and corrections is safe and effective.

Transcutaneous oxygen tension-guided hyperbaric oxygen therapy for preventing skin necrosis after hyaluronic acid filler injections.

Hyaluronic acid (HA) fillers, popular for facial cosmetic enhancements, pose risks of vascular complications like skin necrosis due to arterial blockage, necessitating effective treatments such as hyperbaric oxygen therapy (HBOT). This study presents a series of cases where measurements of transcutaneous oxygen pressure (TcPO2) informed the application of HBOT for skin necrosis induced by HA. In cases 1 and 3, following the injection of HA, potential skin necrosis was observed. In addition to standard treatment, TcPO2 revealed values below 40mmHg, indicating tissue hypoxia. Treatment with HBOT increased TcPO2 levels to above 200mmHg, suggesting that HBOT could correct the hypoxia. Monitoring TcPO2 levels also aided in determining the optimal time to discontinue HBOT. In cases 2 and 4, patients received standard treatment, resulting in TcPO2 levels above 40mmHg, indicating adequate tissue oxygenation, and no additional HBOT was administered. All four patients mentioned above showed good clinical recovery. This study investigates the application of TcPO2 measurement technology in aiding decisions on whether to utilize HBOT in the treatment of complications arising from HA fillers, as well as in optimizing HBOT protocols.

Survey among women using Botox, Filler, and plasma injections in Basrah

Objective. Cosmetic procedures are popular in the world and practiced by both male and female. The origin of Botox is botulinum toxin of Clostridium botulinum, two main commercial types of botulinum (A and B) have been used in cosmetic clinics. The present study studied the distribution of the women according to types of cosmetic procedures, age groups, marital status, job status, and their knowledge about these procedures and its side effects. Methods. A total of 100 women were included with age group between (≤30 - &gt;30) years. 54 (54%) have obtained cosmetic procedures (Botox, Filler, and plasma injections) while 46 (46%) have not obtained any cosmetic procedure. Platelets rich plasma was done by cosmetic specialized physician in private cosmetic clinic by using (Regen Kit BCT A-PRP). Platelets count was done in private Hematology laboratory by specialized Hematology physician. The device used for platelet count was (System XS 500). Collected data was subjected to statistical analysis by using SPSS version 20. Results. 51.85% women obtained their cosmetic procedures at a doctor clinic, (37.04%) at a Beauty Salon, and (11.11%) at both doctor clinic and Beauty Salon. Women within age group (≤30), (12%) have Botox only, (20%) have Filler only, (20%) have plasma injections only, (32%) Botox and Filler, (16%) have Botox, Filler, and plasma injections. 24.14% of women within age group (&gt; 30), have Botox only, (6.90%) have Filler only, (13.79%) have plasma injections only, (31.03%) Botox and Filler, (6.90%) have Botox and plasma in­jections, (17.24%) have Botox, Filler, and plasma injections. Platelets count in PRP samples in stage 1 sample from woman no.1 was 373 × 109/L, while in (stage 2) sample was 724 × 109/L. Platelets count in whole blood of woman no.1 was (202 × 109/L). Platelets count in stage 1 sample from woman no.2 was 413x 109/L, while in (stage 2) sample was 808 × 109/L, Platelets count in whole blood of woman no.1 was 320 × 109/L. There was statistically significant increase in platelets count in stage 1 and stage 2 in both samples (P-value=0.05). Conclusions. Women within age group (≤30) prefer to do cosmetic treatment even if they do not need that. Many women have awareness and confidence in doing these cosmetic treatments in doctor clinic rather than beauty salon. PRP platelets count indicated that using (Regen Kit BCT A-PRP) was successful in obtaining concentrated PRP from woman’s blood sample, comparing with the normal platelets count in whole blood. Results also explained that increasing the speed and period of centrifugation in the method of (Regen Kit BCT A-PRP) might give high concentrate of PRP.

Immediate improvement of alar drooping and nostril shape by hyaluronic acid filler injection into the perialar regions: a case study

Immediate improvement of alar drooping and nostril shape by hyaluronic acid filler injection into the perialar regions: a case study

Periorbital Lumps After the Injection of Hyaluronic Acid of Forehead: A Complication of Facial Fillers

With the increasing application of hyaluronic acid injection, the complications are gradually increasing. Fillers are implants, and essentially foreign bodies, and filler injection is a blind procedure in which the physician is unable to see exactly where the material is placed. With these characteristics, injectable fillers have the potential for a myriad of complications. During this case, we found that with the correct diagnosis of filler migration and hypersensitivity reactions and injecting hyaluronidase immediately, good clinical results can be obtained.

Dermal Fillers in the Oculoplastics Office: Applications and Strategies for Complication Prevention and Treatment.

Dermal Fillers in the Oculoplastics Office: Applications and Strategies for Complication Prevention and Treatment.