Hyaluronic Acid Filler Research Articles

Patient Safety: Acknowledging Acute Angioedema Following Cosmetic Injections

To report a case of acute angioedema following hyaluronic acid filler and onabotulinumtoxinA injection in an individual with allergies, recent viral vaccination, and polymyalgia rheumatica. This is a retrospective case report. A 63-year-old female with a history of allergies, asthma, and polymyalgia rheumatica on lisinopril presented with angioedema 4 hours following facial filler injection and botulinum toxin injection. The patient was successfully treated with epinephrine, diphenhydramine, and methylprednisolone. Although cosmetic injections are commonly performed, clinicians must be vigilant about rare, yet serious side-effects such as angioedema. This case underscores the importance of thoroughly evaluating medical histories before cosmetic injections and addressing patient concerns after the procedure.

Effectiveness and Safety of a Hyaluronic Acid Filler for Chin Augmentation and Correction of Chin Retrusion: A Multi-center, Prospective, Randomized Controlled Trial.

The chin significantly influences facial aesthetics, contributing to the overall balance and harmony of the face. This study aimed to assess the effectiveness of the hyaluronic acid filler Hyamax® Volumizer for chin augmentation and correction of chin retrusion compared to a no-treatment control. Participants aged 18-55 years with mild to moderate chin retrusion were randomized in a 3:1 ratio to receive either the treatment group (n = 150) or control group (n = 50). Evaluations included blinded assessments using the validated Galderma Chin Retrusion Scale, Global Aesthetic Improvement Scale for aesthetic enhancement, and safety follow-up. The Galderma Chin Retrusion Scale responder rate (≥1 grade improvement) was significantly higher for the treatment group (70%) compared to the control group (0%) at 6 months (p < 0.0001), and remained higher at 12 months (54.67% vs. 0%; p < 0.0001). Aesthetic improvement rates were consistently high as reported by both blinded evaluating investigator (≥89.33%) and subjects (≥91.33%). Treatment-related adverse events were mild to moderate. Hyamax® Volumizer treatment is safe and effective when injected in the chin to treat chin retrusion, with results lasting through 1 year. 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 .

Effect of facial fillers on post-rhinoplasty oedema- a hypothesis based on literature review.

In the quest of achieving younger and media driven facial aesthetics, the use of fillers in the face has recently expanded exponentially. Therefore, it is inevitable that every facial plastic surgeon (FPS) will be facing patients with facial fillers. A consequence of fillers is a sub-optimal/altered lymphatic drainage, which has a direct impact on post-operative oedema following facial surgery including rhinoplasty. In the senior author's experience (AD), it was observed that patients with facial fillers had persistent oedema post-rhinoplasty. This research hypothesizes that prolonged post-rhinoplasty oedema may be related to fillers and aims to gather evidence from the literature to support this hypothesis. It also investigates whether fillers compromise lymphatic drainage. A narrative review was performed on selective articles based on fillers and post-rhinoplasty oedema. Then, it is methodologically analyzed to look for a standard theory and categorize it throughout the discussion. Theoretically, with inherent characteristics of hydrophilic nature, hardness, volume and back-flow phenomena, fillers can lead to prolonged oedema. Additionally, they can either directly block or indirectly exert pressure on the lymphatic pathways and hinder drainage. This research findings support the hypothesis that facial fillers can impact post-operative facial oedema. Future research is required to objectively measure the effect of fillers on facial lymphatic drainage. Facial plastic surgeon (FPS), Hyaluronic acid (HA), submandibular (SM), Lymph nodes (LN), ultrasonography (US). Hyaluronic acid fillers, dermal oedema, prolonged post-filler oedema, recurrent oedema, persistent oedema, facial oedema, face lymphatics. 'Conflict of Interest: 'none declared'. No commercial interest or financial support.

Efficacy and Safety of Hyaluronic Acid Combined with Botulinum Toxin Type A in the Treatment of Midcheek Groove: A Prospective Study.

The midcheek groove, a diagonal wrinkle in the infraorbital and infrazygomatic regions, disrupts the entire midface smooth lines and impacts facial aesthetics. Despite current treatments' limited effectiveness, including hyaluronic acid fillers and surgical risks, and the neglect of the medial orbicularis oculi muscle, this study explores the efficacy and safety of combining botulinum toxin type A with sodium hyaluronate injection for midcheek groove treatment, considering anatomical and clinical factors. In this prospective study, healthy participants with midcheek grooves (depth >3 mm) were treated with botulinum toxin type A combined with hyaluronic acid injections. Data were collected at baseline, 4, 12, and 32 weeks as well as 30 min after treatment, and at 1, 3, and 6 months follow-up. Changes in the depth of the midcheek groove were measured using a three-dimensional scanner and assessed using the Patient Satisfaction Assessment Scale. Subgroup analyses were performed to assess the impact of different clinical subtypes on treatment outcomes. Thirty-six volunteers completed this study, and the midcheek groove depth was significantly reduced at 30 min after treatment and at 1, 3, and 6 months of follow-up (p < 0.001). The medial half of the midcheek groove had the best efficacy at 1 month after treatment, while the lateral half responded best at 30 min after treatment. Subgroup analyses showed that clinical subtypes affected treatment efficacy. No complications or severe adverse reactions were observed. Botulinum toxin type A combined with hyaluronic acid injection effectively improved the midcheek groove. 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 .

Surgical and Non-Surgical Approach for Tear Trough Correction: Fat Repositioning Versus Hyaluronic Acid Fillers

Objective: This paper compares two popular techniques for tear trough correction—fat repositioning and hyaluronic acid (HA) fillers—highlighting their efficacy, safety profiles, patient satisfaction, and associated complications. Methods: A narrative review of 20 studies comparing fat repositioning and HA fillers was conducted, focusing on parameters such as duration of results, volume restoration, complication rates, and patient satisfaction. Results: Fat repositioning provides long-lasting results but carries higher surgical risks compared with HA fillers. The transconjunctival approach is suitable for patients with minimal skin excess. The supraperiosteal plane allows for a quicker procedure and, despite postoperative edema and temporary irregular contouring, shows no difference in final cosmetic outcomes compared with other planes. Internal fixation reduces the risk of fat relapse and skin scarring but carries the risk of suboptimal positioning. HA fillers offer immediate, minimally invasive results but require periodic maintenance. The use of a cannula reduces the risk of vascular occlusion. Combining a high G’ filler for the midface with a low G’ with low hydrophilicity for the tear trough reduces the amount of filler needed and prolongs the results. Both surgical and non-surgical methods are effective, depending on patient needs and anatomical considerations. Conclusions: Fat repositioning is ideal for patients seeking long-term correction and are willing to undergo surgery, while HA fillers suit those preferring non-invasive treatments with customizable, short-term effects. Both techniques have pros and cons that must be matched to patient goals and conditions.

Delayed inflammatory reaction to hyaluronic acid filler following COVID-19 vaccination: A case report and review of the literature

Delayed inflammatory reactions (DIRs) to coronavirus disease 2019 (COVID-19) vaccines were rarely reported in patients receiving hyaluronic acid (HA) soft-tissue fillers. We present a case of a DIR to HA filler that occurred within days after receiving the second dose of the Pfizer-BioNTech COVID-19 messenger ribonucleic acid (RNA) vaccine and provide a comprehensive summary of its clinical presentation and treatment.

A case of bone resorption in the mentum caused by hyaluronic acid filler in a patient with skeletal Class II jaw deformity.

Chin augmentation by hyaluronic acid filler injection rarely causes abnormal bone resorption in the mentum. Thus, when taking the history of a patient with jaw deformity, it is imperative to check the history of treatment of the mentum. Hyaluronic acid (HA) filler injection is a common procedure in nonsurgical cosmetic chin augmentation. Due to its high biocompatibility and simple injection technique, HA filler injection is a popular procedure. However, adverse events such as allergic reactions and foreign body reactions have been reported in some cases. In this study, we report a case of skeletal Class II jaw deformity in which bone resorption was observed in the mentum after HA filler injection. The purpose of this study is to discuss the indications for HA filler injection in skeletal Class II cases that require orthognathic surgery. The patient was a 30-year-old woman. To improve retrusion of the mentum, she has been receiving HA filler injections in the mentum three times every 6 months in the cosmetic surgery clinic since 2015. However, the retrusion of the mentum did not improve, which prompted here to visit the orthodontic clinic. Radiographs and CT revealed bowl-shaped bone resorption surrounding the foreign bodies in the mentum. She was diagnosed with maxillary protrusion, vertical maxillary excess, mandibular retrusion, and bilateral condylar resorption. Bimaxillary orthognathic surgery (BOGS) and removal of residual HA fillers were planned after completion of the preoperative orthodontic treatment. After BOGS, the foreign bodies were completely removed, and the resorption cavities were filled with excess bone segments from the surgical sites. X-ray photoelectron spectroscopy analysis of the foreign bodies suggested the presence of HA. One year after the BOGS, no progression of condylar resorption occurred, and bone healing at the mentum had a good prognosis. Therefore, the patient underwent reduction and advancement genioplasty. She was satisfied with her facial profile and occlusal function. Unexpected bone resorption in the mentum caused by HA filler injection is often discovered incidentally. Although, patients may feel hesitant to confess their history of treatment of the mentum, it is important to ensure that they are carefully interviewed.

Corporal Filler HD, a Minimally Invasive Technique for Male Body Contouring: A Pilot Study.

The perception of body image is highly influenced by culture and society. Lean, more muscular, and strong bodies are usually pursued by men. Body aesthetics procedures have become popular, and minimally invasive procedures have been used to achieve body image satisfaction. This article describes a technique that utilizes hyaluronic acid filler to enhance muscular contours in the abdominal and pectoral regions. The procedure involves injecting hyaluronic acid filler at a level anterior to the pectoralis major and rectus abdominis muscles through marked entry points, creating an illusion of light and shadow that accentuates muscle definition. Additionally, the iliac region can be addressed to enhance the oblique muscles. The results are illustrated with pre- and postprocedure images, demonstrating a significant aesthetic improvement, high patient satisfaction, and absence of serious adverse events. This minimally invasive technique is suitable for patients with a low body fat percentage and a desire to enhance muscle definition, providing immediate results with no downtime. Although the scientific literature on filler applications in the thoracoabdominal region is limited, this study demonstrates that precision in minimally invasive procedures can yield highly satisfactory outcomes.

Decomposition and Changes in InVivo Post-HA Filler Injection: A Review.

Hyaluronic acid (HA) fillers are widely used in aesthetic medicine, but their invivo behavior and long-term effects are not fully understood. To review the decomposition and changes occurring in the body following HA filler injections, focusing on crosslinking agents, degradation processes, and tissue responses. This review analyzed oxidative and enzymatic degradation processes of HA fillers, evaluated the impact of 1,4-Butanediol Diglycidyl Ether (BDDE) crosslinking, and examined histological changes post-injection. Uncrosslinked HA degrades rapidly due to endogenous hyaluronidase, while crosslinked HA undergoes slower degradation via free radicals and hyaluronidase. Complete cross-linking (C-MoD) showed better durability compared to partially cross-linked BDDE (P-MoD). The concept of modification efficiency (MoE) was proposed to optimize filler safety and viscoelastic properties. Histological analysis revealed collagen capsule formation and autologous tissue replacement, affecting long-term outcomes. The degree of chemical modification (MoD) influences filler durability and safety, with concerns raised about potential delayed immune reactions from accumulated pendent BDDE. Clinicians should consider injection site, tissue conditions, and filler properties for safe and effective HA filler use. Emphasizing thorough BDDE removal and optimal crosslinking can enhance treatment safety and efficacy. The balance between achieving desired viscoelastic properties and minimizing potential risks is crucial. Future studies should include diverse ethnic groups to validate findings and further explore long-term tissue responses to HA fillers.

The "4.3," A New Filler Lips Technique.

The "4.3" technique is a hybrid lip augmentation approach that combines the aesthetic benefits of the vertical-lip technique with the fewer entry points of the retrograde linear technique. This method aims to create natural-looking, harmonious, and defined lips using hyaluronic acid (HA)-based fillers, to enhance volume and contour. The objective of this study is to evaluate the effectiveness, safety, and reproducibility of the "4.3" technique in achieving natural lip augmentation with minimal filler volume and reduced injections. This technique is applied to improve the shape and volume of the lips while minimizing the risk of complications. The technique was applied to male and female patients with standard anatomical features who desired subtle enhancements in lip contour, projection, and volume. The procedure involved four injections in the upper lip and three in the lower lip, using a combination of retrograde linear and vertical techniques. A total of 0.7 mL of HA filler were used for each patient. The "4.3" technique achieved consistent and aesthetically pleasing results across all patients, with improvements in lip volume, shape, and definition. The reduced number of injections minimized discomfort and risk of vascular complications. The use of Tri-Hyal technology contributed to smooth, plump lips with harmonious proportions. The "4.3" technique is a standardized, intuitive, and reproducible method suitable for most patients, regardless of sex. It allows for natural-looking lip augmentation using a reduced volume of filler and fewer injections, making it a safe and effective option for enhancing lip aesthetics.

Structural Analysis of Hyaluronic Acid Fillers Using Nuclear Magnetic Resonance: Implications for Quality Control and Clinical Performance.

Potential disruptions in the biocompatibility of hyaluronic acid (HA) fillers can arise with mono-linked 1,4-butanediol diglycidyl ether (BDDE) or unreacted (pendant) 1,4-butanediol di-(propan-2,3-diolyl) ether. Assessing the filler's degree of modification involves evaluating improperly cross-linked BDDE. This study analyzed commercially available HA fillers using nuclear magnetic resonance (NMR), focusing on key parameters, such as the degree of modification (MoD), the cross-linker ratio (CrR), and the degree of cross-linking. We assessed thirteen commercially available HA fillers using NMR. The samples were placed in an NMR instrument, and each sample was analyzed for 26 h, including MoD and CrR assessments. MoD 1H ranged from 17.065% to 2.239%, MoD 13C ranged from 12.567% to 1.947%, and CrR 13C ranged from 0.394 to 0.014. Significant distinctions were observed in the CrR 13C values when the MoD values of the products were similar. This study underscores the importance of considering the MoD and the CrR together to ensure optimal cross-linking and minimize the risks associated with residual BDDE impurities. Utilizing NMR for HA gel characterization provides valuable insights regarding product quality control, safety assessments, and clinical performance evaluations for esthetic interventions, contributing to filler product improvements. Further studies correlating NMR findings with real-world outcomes are essential for ensuring safety and efficacy.

Multimodal Pilot Evaluation of a Hyaluronic Acid Infraorbital Filler Using Precise, Multi-Positional, 3D Imaging Quantification, Patient Reported Outcomes, and Anatomic Cadaveric Assessments

Abstract Background Despite the high demand of filler in the infraorbital area, there remains debate on injection practices, precise anatomical placement, and hyaluronic acid (HA) filler behavior. Objectives We aimed to contribute to the clinical and anatomic understanding of infraorbital HA injection via a prospective patient injection study in combination with a cadaveric analysis. Methods Patients were injected with Volbella XC into the tear trough region by a single experienced aesthetic plastic surgeon. Over a 90-day period, precise undereye volumetric measurements using 3D photogrammetry (VECTRA-M3) and patient reported outcomes (FACE-Q) were collected and analyzed relative to two pretreatment severity scales. Juvéderm Vycross and Restylane NASHA products were injected into the infraorbital and malar region in six cephalus specimens and evaluated with regards to the anatomic injection location with and without common clinical physical manipulations. Results Eleven patients participated with a 100% retention rate. Infraorbital HA volume maintenance was 70-81% at 30 days and 50-70% at 90 days. Significant improvement was noted in the eyes, overall facial appearance, and cheekbones (p&amp;lt;0.05) with FACE-Q outcomes, irrespective of pretreatment severity. In the cadaver examination, we observed differences in the anatomic locations occupied by Juvéderm and Restylane products as well as in behavior after physical manipulation between gel types. Conclusions Volbella XC effectively augments undereye volume to diminish infraorbital hollowing as measured over a 90-day period with significantly improved PROs. Enhanced knowledge of the behavior of Volbella XC and other HA fillers in this sensitive anatomic region will lead to improved patient outcomes.

Efficacy and Safety of Cell-Assisted Acellular Adipose Matrix Transfer for Volume Retention and Regeneration Compared to Hyaluronic Acid Filler Injection.

Cell-assisted acellular adipose matrix (AAM) transfer is a novel technique for soft tissue volume restoration, where AAM acts as a scaffold for tissue proliferation and promotes host cell migration, vascularization, and adipogenesis. This study aimed to evaluate the efficacy and safety of in vivo cell-assisted AAM transfer compared to hyaluronic acid (HA) filler injection. Human adipose tissue was used to manufacture AAM, and murine adipose-derived stem cells (ASCs) were prepared. Nude mice were divided into four groups: AAM transfer (AT), ASC-assisted AAM transfer (CAT), HA filler injection (HI), and ASC-assisted HA filler injection (CHI). Eight weeks post-transfer, in vivo graft volume/weight, histology, and gene expression were analyzed to assess efficacy and safety. The AAM retained its three-dimensional scaffold structure without cellular components. AT/CAT showed lower volume retention than HA/CHA; however, CAT maintained a similar volume to HA. Histologically, adipogenesis and collagen formation were increased in AT/CAT compared to HA/CHA, with CAT showing the highest levels. CAT also demonstrated superior angiogenesis, adipogenesis, and gene expression (Vegf and Pparg), along with lower Il-6 expression, higher Il-10 expression, and reduced capsule formation, indicating better biocompatibility. Cell-assisted AAM transfer is a promising technique for volume retention and tissue regeneration, offering a safe and effective alternative to HA filler injections. 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 .

A Unified Approach to Facial Contours and Volume Correction: The Role of the Cheek and the Chin.

Facial proportions and contours influence perceptions of beauty and youthfulness. In particular, the shape and definition of the midface and lower face impact the overall appearance of the face. This review provides anatomical evidence to support a holistic approach to facial analysis and rejuvenation that starts with assessment and treatment of the midface and lower face to create an aesthetically desirable facial balance. The cheek and chin can be considered "anchors" or starting points within full-face treatment because of the noticeable impact of their treatment on the definition and contour of the entire face. Age-related changes in the cheek and chin affect overall facial appearance and can produce unintended facial emotional attributes such as looking tired, angry, or sad. Patients seek facial aesthetic treatment typically for a global improvement such as revitalization or genderization of facial features. Best practices in aesthetics have evolved from treatment of individual areas to a holistic paradigm that uses multimodal therapy to improve overall facial emotional attributes. Hyaluronic acid fillers are useful for volume replacement and smoothing abrupt transitions that develop with age throughout the midface, chin, and jaw. A combination of hyaluronic acid filler for volume restoration and sodium deoxycholate and/or onabotulinumtoxinA for volume reduction where appropriate may optimize lower facial contour. This review highlights the importance of facial angles and contours as well as the significance of panfacial assessments and treatment, focusing on the relationships within areas of the face, specifically the midface and lower face, to optimize results.

Manufacturing Process of Hyaluronic Acid Dermal Fillers.

Hyaluronic acid (HA) fillers are extensively utilized in aesthetic medicine due to their biocompatibility, reversibility, and effectiveness in enhancing skin hydration, volume, and overall appearance. These fillers are predominantly produced through microbial fermentation, followed by a critical cross-linking process that enhances their longevity by resisting enzymatic degradation. This review provides a thorough examination of the manufacturing processes that differentiate HA fillers, with particular attention to the distinctions between biphasic and monophasic variants. Unlike previous studies, this review emphasizes the specific cross-linking techniques and their substantial impact on the fillers' rheological properties, such as elasticity and cohesiveness, which are crucial to their clinical performance and patient outcomes. Additionally, the review offers a comprehensive comparison of HA fillers with non-HA alternatives, including calcium hydroxylapatite, poly-l-lactic acid, and polymethyl methacrylate, highlighting the unique advantages and potential complications associated with each type. By presenting novel insights into the latest advancements and challenges in filler technology, this review aims to provide clinicians with a deeper understanding of filler properties, thereby guiding them in making informed decisions to optimize patient safety and aesthetic results.

Does cannula's size alter rheological properties of hyaluronic acid filler?

This study evaluated the rheological properties of various hyaluronic acid (HA) gels after passing through different-sized cannulas (22-G and 25-G). Five commercial brands of highly crosslinked HA fillers were analyzed: (A) Rennova® Ultra Deep, (B) Restylane® Lyft, (C) Hialurox® - Ultra Lift, (D) Belotero® Volume, and (E) E.P.T.Q S500. Rheological characterization was conducted using an automated controlled stress rheometer. The rheological properties of the fillers were assessed both before and after passing through the cannulas. Each filler brand and cannula size was tested three times by a researcher who was blinded to the commercial brands. For data analysis, frequencies of 0.1, 0.5, and 2 Hz were employed. The rheological properties (storage modulus [G'] and loss modulus [G"]) of the high-crosslink HA fillers did not change after being passed through cannulas of different sizes (22-G and 25-G) (p > 0.109) compared to baseline measurements (no cannula). Furthermore, all fillers displayed desirable solid-like, volumizing behavior at low frequencies and strain amplitudes (<10 %). Under physiologically relevant conditions for skin and facial applications, the cannula size did not alter the rheological properties of high crosslink HA fillers.

The Hybrid Filler Technique: A 5-Year Retrospective Analysis.

The combination of calcium hydroxylapatite (CaHA) and hyaluronic acid fillers (CPM-HA, cohesive polydensified matrix-based hyaluronic acid fillers, Belotero® range, Merz Pharmaceuticals GmbH, Frankfurt, Germany), known as hybrid fillers, has emerged as a popular approach in aesthetic medicine. Premixed CaHA with CPM-HA offers several advantages, including enhanced tissue elevation and reduced early volume loss after injection. The objective of the present study is to assess the safety of premixing CaHA and CPM-HA fillers for rejuvenation purposes or as an aesthetic harmonization treatment. This retrospective study presents the clinical experience of two expert injectors who consistently used premixed CaHA and CPM-HA fillers for aesthetic treatments between March 2018 and December 2023. The premixed hybrid formulation was standardized and administered following a published protocol. A total of 2112 patients were treated, with meticulous follow-up over a minimum of one year. In the 2112 patients treated, only 5 minor adverse events (0.24%) were reported. The adverse events consisted of 4 non-inflammatory nodules of which 2 completely resolved with hyaluronidase, and 1 case of transient edema. Secondary findings consist of the treated areas, type of CPM-HA used and mixing ratios that were applied. The results from the current retrospective study, with the largest published cohort so far, are consistent with prior publications and strongly support a good safety profile of the CaHA:CPM-HA hybrid blend. 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 .

The Redefinition and Volumization of the Lip Area with Hyaluronic Acid: A Case Series

Background: The increasing popularity of non-surgical cosmetic enhancements for the lower face and perioral area, particularly through hyaluronic acid (HA) fillers, reflects the growing desire for improved lip volume and definition. This study showcases the effects of a specific HA filler on lip fullness, shape, and overall perioral rejuvenation. Methods: We conducted a retrospective single-site observational analysis of adult female patients treated with Genefill Soft Fill HA injections in the lips and perioral areas. Both patient and physician satisfaction were evaluated using the Likert scale and Global Aesthetic Improvement Scale (GAIS), respectively. The outcomes for natural appearance, volume, and durability were assessed using a five-point scale. The patients were followed up with for up to six months to monitor any adverse events. Results: The cohort included thirteen female patients with an average age of 55.3 ± 8.3 years. Approximately 1.2 ± 0.4 mL of filler was used per patient. The results indicate high satisfaction, with scores above 4 for naturalness, volume, and durability. Over 92% of patients reported a significant improvement in appearance. No moderate or severe adverse events were reported. Conclusions: Genefill Soft Fill HA filler is both effective and safe for enhancing lip esthetics, with high satisfaction rates among recipients and no significant adverse events observed.

Late Subcutaneous Infection Caused by Serratia marcescens Following Hyaluronic Acid Injection: A Case Report and Systemic Review.

The field of cosmetic filler injection has experienced rapid development over the past two decades, especially in facial augmentation utilizing hyaluronic acid (HA) fillers. Gram-negative bacteria are found to be the main pathogens of infective nodules after HA injection. The occurrence of cutaneous infections attributed to Serratia marcescens is exceedingly rare and predominantly noted in patients with compromised immune systems. To summarize the clinical features, diagnosis, and treatment of subcutaneous infection caused by Serratia marcescens following hyaluronic acid injection. A rare case of cutaneous Serratia marcescens infection following hyaluronic acid injection was presented. A comprehensive review of the published literature describing the management of skin infection caused by S. marcescens in immunocompetent patients was then conducted, which encompassed three case series and eight case reports published between 1999 and 2017. Data extraction included information on authors, gender, age, signs and symptoms, previous treatment, corresponding management strategies, and follow-up duration. Serratia marcescens were isolated in abscesses (n = 6, 35.29%), painful nodules (n = 2, 11.76%), ulcers (n = 6, 35.29%), and others (n = 3, 17.65%). In cases providing salvage plans (n = 11), quinolones were shown to be the most effective antibiotics for salvage, with eight full recoveries (72.73%), and trimethoprim-sulfamethoxazole was the second most useful antibiotic (18.18%). With the help of pathogen examination and drug-sensitive tests, sensitive aminoglycosides, quinolone (especially moxifloxacin), or TMP-SMX for at least 2 weeks can be considered as the first-line treatment of late subcutaneous infection caused by Serratia marcescens following hyaluronic acid injection.

Combined treatment of atrophic scars using radiofrequency microneedling and hyaluronic acid fillers with subcision

Introduction. Atrophic scars may be associated with significant psychological stress and a substantial negative impact on quality of life. Despite the great relevance of the atrophic scars therapy, existing treatment methods do not always provide their complete elimination.Aim. To study the efficacy of combined therapy of atrophic scars with radiofrequency microneedling (RF-MN), subcision and hyaluronic acid filler injection.Materials and methods. Ten female patients aged 28–44 years with a clinical diagnosis of atrophic scars were randomly assigned to two groups. Group 1 received RF-MN alone, while Group 2 received a combination treatment comprising RF-MN, subcision, and hyaluronic acid injections. Clinical effectiveness was assessed using the Goodman-Baron scar rating scale and the Global Aesthetic Improvement Scale (GAIS). Ultrasound was used to determine the changes in dermal thickness. The volume of depressions and skin texture were measured using the Antera 3D®. The safety of the treatment was evaluated by recording adverse events.Results. The combined method demonstrated superior efficacy compared to RF-MN alone in the majority of efficacy parameters. In Group 2, a statistically significant reduction in Goodman-Baron scale was observed in 100% of patients (p = 0.026). 3D measurements of the face demonstrated a more pronounced improvement in skin texture in Group 2 relative to Group 1. Statistically significant changes (p = 0.027) in the Face-Q scale were exclusively observed in the group that received the combined treatment. Ultrasonic imaging demonstrated a restoration of dermal thickness following treatment. No serious adverse events were observed. Expected local adverse events (pain, erythema, swelling, and bruising) were mild and resolved spontaneously within 1–7 days.Conclusion. The combined treatment with RF-MN followed by subcision and hyaluronic acid filler injections demonstrated its efficacy in patients with atrophic scars.