Filler Migration Research Articles

Precise Needle and Cannula Placement in the Forehead During Aesthetic Procedures: Can Device and Angulation Influence Accuracy? A Fresh Frozen Specimen Study.

Myomodulation is a technique aimed at enhancing the dynamics of muscle contraction and relaxation through methods like hyaluronic acid (HA) injection. Achieving optimal outcomes depends on the precise placement of the injected product within the targeted anatomical plane. This is particularly important in the forehead, an area with elevated vascular risk. The selected treatment techniques must ensure both efficacy and safety. This study aims to assess the anatomical precision of HA injections in the forehead using different techniques and devices. Four fresh frozen specimens were injected with HA by five experienced board-certified plastic surgeons using three different techniques/devices: (1) a 50mm, 22G microcannula; (2) a 13mm, 27G needle with the bevel down at a 45-degree angle; and (3) the same needle positioned at a 90-degree angle. Ultrasound analysis was used to evaluate the precision of each approach. Both the cannula technique and the needle technique with the bevel down at a 45-degree angle consistently delivered the filler to the supraperiosteal layer in 100% of cases without spreading. However, the 90-degree needle technique, despite correct placement on the periosteum, resulted in filler dispersion across multiple layers. The accuracy of filler placement in the forehead is influenced by the choice of device and its angulation. It is recommended to use a cannula with the entry point at the frontalis crest or a needle angled at 45 degrees to the skin. The use of a needle at a 90-degree angle should be avoided to ensure precise placement and avoid filler migration. 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 .

Comparing the Effects of Different Injection Techniques Used in Lip Augmentation on Filler Migration and Patient Satisfaction.

Lip rejuvenation has several aims, including enhancing lip volume, adjusting the upper and lower lip's length, diminishing fine lines, contouring and redefining the cupid bow and vermilion border, and eversion of the vermilion. Within the scope of this research, we aimed to compare popular injection techniques to augment the size of the lips. This randomized retrospective study included 216 female patients aged 19 to 39, who desired a lip filler treatment from 2017 to 2023. Pre- and post-procedure results were elaborated with top-to-the-bottom technique in Group 1, bottom-to-the-top technique in Group 2, and lateral-to-medial techniques in Groups 3 and 4.Once the patients were sufficiently anesthetized, the hyaluronic acid at a concentration of 20 mg/mL with 0.3% (3 mg/mL) lidocaine, was used in all groups. Patients were followed up for three weeks. Patient satisfaction scores were evaluated on a scale from 0 to 5 using a survey on the last follow-up day. A statistically significant difference was found between the groups regarding satisfaction scores (p<0.05).The patient satisfaction scores after injection were 4.78/5 in Group 1, 3.70/5 in Group 2, 4.15/5 in Group 3, and 3.85/5 in Group 4. Kruskal-Wallis variance analysis for more than two groups revealed statistically significant differences between Group 1 and Group 2 (p<0.001), Group1 and Group 3 (p<0.001), Group 1 and Group 4 (p<0.001), and Group 2 and Group 3 (p=0.009) (Mann Whitney U-Test with Bonferroni adjusted). No major complication was observed in any of the patients. In this study, patient satisfaction was found to be highest in the group with needle orientation top to bottom, taking into account migration to the upper lip. These findings showed that the direction of the needle during injection also determines the direction of distribution of the filler on the lip and may be an important factor in patient satisfaction.

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.

Experimental and simulation studies of degraded EPDM composite in the coupled gamma radiation-thermal environments

The degradation behaviors, mechanisms and compatibility are not well understood and hard to be harnessed for EPDM composite in the coupled gamma radiation-thermal environments. This contribution performs a thorough study accordingly with 0 ∼ 200 kGy dose under temperatures varying from room temperature to 90 °C in N2/O2 mixture atmosphere. Radiation-thermal aging leads to annealing effect and chemi-crystallization that rebuilds the semi-crystalline structure and invokes competitive filler migration, reconfiguration and loss. Crosslinking reactions prevail the scission during the investigated conditions. However, the surface oxidation and damage are not severe. In-situ nondestructive gas-phase FTIR sensitively find the formed various gaseous products, whose generation kinetics behaviors are temperature and dose dependent. Most surprisingly, the radiolysis caused carbonyl sulfide and carbon disulfide are discovered with indispensable gamma radiation, which manifest temperature reined conversion thermodynamics and kinetics behavior. The qualitative and quantitative analysis of gas products is also validated by GC and GC-MS tests. The evolved semi-crystalline structure, macromolecular chain network and filler network significantly impact the mechanical property, but the barrier property and hydrophobic property are slightly influenced. The inverse temperature effect occurred at 50 °C for the mechanical properties, which show abnormal rejuvenation behavior due to the counteraction between aging induced change in molecular structure, aggregation structure and filler reconfiguration, migration and loss. The multiscale structure-property-behavior relationships possess good interdependency, indicating the main aging mechanism and failure mode are almost invariant. By ReaxFF simulation, the complex degradation mechanism for EPDM composite at atomic scale is revealed for the first time.

Subcutaneous Washout Procedure (SWOP) for Treating Severe Complications of an Aesthetic Gluteal Augmentation with a Copolyamide Filler

Apart from surgical procedures for breast and buttock augmentation, copolyamide fillers can be locally injected for an increase in volume. This method is especially popular in Asia. A 39-year-old female patient had received a buttock augmentation by injection of a copolyamide filler. She presented with multiple abscesses six years after the augmentation. She had developed multiple fistulas and the filler had migrated down to the thigh muscles. In the presented case, the patient experienced multiple complications such as abscess formation, filler migration and chronic infection, with a significant time delay. Complete removal of the filler is only possible by removing surrounding tissue as well. Surgical treatment with repeated debridements and administration of an intravenous broad-spectrum antibiotic are the current standard of care. In contrast, the SWOP technique presented here appears to be less invasive and less likely for local recurrence. A breast or buttock augmentation with copolyamide fillers is associated with a high risk of abscess and fistula formation leading to a permanent disfigurement of the patient.

Post-Treatment Displacement of Facial Soft Tissue Fillers-A Retrospective Ultrasound-based Investigation of 382 Zygomatic Regions.

Clinical and ultrasound experience has revealed that after soft tissue injections of the lateral cheek, the filler may displace from the zygoma to the caudal temporal area. To obtain more data to provide insight into product distribution when soft tissue fillers are injected in the zygomatic region. Two hundred patients were examined with facial ultrasound imaging of the zygomatic and temporal region. Inclusion criteria were simply a positive response on the screening questionnaire as to whether or not they had filler injections placed in their lateral cheek. Control injections were also performed to the zygomatic regions of a body donor and in 10 patients ultrasound-guided. A correlation was found between the layers in which filler was detected on the zygoma and where it was ultimately found in the temples. Four different redistribution patterns were observed: (1) migration of filler within the superficial muscular aponeurotic system (SMAS) on the zygoma into the superficial temporal fascia. Migration of filler from the lateral suborbicularis oculi fat to (2) the deep interfacial plane of the temple or (3) to the superficial temporal fat pad; (4) migration from the supraperiosteal layer of the zygoma to the superficial temporal fat pad. Body donor and patients: filler deposits injected on the zygoma were witnessed to shift during injection into the caudal part of the temple. Soft tissue filler aliquots may be redistributed into the temples after injections of the lateral side of the zygomatic arch. The displacement follows a distinct pattern depending on the initial layer of injection.

Ultrasonographic features of nonvascular complications of hyaluronic acid fillers: a retrospective study at a reference center for dermatologic ultrasonography

Hyaluronic acid filler injections have been associated with early, temporary, and delayed-onset complications. High-resolution ultrasound with Doppler analysis has been increasingly used to detect and identify such complications. We comprehensively describe the most common ultrasonographic findings of nonvascular complications associated with hyaluronic acid filler injections. This retrospective, cross-sectional, observational study was conducted at a reference center for dermatologic ultrasound in Bogotá, Colombia. Ultrasound reports documented the ultrasonographic findings of nonvascular complications of hyaluronic acid filler injections. Fifty-two complications were documented in a cohort of 50 patients (women, 88%). The infraorbital region was the most common site affected (23%), followed by the nasolabial region (22%). The Tyndall effect was the most common complication (25% of all), followed by changes in rheology (21%) and pseudosarcoidal (foreign body granuloma) reaction (15%). The Tyndall effect stood out for its distinctive ultrasonographic characteristics. We discuss the ultrasonographic findings and pathogenesis of other complications, including filler migration, early hypersensitivity, aseptic abscess, overcorrection, and filler material interaction. The clinical presentation of hyaluronic acid filler complications can be confusing, delaying timely diagnosis and treatment. High-resolution ultrasound with Doppler analysis is a valuable tool for avoiding unnecessary treatments and ensuring timely diagnosis and treatment.

Vulvar migration of injected polyacrylamide hydrogel following breast augmentation: a case report and literature review

BackgroundVulvar migration is a rare complication of filler injection for breast augmentation, generally presenting as repeated pain and fever. We will report a case of woman with polyacrylamide hydrogel breast injection develops vulvar abscess.Case presentationA woman with a history of polyacrylamide hydrogel breast injection was noted to have vulvar abscess due to migration of filler materials. Filler removal surgery and vacuum sealing drainage was performed for this patient. The patient was discharged from the hospital with no further complications. After a review of pertinent literature, only four previous case reports are found. Local inflammatory response, infection, large volume injections, inframammary fold destruction, hematogenous or lymphatic migrate, trauma, gravity and external pressure could play essential parts in the migration of injected filler.ConclusionPolyacrylamide hydrogel migration poses a worldwide challenge, necessitating personalized solutions. Our case study underscores the importance of comprehensive examinations for individuals with a history of filler breast injection when suspecting vulvar filler migration.

A Natural Flat Volumized Lips Filler Technique: Retrospective Analysis of 920 Patients.

Traditionally, hyaluronidase (HYAL) is used after hyaluronic acid (HA) injection to dissolve the undesired migration of product. To describe a novel lip augmentation technique that uses HA and HYAL simultaneously in patients who previously had HA migration. Nine hundred twenty female patients were included. In the first group ( n = 793), HA injections were performed in subcutaneous plane of the lips. In the second group who had previous product migration ( n = 127), 7.5 units of HYAL is injected in 4 points in ergotrid area before proceeding with HA injection. The medicis lip fullness scale scores after 2 weeks improved in all patients, while 92% of patients perceived the results as "very much improved" with Global Aesthetic Improvement Scale ( p ˂ .001). There was no difference between 2 groups regarding the patient satisfaction rates ( p ˃.05), while filler migration was seen in 0.2% ( n : 15) of patients in the first group during the follow-up period. The new vertical injection approach provided an increased vertical height, optimal eversion, and an incisor display on the lips. The simultaneous use of HYAL before HA injection seems to be a safe and effective practice in 1-stage treatment of the previously injected lips with filler migration into ergotrid area.

Distant migration of copolyamide breast filler following mammography: a case report

Copolyamide fillers, such as Aquafilling, have been used off-label for breast augmentation in many countries, including Korea. However, safety concerns have arisen due to reported complications, including induration, masses, mastalgia, firmness, asymmetry, migration, infection, and dimpling. We report the case of a 33-year-old woman who presented with distant migration of copolyamide breast filler to the left lower abdomen and inguinal area following mammography for breast cancer screening. This case highlights the potential risks associated with the migration of copolyamide breast fillers, particularly in the context of cancer screening procedures, and emphasizes the importance of awareness and vigilance among clinicians and patients.

Reinforcement effects of graphite fluoride on breakdown voltage rating and Pyro-Resistive properties of carbon Black/Poly (vinylidene fluoride) composites

The utilization of conductive polymer-matrix composites (CPCs) with a high concentration of filler as an overcurrent protection device can reduce operational load and improves circuit stability. However, limitations such as reduced positive temperature coefficient (PTC) intensity and inferior voltage breakdown strength hinder its development. To overcome this, the study investigates the integration of graphite fluoride into carbon black (CB)/Poly (vinylidene fluoride) (PVDF) composites. The graphite fluoride-doped CPCs demonstrate outstanding voltage resistance, PTC intensity, and electrical properties, which can be ascribed to the heightened compatibility and adhesion between CB and PVDF, resulting in diminished migration and agglomeration of conductive fillers during current shock and thermal conditions. Graphite fluoride also acts as a shield, counteracting the negative effects of electrical, chemical, and thermal breakdown failures, thus inhibiting PVDF degradation during current impact. Overall, this approach significantly enhances the voltage withstand capability of overcurrent protection devices under current saturation conditions.

Polycarbonate composites for material extrusion-based additive manufacturing of thermally conductive objects

Enhanced thermally conductive polymer composites can be used in many engineering applications where either the physicochemical properties of plastics or the processing properties of plastics are required. Rapid prototyping is currently being addressed for a number of applications that require good heat transfer properties. Such applications include various types of heat exchangers containing coolant/heating fluid as well as passive heat sinks for standard heat removal from various types of heat-generating products. The present work is focused on the research of thermally conductive composites for printing such structures using additive manufacturing (AM), namely material extrusion. In this study, a number of parameters of the composites were investigated that affect the final properties of the printed structures; these include the TC (Thermal Conductivity), mechanical properties, and printability of the composites, depending on the composition, but also the printing direction. The composites studied were made up of a matrix of PC (Polycarbonate) and a mixture of different thermally conductive fillers, specifically, h-BN (Hexagonal Boron Nitride), EG (Expanded Graphite), PCFs (Pitch-based Carbon Fibers) and Al (Aluminum Particles). Different types of thermally conductive composites were studied, from binary to ternary combinations of fillers. One of the best-performing composites was achieved for the combination of all four types of filler, where thermal conductivity along the printing direction was achieved for the PC matrix with 30 wt% of the mixture of all fillers. Up to 1.56 W m−1 K−1 was achieved, which is 5-fold higher than for neat PC. Although these composites have approximately half the tensile strength only, the hardness is similar to that of the neat PC. The behavior of fillers was observed by SEM analysis. Al, EG, and PCFs behave predictably. Unusual behavior was observed in the case of PC only with h-BN, where the filler migration from the matrix to the voids between the non-fused printing paths occurred, likely caused by a larger amount of dispersion component of the overall surface energy of h-BN. Such phenomena could be used in the optimized form in the future so that segregated thermally conductive structures could be created using material extrusion-based AM and allow even higher thermal conductivity of final structures.

Case study: Managing filler migration and poor placement with topical and injectable hyaluronidase and filler multilayering

More careful consideration and screening should be employed when assessing patients for lip filler and lower face treatments. It is common to dismiss the lips as simple treatment areas, however their variability can predispose patients to many complications. Furthermore, filler treatments cannot be an exercise in simply balancing ratios for results to look natural. It is important to learn the utility of both topical and injectable dissolving agents, as well as a multilayering filler approach in resolving and treating the lower face.

Filler Migration after Facial Injection—A Narrative Review

Background: The injection of dermal fillers for facial esthetics has become a very popular procedure. Although usually safe in the hands of the experienced user, filler injections may bear a risk of unwanted side effects. Material and Methods: This is a narrative review of dermal filler migration after facial injections. We performed research on the literature on Pubmed and Google Scholar. Inclusion criteria were observational studies, case reports, and clinical trials which investigated the association of facial filler injections to filler migration. Animal studies have not been considered. Intravascular injections were excluded. Results: We identified 28 reports that met the inclusion criteria. The age range of affected patients was 21 to 86 years (mean ± standard deviation: 47 ± 14.8 years). Women were 25 times more reported than males. Hyaluronic acid and polyalkylimide were the most commonly encountered filler substances. Injections into the nose, lips, nasolabial folds, and forehead (including glabella) are more often reported for filler migration than injections into the cheeks. Tear-trough correction bears a risk for orbital migration. The delay from injection to presentation of filler migration was highly variable. Very late filler migration was more commonly seen with permanent fillers than non-permanent products. Conclusions: Filler migration distant from the injection site can occur even several years after the primary treatment. All filler types can be involved. Permanent fillers bear a higher risk of very late filler migration. Migration of permanent fillers needs surgical treatment, while HA fillers respond to hyaluronidase injections. Detailed knowledge of facial anatomy, safer injection techniques, and filler qualities are preventive measures.

Botulinum neurotoxin injection for treating plunged nose and post-rhinoplasty: anatomical perspectives of depressor septi nasi, nasalis, leveator labii superioris alaeque nasi muscle.

Botulinum neurotoxin (BoNT) injection for the treating plunged nose, post-rhinopasty and hyaluronic filler migration is common procedures in clinical settings. However, the lack of thorough anatomical understanding makes it difficult to locate the nose region muscles. The anatomical considerations concerned with BoNT injection into the nasalis, levator labii superioris alaeque, and depressor septi nasi muscles were reviewed in this study. The injection spots have been presented for the nasalis, levator labii superioris alaeque, and depressor septi nasi muscles, with the recommended injection technique for each muscle. We have suggested the ideal injection sites in association with outer anatomical landmarks of the nose region. Moreover, these proposals would support a more accurate procedure of BoNT injection in relieving plunged nose, preventing post-rhinoplasty deviation, and migration of the hyaluronic acid filler.

Liquid silicone filler migration following illicit gluteal augmentation

The illicit use of fillers has significantly increased, especially among transgender women (transwomen) attempting to fulfill unmet gender affirmation needs. We present a case of liquid silicone filler migration to the distal lateral thigh, multiple years following an illicit gluteal augmentation, and mimicking a neoplasm. Initial clinical and imaging findings were inconclusive necessitating advanced imaging, an orthopedic oncology surgical consultation, and finally an ultrasound-guided biopsy. Knowledge of the increasing use of fillers, their complications, and imaging findings is critical as these patients commonly choose not to disclose this history. A radiologist suggesting this diagnosis may assist the clinician, who is often unaware of this history which could help prevent unnecessary imaging and invasive procedures.

Efficacy of Retrobulbar Filler Injections for Correcting Enophthalmos Associated with Phthisis Bulbi or Anophthalmos

Purpose: To describe the clinical outcome of retrobulbar injection of synthetic fillers to correct enophthalmos associated with phthisis bulbi or anophthalmos.Methods: We retrospectively reviewed the medical records of patients who underwent enophthalmos correction using retrobulbar filler injections at Asan Medical Center between January 2015 and October 2019, and who were followed for at least 6 months. We evaluated the number of injections and amount of filler injected, improvement in enophthalmos, interval between injections, and adverse effects of filler injection.Results: The study enrolled five patients (four females and one male). Two patients had anophthalmos after evisceration and three had phthisis bulbi. Two patients received hyaluronic acid (HA) filler only, one had collagen-polymethylmethacrylate (PMMA) filler only, and two had both fillers. The HA and collagen-PMMA filler volumes per injection were 1.0–1.4 and 0.75–1.0 mL, respectively. The average degree of enophthalmos, compared to the contralateral eye, was 1.8 mm; the amount of enophthalmos correction per 1 mL of filler injection was 1.5 mm for HA filler and 1.4 mm for collagen-PMMA filler. The longest duration of enophthalmos correction was 15 months for HA filler and 25 months for collagen-PMMA filler. There were no significant adverse effects, but anterior migration of HA filler was observed in one case that resolved with hyaluronidase injection.Conclusions: Retrobulbar filler injection is a safe, effective, minimally invasive procedure for correcting enophthalmos in patients with anophthalmos or phthisis bulbi. If HA filler injection shows good outcomes without adverse effects, semi-permanent fillers can be used for long-term maintenance of enophthalmos correction. Further studies with more patients and long-term follow-up are needed to compare the effectiveness of various fillers.

Migration of Electroconductive Carbon Nanoparticles in Polymer Composites Melts

AbstractProcess of nanoscale carbon filler migration in polymer composite melts is studied. Monotonous decrease of electrical resistance is observed for composite materials during their stay in a melted state. This is especially pronounced for composites with concentration of filler much lower than percolation threshold determined for a specific matrix/filler/mixing method combination. This phenomenon can be observed for composites based on different polymer matrices. Also, it is demonstrated that the type and geometry of the electrically conductive filler does not affect presence of the phenomena. A setup for measurement of conductance for volume and surface layer components is used. The results of electrical conductance measurements of the polymer composite melt using this setup allows to attribute the increase of composite material conductance to formation of filler enriched surface layer. To obtain information on the processes occurring at the microscopic level, molecular dynamics simulations are conducted. Variation of several simulation parameters with comparison of the results to experimental data allows to understand the macroscopic composite material conductance behavior.

Study on the Change Behavior of Fluorosilicone Rubber in RP-3 Kerosene

Fluorosilicone rubber has excellent high temperature oil resistance and has been widely used in high temperature oil media. The performance of fluorosilicone rubber will degrade with the length of oil immersion time. In this paper, through oil resistance test, hardness test, tensile test, infrared analysis, differential scanning calorimetry analysis and thermal weight loss analysis, the performance, structure and composition changes of fluorosilicone rubber FS6265 at 150°C and RP3 kerosene soaking process are studied. The results show that in 150°C, RP3 kerosene, the mass and volume of fluorosilicone rubber FS 6265 first increase and then decrease. The hardness and tensile strength gradually decrease with the increase of immersion time, the elongation at break tends to increase slightly and then decrease. The performance changes are mainly caused by swelling, filler migration, side chain rupture and cross-linking damage. The swelling in the early stage of immersion plays a major role, and the filler migration, side chain and cross-linking failure play a major role in the later stage.

Toward high dielectric constant and low dielectric loss nanocomposite via kinetical migration

Controlling the selective localization of nanoparticles in an immiscible polymer blend is a promising concept for developing high-performance polymeric dielectrics. However, the mechanism of the dielectric regulation has not been lucidly studied. In this work, PLA/PVDF/CNTs nanocomposites with tunable dielectric properties were fabricated via tailoring the localizations of CNTs based on kinetic-based approach. The dielectric evolutions were attributed to the synergistic effects of the “sea-island” structure, and the number and average capacitance of the microcapacitors in PLA/PVDF/CNTs nanocomposites. Ultimately, we obtained the PLA/PVDF/CNTs nanocomposites with a high dielectric constant of 956.6@1 kHz, which was more than 100 times higher of the virgin PVDF, at a very-low dielectric loss of 0.17@1 kHz. Since the interface interaction was enhanced by locating CNTs at interface, the highest tensile strength of nanocomposites fabricated by two-step method reached 59.1 MPa at a mixing time of 12 min. This work not only reports a high-performance polymeric dielectric with a high dielectric constant and a low dielectric loss, but also intends to propose a general insight in the effect of kinetically regulated migration of conductive fillers on the as-prepared nanocomposites.