Hyaluronic Acid Filler Injection Research Articles

High-dose pulsed hyaluronidase for managing nasal skin necrosis following hyaluronic acid treatment in nasolabial folds: A case report

The growing popularity of soft tissue filler injections has brought attention to the associated risks, particularly vascular complications, and their treatments. This case report focuses on a 34-year-old female who developed nasal skin necrosis following hyaluronic acid (HA) filler injection for nasolabial fold (NLF) enhancement. Despite the careful procedure, complications emerged rapidly, emphasizing the critical importance of prompt diagnosis and intervention. A total of 10,000 turbidity reducing units (TRU) of hyaluronidase (HSE) were administered in a high-dose pulsed manner, alongside hyperbaric oxygen therapy. The patient experienced a gradual but significant improvement over 60 days. This case underscores the need for constant vigilance in aesthetic medicine and the potential consequences of even minute HA amounts, exceeding zero, in causing severe vascular events.

One-Year Safety Evaluation of New Hyaluronic Acid Fillers (YYS Series): A Prospective, Multicenter, Observational Study.

With the continuous increasing availability of new filler products, each hyaluronic acid filler brand has distinctive pharmacokinetics, which may be associated with different complications. Therefore, the long-term safety of new generations of fillers should be evaluated. This prospective, multicenter, observational, postmarketing study (ClinicalTrials.gov identifier: NCT04738019) aimed to investigate the incidence of delayed-onset nodules and adverse reactions after the injection of new hyaluronic acid fillers (YYS series) into the facial skin. Subjects scheduled to receive an injection YYS series filler were followed up for 52 weeks. The authors aimed to determine the incidence of a self-reported delayed-onset nodule-a visible or palpable nodule or mass at the injection site that was detected beyond the 14th day following the injection-during the 1-year follow-up period. Among the 1,022 subjects who received an injection of the YYS series, the incidences of delayed-onset nodules were 0% for YYS 360, YYS 540, and YYS 720. A 0.21% incidence (1 delayed hypersensitivity reaction) of a delayed-onset adverse reaction was noted for YYS 720, although none were reported for YYS 360 and YYS 540. In this study, a notably low frequency of adverse reactions associated with the YYS series was observed.

Use of bipolar radiofrequency in combination with hyaluronic acid filler in the treatment of vaginal atrophy induced sexual dysfunction in cancer survivors: a case series

Cancer is not only the leading cause of mortality but also has serious negative consequences related to the sexual, mental, and social life not only of the patients themselves but also of their families. Among women who survived cancer, treatment consequences and sexual dysfunctions are serious problems affecting sexual well-being. The aim of this article was to evaluate the effectiveness of the use of non-hormonal bipolar radiofrequency in combination with hyaluronic acid filler in the treatment of vaginal atrophy-induced sexual dysfunction in cancer survivors. We described 3 cases that reported beneficial results with bipolar radiofrequency in combination with hyaluronic acid filler in the treatment of vaginal atrophy-induced sexual dysfunction in cancer survivors. The validated tool, The Female Sexual Function Index (FSFI), before and after treatment was used to assess the progress and effectiveness of the method used. The procedure used for each patient consists of 4 sessions. During the first one, a treatment using bipolar radiofrequency and hyaluronic acid filler injection was performed. The following 3 sessions with intervals – between 3 to 4 days were only RF treatments. Our case series showed that combined therapy of hyaluronic acid and bipolar radiofrequency was effective and significantly improved overall sexual function (FSFI). The treatment turned out to be safe and painless with no side effects.

Evaluation of the histopathological effects of injectable hyaluronic acid as a filler material in rat’s lip

ObjectivesThe present work aimed to examine the early and late histopathological changes occurring in the lower lips of rats, as a result of hyaluronic acid injection, and to determine whether it could really bring us closer to the ideal soft tissue filler material. This research highlights the importance of experimental studies on this subject, since adverse reactions have been observed routinely in dental practice. Material and methodsThe present study was carried out on 36 adult male albino rats and was divided into two equal groups, each consisting of 18 rats; group I (control group) and group II (experimental group). Rats in the experimental group were injected with hyaluronic acid (0.07 ml), whereas rats in the control group were injected with 0.9% sodium chloride. ResultsThe results showed inflammation triggered by the injection of hyaluronic acid. On examining the specimens histologically using Hematoxylin and Eosin stains, Toluidine Blue stain and immunohistochemistry with anti-CD68 antibody, there was a significantly greater inflammatory response in the groups at early interval with hyaluronic acid compared with the control (P < 0.0001). Higher collagen formation was also observed with Masson’s Trichrome staining. ConclusionThe undesirable effects of hyaluronic acid filler injection can be detected at early intervals following its injection. Fortunately, all the undesirable effects are transient and decrease by time, reaching levels comparable to normal. Overall, HA was well-tolerated by tissues, reflecting how this filler material possesses a biocompatible property.

Etiology of Delayed Inflammatory Reaction Induced by Hyaluronic Acid Filler.

The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient's immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient's immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.

(342) Glans Augmentation and Glans – Bulbospongiousus Reflex

Abstract Introduction The creation of a barrier at the level of glans by the bulking agents blocking accessibility and inhibiting the tactile stimuli to reach the dorsal nerve of penis (branch of pudendal nerve) receptors is the theory behind the effect of hyaluronic acid in the field of premature ejaculation. Clinically there is a doubt about that as filler injection in frenular delta (most sensitive area in penis) and in G-spot at female accelerates time of ejaculation, some cases with history of failed dorsal neurectomy my response to hyaluronic acid injection, filler or fat injection in penis shaft doesn’t improve ejaculation time, in the opposite side implants like Elist`s implant (pneuoma) or other solid inner condoms improves premature ejaculations. The cause is that the hard implant masks pressure on the corona thus inhibits glans – bulbospongiosus reflex which delays the second phase of ejaculation, ring application at coronal sulcus delays ejaculation for the same reason, filler or fat is not solid and doesn’t resist pressure and compressed due to pressure. In glans area compression is not possible due to tight space at glans mucosa. Objective Explanation why glans augmentation by filler delays ejaculation. Methods Seven patients with history of previous glans penis augmentation (hyaluronic acid) with good response (12-14 months ago) instead of re-injection, Alaa Aglan operation was done, cutting of bulbospongiosus muscles bilaterally plus frenular delta excision 4 months post-operative all patients were injected by hyaluronic acid at glans. Results All patients were satisfied by the operation, 3 months post-operative the gained time was calculated for each patient (by himself) then hyaluronic acid injection was done. No change in time was reported in all patients and they reported that it was still the same time gained after surgery despite all patients reported satisfactory results after previous injection one year ago. Conclusions Inhibition of glans – bulbospongiosus reflex is the main cause to delay ejaculation after glans augmentation. Disclosure No.

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 .

Correction of Lying Ear and Aesthetic Modification of Helix and Ear Lobule With Hyaluronic Acid Filler Injection: Experience in Chinese Patients

Abstract Background Large and long ears are regarded as symbols of wealth and health in East Asian culture, and people with lying ears often want their ears to be more exposed and prominent. Surgeries to correct lying ears have been documented. Objectives The aim of this study was to report the correction of lying ears and the aesthetic modification of helix and ear lobule with hyaluronic acid (HA) injections. Methods HA injections were performed at the auriculocephalic sulcus to increase the cranioauricular angle (CA) and correct lying ears. The injections at helix and lobule were case specific. The CA was measured and photographs were taken at baseline and at 1-, 3-, 6-, and 10-month follow-ups. Efficacy was assessed with the 5-point Global Aesthetic Improvement Scale (GAIS). Adverse events were recorded. Results Forty-six patients (92 ears) received HA injections and completed follow-ups. Instant correction outcomes were observed. Sixteen (34.8%) patients received 1 touch-up injection, the clinical efficacy of which persisted for 1 to 1.5 years. For over 90% of cases with touch-up treatment the GAIS was “very much improved” or “much improved” at all follow-ups. The GAIS for over 70% of cases without touch-up treatment was “very much improved” or “much improved” at 1-, 3-, and 6-month follow-ups. CA increased significantly compared with the baseline. Patients also reported “more V-shaped face shape” and “lifted jawline” effects. No serious adverse events occurred. Conclusions As an alternative technique to surgeries, HA filler injections at the auriculocephalic sulcus effectively corrected lying ears. This technique produced immediate, long-lasting, and aesthetically pleasing results. The side effects and downtime were minimal. Level of Evidence: 3

Isolated Ophthalmoplegia After Periorbital Hyaluronic Acid Filler Injection.

Facial filler injections are the second most commonly performed in-office cosmetic procedure. Vision loss is the most feared complication of hyaluronic acid (HA) filler injection, but isolated ophthalmoplegia can also occur. We report the case of a 45-year-old woman who developed nausea and diplopia following HA filler injection to the bilateral periorbital region. She presented with a left hypertropia and left-sided motility deficit without vision involvement. MRI of the orbits demonstrated mild enhancement and enlargement of the left inferior rectus and inferior oblique muscles. Treatment consisted of hyaluronidase injection and oral steroids. HA filler can cause isolated ocular misalignment and diplopia without associated vision loss. Patients should be counseled on these risks before undergoing soft tissue augmentation of the face with HA filler.

[What is 'botox', what are fillers, and how safe are these cosmetic injectables?]

Botulinum neurotoxin type A (BoNT-A, popularly referred to as 'botox') is a muscle-relaxant that is injected into the mimic facial muscles to soften wrinkles in more than two percent of Dutch women annually. A similar number of women undergo filler injections with hyaluronic acid hydrogels, used to counteract the aging appearance of the skin, or to create desired facial contours. Complications are generally mild in nature and rare (certainly compared to surgical complication rates) and include nodules, bumps and a temporary heavy feeling of the eyebrows. Vascular complications related to filler injections (1:7000) can potentially lead to unilateral blindness or skin necrosis. In the Netherlands, the risk of blindness over the past six years is estimated to be 1 in every 1.4 million filler injections. Permanent skin damage due to gangrene has never been reported in the Netherlands. In conclusion, BoNT-A and hyaluronic acid filler injections are safe procedures in the hands of appropriately trained healthcare professionals.

Purtscher-like retinopathy and paracentral acute middle maculopathy following breast filler injection

BackgroundTo report a rare case of pulmonary and ocular complications with visual loss due to bilateral Purtscher-like retinopathy and paracentral acute middle maculopathy (PAMM) following a hyaluronic acid (HA) filler injection to the breast. Systemic and visual recovery was attained following corticosteroid therapy.Case presentationA 27-year-old lady presented with painless blurring of vision in both eyes for 2 weeks following hyaluronic acid breast filler injections by a non-medical practitioner. She was initially admitted to the medical ward for diffuse alveolar haemorrhage and altered sensorium. The presenting visual acuity was counting fingers in both eyes. Bilateral dilated fundus examination showed hyperaemic discs, concentric rim of retinal whitening around macula with patches of polygonal-shaped retinal whitening, generalised cotton-wool spots, tortuous veins, and flame-shaped haemorrhages. Spectral-domain optical coherence tomography (SD-OCT) macula revealed hyper-reflective bands at the inner nuclear layer (INL). Fluorescein angiography demonstrated hot discs, delayed arm-to-retina time, arterial filling, and arterio-venous transit time with staining of the vessels at the posterior pole. She was managed with a tapering dose of systemic corticosteroids. The visual acuity improved to 6/12 over 8 weeks with significant anatomical and functional improvement. Dilated fundus examination showed resolution of initial funduscopy findings. The hyper-reflective bands on the OCT had resolved with subsequent thinning of the INL and disorganisation of retinal inner layers.ConclusionFiller injections are in increasing demand and are frequently being performed by non-medical practitioners. Visual loss from non-facial HA fillers is rare. Inadvertent entry of HA into a blood vessel may potentially cause systemic and sight-threatening ocular complications. Good anatomical knowledge and proper injection technique are vital in preventing this unfortunate sequela. There are limited reports on successful visual recovery following various treatment approaches and we hope this case provides valuable insights.

Adverse Events Associated with Hyaluronic Acid Filler Injection for Non-surgical Facial Aesthetics: A Systematic Review of High Level of Evidence Studies.

Hyaluronic acid (HA) dermal fillers are widely used in aesthetic medicine. While generally safe, potential complications can arise. This systematic review aims to identify and classify potential complications linked to the use of HA dermal fillers, as informed by high-quality, low-risk-of-bias studies. This review follows the Cochrane review standards for clinical systematic reviews. This systematic review analyzed 48 high level of evidence studies on the use of hyaluronic acid (HA) dermal fillers in non-surgical facial aesthetics and the adverse events that occurred.The inclusion criteria were randomized control studies on HA dermal fillers and their complications. Excluded were case reports, case series, observational studies, and other non-randomized research due to their inability to provide generalized conclusions and their inherent publication bias. Adverse events were classified into three categories: expected reactions, product or technique-related adverse events, and severe adverse events. Most adverse events were short-lived injection site reactions, which resolved spontaneously. Specific HA fillers and injection techniques influenced the occurrence of adverse events, which generally resolved within weeks without treatment. Severe adverse events were rare, persisting for months and requiring active medical intervention. This classification system can enhance understanding, prevention, and treatment of HA filler complications, and support patient education. The common complications were injection site reactions, with persistent symptoms treated with topical steroids, NSAIDs, or hyaluronidase. Severe complications included severe edema, angioedemaand others, often necessitating specific treatments. HA dermal fillers are generally safe and effective, with most adverse events being transient and mild to moderate in severity. Severe adverse events, although rare, do occur and are generally non-treatment related. Informed consent, patient education, and professional training are crucial for safe and successful outcomes. Level of Evidence II 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 .

Hyaluronic Acid Filler Injection Guided by Doppler Ultrasound.

Doppler ultrasound can be used to detect almost all arteries of the face before injecting the hyaluronic acid (HA) filler. The relatively more dangerous sites of filler injection are the glabellar wrinkle, forehead, temple, nose, and nasolabial fold area, and it is recommended to map the vasculature of these areas by Doppler ultrasound before performing filler injection. The Doppler ultrasound detection method is included as a video. Internal carotid arterial branches, the supratrochlear, supraorbital, and dorsal nasal arteries, and external carotid arterial branches, the superficial temporal and facial arteries, are very important arteries when injecting HA filler; thus, Doppler ultrasound detection is recommended.

"Nonsurgical Rhinoplasty in Patients of African Descent: A Retrospective Review".

There is a paucity of research on non-surgical rhinoplasty in the population of African descent. In this group, underlying anatomy and aesthetic ideals vary, necessitating differences in the consultation process and in treatment. We present a case series from a single clinician's practice performing non-surgical rhinoplasty on patients of African descent. A retrospective chart review was completed on eligible patients who received non-surgical rhinoplasty treatment with hyaluronic acid filler injections by the first author (A.H.) from March 2018 to February 2021. Demographic variables, indications for treatment, patient-reported outcomes and adverse events were reviewed. We also share the first author's technique for non-surgical rhinoplasty in this patient cohort. A total of 487 patients of African descent or mixed race including African descent were included in this study. The most common indications for treatment were lack of bridge definition (63.9%); excessive alar width (61.6%); and a bulbous tip (61.6%). Median filler volume was 0.6ml (range 0.3-2.1ml) at the initial treatment visit. There were no reported cases of infection, vascular occlusion, or necrosis. This study is the first to illustrate the effectiveness and safety profile of non-surgical rhinoplasty in a population of African descent. Anatomic variations and the desire for racially congruent results must be acknowledged to ensure satisfactory outcomes.

Nonsurgical Rhinoplasty: Diamond Injection Technique for Nasal Tip Contouring.

Background: A more pleasing nasal tip appearance is becoming the most frequent reason for nonsurgical aesthetic rhinoplasty procedures. Objective: To present the "Diamond Injection Technique," an innovative 4-point hyaluronic acid (HA) filler injection procedure for nasal tip refinement and to assess its aesthetic outcomes and efficacy. Methods: Data were collected from a prospective single-center cohort of patients undergoing nonsurgical rhinoplasty with injectable fillers. Anthropometric measurements, the 5-point Global Aesthetic Improvement Scale (GAIS), and a patient-reported questionnaire were used to evaluate the aesthetic outcomes and treatment efficacy before treatment and 6 months later. Results: The study included 107 patients; 82 were women. The median age was 35 (18-47) years. The mean volume of HA filler injected was 0.12 mL (range: 0.05-0.2). At 6 months, the GAIS-calculated outcome was excellent in 90.65% of patients, with a high degree of patient satisfaction and objectively pleasant changes in anthropometric measurements. Conclusions: The "Diamond Injection Technique" proves to be a safe, comprehensive, and effective procedure for refining the nasal tip to a pleasing diamond shape, satisfying a high percentage of patients.

Dermal Thickness Increase and Aesthetic Improvement with Hybrid Product Combining Hyaluronic Acid and Calcium Hydroxyapatite: A Clinical and Sonographic Analysis.

This was a single-center, prospective, quasi-experimental study comprising 15 participants between 32 and 63 years of age. Each participant received a single-session treatment based on facial subcutaneous injections of HArmonyCa, a hybrid combination filler comprising hyaluronic acid and calcium hydroxyapatite. This study involved an intrapatient control design and a 120-day follow-up with clinical and sonographic assessment. For this purpose, standardized photographic images, high-frequency ultrasound evaluations, and physician- and patient-oriented overall aesthetic improvement scores were recorded at 0, 30, 90, and 120 following the procedure. According to our findings, 20% of the subjects had an exceptional improvement; 20%, "very improved"; and 60%, "improved." Intrapatient sonographic comparison showed a significant increase in dermal thickness, at 90 and 120 days, only on the side treated (P < 0.001). In our clinical study, a single-session treatment with a hybrid product combining hyaluronic acid and calcium hydroxyapatite resulted in positive cosmetic satisfaction and increased dermal thickness.

Determination of Hyaluronic Acid Dermal Filler Impurities Using SEM/EDS Analysis.

Although hyaluronic acid (HA) filler injections are associated with various non-vascular inflammatory complications, the underlying mode of action remains unclear. The hyaluronic acid filler may not be sufficiently pure, leading to an immune response. The present study attempted to identify any impurities in hyaluronic acid fillers available on the market. Particles were counted after degrading hyaluronic acid filler with hyaluronidase. Particulate matter was subsequently observed using scanning electron microscopy, and the particle components were evaluated using energy-dispersive X-ray spectroscopy. Different quantities of impurity particles (>10 and 25 μm) were detected microscopically. Silicon and aluminum isotopes were also detected. Hyaluronic acid fillers were contaminated with these particles. The degree of contamination varied substantially among the tested filler products. These contaminant particles may evoke reactions in the patient's body. Clinicians should be aware of this source of possible contamination and its effects.

Anatomical proposal for hyaluronic acid filler injection in subzygomatic arch depression: A dual-plane injection technique.

A subzygomatic arch depression creates a bulky face outline. To smoothen these depressions and correct facial contours, hyaluronic acid filler injection methods are frequently used. However, the complexity of the subzygomatic region make it difficult for practitioners to effectively volume the region. The conventional injection of single layer injection has limitations of lack in volume addition and unwanted undulations and spreading. The anatomical factors were reviewed with ultrasonography, three-dimensional photogrammetric analysis, and cadaver dissection. In this anatomical study, the present knowledge on localizing filler injection with a more precisely demarcated dual-plane injection was suggested. This study presents novel anatomical findings related to the injection of hyaluronic acid filler injection in the subzygomatic arch depression.

Use of Hyaluronic Acid Filler in Patients with Secondary Cleft Lip Deformity.

Retrospective case note review was undertaken of all patients treated in the clinic over a two-year period. 20 patients underwent HA filler injections to the upper lip 26 times. Most were female (F:M = 3:1) and patients were aged 18-58 years. Most patients had a unilateral cleft lip +/- palate (n = 13, 65%). The most common indication was to address upper lip volume (n = 13, 65%). Other indications included vermillion notch (n = 5, 25%), cupid bow peak height asymmetry (n = 4, 20%), scar asymmetry (n = 1, 5%) and nasal sill flattening (n = 1, 5%). Small volumes of filler were used with an average of 0.34 ml (range 0.05-1.2 ml). There were no complications and one patient reported pruritis post procedure. HA filler is a safe and reliable treatment for certain aspects of asymmetry following cleft lip repair. It can be used to address volume deficiency and asymmetry, cupid bow peak height discrepancies and a vermillion notch for patients who do not want surgery. Injection of HA to the lips can be performed easily, with appropriate training, in the outpatient setting.

Recovery of Acute Ophthalmoplegia after Hyaluronic Acid Filler Injections to the Temples: A Case Report and Review of the Literature.

Soft tissue filler injection is the second most common nonsurgical cosmetic procedure. Despite the safety of fillers, as use has grown, so has the number of patients affected by adverse events. Ophthalmoplegia following cosmetic filler injection is a rare complication, mostly occurring after injection to the glabella, nasolabial fold, periorbital, and lateral nasal site. In all cases where ophthalmoplegia has been reported following fillers, patients have simultaneously experienced vision loss and other ocular symptoms. We report a case of isolated acute ophthalmoplegia following hyaluronic acid injection solely in the temple region. A 40-year-old woman, 3 hours after the procedure, presented to our hospital with left eye ophthalmoplegia, ptosis, and hypotropia. Treatment started with hyaluronidase, steroids, and anticoagulants. After 4 weeks, left eye ophthalmoplegia remained unchanged, and through a 10-week follow-up, all left ocular movements improved, and only mild hypotropia and ptosis persisted. This case report shows that ophthalmoplegia may also happen with temple region filler injections. We also review available prevention techniques and treatments to avoid such complications when performing soft tissue fillers for gaunt appearance correction.