Soft Tissue Filler Research Articles

ODP095 HYPERCALCEMIA FROM SILICONE BUTTOCK INJECTION INDUCED GRANULOMA.

Abstract Granulomatous disease is an infrequent cause of non-PTH mediated hypercalcemia. Hypercalcemia from granulomas due to cosmetic silicone injections are not commonly recognized. A 57 year old woman with rheumatoid arthritis was incidentally discovered to have hypercalcemia. Laboratory studies reported elevated calcium 11.0 mg/dL (RR: 8.6-10.2), suppressed PTH 12.7 pg/mL (RR: 15-65), low 25 OH - vitamin D 13ng/mL (RR 30-100), normal 1-25 dihydroxyvitamin D 78 pg/mL (RR 18-72), SPEP Kappa/Lambda Ratio 2.12 (RR 0.26-1.65), but no M spike, normal UPEP, an eleavted 24hr Urine Calcium 451.5 (RR: 100-300). PTHrp 20 pg/mL (RR: 14-27). Quantiferon test negative. ACE level 76 (RR: 9-67). X-ray of the chest showed no hilar adenopathy. Patient had a non-FDA approved silicone buttocks injection 20 years earlier. Patient's main complaint consisted of buttocks pain and tenderness as well as discomfort upon sitting. PET/CT showed "heterogeneous density in the bilateral gluteal region from silicon implants". "The thickness of the implant is about 6 cm in the soft tissues metabolically active diffusely with a maximum SUV of 2.84. This is consistent with silicone granulomas". A biopsy showed "Clear annular histiocytic inclusions consistent with macrophage ingestion of foreign substance. Abundant surrounding inflammatory reaction with numerous multi-nucleated giant cells consistent with granulomatous response." Plastic surgery was consulted and were unable to surgically remove the silicone. Patient was offered medical treatment for hypercalcemia, but deferred due to concern for side effects. Cosmetic enhancement is a growing industry and cosmetic fillers including silicone have been used throughout the 20th century. Previously considered inert silicon may have inflammatory reactions attributed to denatured silicon, incorrect injection and large injection volumes. Silicon induced granulomas frequency ranges from 0.01–5% and may appear 2–25 years after the injections. Histologic diagnosis is critical and is similar to those found in sarcoidosis. Treatment of silicon induced hypercalcemia is similar to treatment of other granulomatous disease utilizing glucocorticoids. Bisphosphonates are considered in cases resistant to glucocorticoid treatment. Surgical treatment is rarely considered. The patient was receiving abatacept therapy (750 mg IV monthly) for rheumatoid arthritis. Abatacept is a monocolonal antibody which binds to CD80 and CD86 on antigen presenting cells (APCs) blocking T-cell activity. Since starting Abatacept treatment the patient's hypercalcemia has improved. There are currently ongoing clinical trials of abatacept to treat sarcoidosis and granulomatosis with polyangiitis that may shed light on the efficacy of this drug to treat granulomatous disease. Due to the rise in the use of cosmetic fillers, complications are also likely to be on the rise. Soft tissue fillers injections have increased in the United States and it is likely that complications from these non-FDA approved treatments will increase. It is important that endocrinologists are familiar with the physiology and treatments. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Synergy of stabilized and nonstabilized hyaluronic acid soft tissue fillers in skin density and skin thickness enhancement.

The aim of this investigation was to assess the effectiveness of a combined treatment with stabilized and nonstabilized HA soft tissue fillers in the correction of midfacial volume and improving skin condition in the treated area. A total of 10 Caucasian female patients participated in the study, with a mean age of 42.2 years. They received stabilized and nonstabilized HA soft tissue fillers in the midface. Nonstabilized HA soft tissue filler was placed unilaterally. Skin density and thickness were measured with an ultrasound device. Aesthetic improvement and patient satisfaction were also assessed 3 weeks posttreatment. Side treated with stabilized and nonstabilized HA showed 65.40% increase in skin density versus the baseline and 7.02% increase in skin thickness versus the baseline. Side treated with stabilized HA showed 26.55% increase in skin density versus the baseline and 4.83% increase in skin thickness versus the baseline. After 3 weeks 62.5% of the patients stated that they were satisfied with the treatment and 37.5% of the patients were very satisfied with the treatment. Skin density and thickness significantly increased in the treated regions. Combined therapies based on stabilized and nonstabilized HA soft tissue fillers appear to be an optimal solution for facial volume and skin quality enhancement and seem to be more effective than stabilized HA soft filler alone. The procedure is safe and satisfactory to the treated subjects.

Vascular Safe Zones for Facial Soft Tissue Filler Injections.

The number of soft tissue filler injections performed by aesthetic injectors has continued to increase over the last few years. To provide a high standard of safety and achieve individualized, reproducible, and long-lasting outcomes, aesthetic injectors must have a solid foundation in anatomy, facial biomechanics, rheology, and injection biomechanics. Adverse events associated with soft tissue filler injections can be severe, especially if the aesthetic injector unintentionally injects the soft tissue filler into the patient's arterial vascular circulation and the administered product reaches the arterial bloodstream. Although the face has a rich arterial vascular supply that may seem overwhelmingly complex, it can be broken down systematically according to its internal and external vascular territories. To provide guidance for aesthetic practitioners performing minimally invasive facial injections for aesthetic purposes, this narrative article will discuss the course, depth, and branching pattern of the facial arteries based on the most frequently injected anatomical regions. In this article, we focus on vascular safe zones rather than danger zones .

Soft Tissue Dermal Filler-Associated Necrosis and Impending Necrosis: A Systematic Review of the Literature.

Cosmetic soft tissue fillers are a popular minimally invasive procedure. Necrosis is a rare yet devastating complication of soft tissue fillers. To date, the relationship between soft tissue fillers and necrosis has not been fully described. To systematically compile published cases of soft tissue fillers resulting in necrosis and collect data regarding the injection, treatment, and outcome. Using PRISMA protocol, a comprehensive search for soft tissue filler necrosis was performed using no time constraints, resulting in 97 articles encompassing 192 cases of soft tissue filler necrosis containing individual-level data. Of the cases analyzed, 66.1% had progressed to necrosis, whereas 33.9% of patients had impending necrosis. Necrosis most commonly resulted from injection of the nasolabial fold (32.4%, n = 88). The filler material most commonly used was hyaluronic acid (71.9%, n = 138). Hyaluronidase was used most frequently as an initial treatment agent (19.1%, n = 88). Forty-three patients (22.4%) with necrosis had a prior minor procedure or surgery. This systematic review is an extensive overview of necrosis as a complication of soft tissue fillers. It serves as a reference tool for any clinician who injects soft tissue fillers and any provider who encounters soft tissue filler necrosis.

Preparation of Thermosensitive Hydroxybutyl Chitosan/Silk Fibroin Hybrid Hydrogels

AbstractEndowing silk fibroin (SF) with the thermosensitivity of rapid in situ gelation remains a challenge in the field of silk fibroin‐based tissue engineering scaffolds and injectable soft tissue fillers. In this study, thermosensitive hydroxybutyl chitosan (HBC)/SF hybrid hydrogels are prepared by physical interaction between HBC and SF. In HBC/SF hybrid system, hydrophobic segments of HBC are aggregated to form microaggregates at physiological temperature, which induce hydrophobic segments of SF to aggregate to the microaggregates by hydrophobic interaction, thus achieving the sol–gel transformation of the two components jointly. The observations and tests of the gelation process show that HBC/SF hybrids with mass ratios of 95/5, 90/10, 85/15, 80/20, 75/25, and 70/30 can complete sol–gel transition rapidly within 5–8 min at 37 °C, and have the reversibility of sol–gel transition. CCK‐8 assay results reveal that the cytotoxicity of HBC hydrogel is effectively reduced by the introduction of SF component. Thermosensitive HBC/SF hybrids have the potential to be used as injectable tissue engineering scaffolds and soft tissue filler.

34368 Analysis of MAUDE database reports involving dermal fillers from 2014-2020

An estimated 1.6 million soft-tissue filler procedures were performed in 2019, a 78% increase from 2012. As usage of fillers increases, there is increasing concern of associated adverse events. We analyzed the U.S. Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database to determine number of dermal filler-related reports, review report details, and compare changes in complications. MAUDE database was filtered for adverse events involving dermal fillers from January 2014 to December 2020.

Evaluation of Paste-Type Micronized Acellular Dermal Matrix for Soft Tissue Augmentation: Volumetric and Histological Assessment in a Mouse Model.

A biological injectable material, paste-type micronized acellular dermal matrix (ADM), has been proven effective in wound healing by filling defects through tissue replacement. This study aimed to compare the efficacy of paste-type micronized ADM on soft tissue augmentation with that of the conventional fillers in animal experiments. Two distinct paste-type micronized ADMs, which were mixed with distilled water (mADM) and gelatin (mADM+GEL), respectively, were compared with conventional fillers, hyaluronic acid (HA) and polymethyl methacrylate (COL+PMMA). Thus, four different types of fillers were each injected into the dorsum of nude mice to compare the volume retention and biocompatibility. During the 8-week experimental period, ultrasound and computed tomography (CT) images were obtained for volumetric analysis. Histological evaluation was performed using hematoxylin and eosin and CD 31 staining. According to the CT images at week 8, the mADM and mADM+GEL showed a higher volume persistence rate of 113.54% and 51.12%, compared with 85.09% and 17.65% for HA and COL+PMMA, respectively. The 2-week interval ultrasound images revealed that the mADM showed a volume increase in width rather than in height, and an increase in height for HA did not vary much. Histological analysis showed marked fibrous invasion and neovascularization with the mADM and mADM+GEL compared to that of the conventional fillers. Paste-type micronized ADM showed soft tissue augmentation with similar effectiveness to that of conventional fillers. Therefore, paste-type micronized ADM has potential as an alternative material for a soft tissue filler in tissue replacement. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Safety and Efficiency of Minimally Invasive Buttock Augmentation: A Review.

Volume restoration and enhancement of the gluteal region appearance has become nowadays a popular concern in particular for many women. Several options are available, none however are without complications and side effects. Volume enhancement with soft tissue fillers of the gluteal region is emerging as a highly attractive minimally invasive modality. It has led unfortunately to more unlicensed, nonmedical practitioners administering illicitly injections for buttock augmentation at relatively low costs. To determine safety, efficacy, and cost effectiveness of mostly used soft-tissue fillers for buttock augmentation, a systematic literature search of PubMed, Medline, and Embase was conducted to identify the mostly used fillers for gluteal augmentation. It was complemented by searching for each of the identified filler material separately to retrieve any missed reports. References of clinical studies and trials, reviews, and consensus reports were reviewed as well for the same objective. In the final analysis 12, mostly strongly biased clinical reports providing a low level of evidence, were identified for inclusion in the review. Two studies involved Polymethylmethacrylate (PMMA), 5 Poly-L-lactic acid, 1 Calcium hydroxyapatite and 4 hyaluronic acid filler injection. No studies were identified involving liquid silicone or Polyacrylamide hydrogel. The little available evidence provided by this review indicates that a specific brand of PMMA in Brazil has a demonstrable relatively good safety, efficiency, and cost-effectiveness record superior to surgical alloplastic gluteal augmentation or to lipofilling only when injected by experts. Gluteal augmentation with soft tissue fillers is not as simple and innocuous as advertised. Serious complications may occur. Moreover, optimal buttock contouring entails not only volume augmentation but also volume removal; thus, volume augmentation with soft tissue fillers may not be ideal. Popularizing this modality must also be approached with great care. Serious complications do occur; they become inevitable when performed illegally by non-specialized, non-authorized, and unscrupulous practitioners in non-accredited facilities. Patients must be warned that adherence to regulations is critical and that only well-trained certified experts practicing legally in accredited facilities can address safely and efficiently their concerns. 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 .

High-Frequency Ultrasound Imaging Findings of Different Mental Injectable Soft Tissue Fillers.

In recent years, the use of mental injectable soft tissue fillers is popular. However, some fillers are difficult to distinguish from pathological tissue, and some non-absorbable fillers need to be removed in time. Therefore, identification of different fillers is important. In this study, we summarized the ultrasonic manifestations of different mental injectable soft tissue fillers to provide references for clinical practice. We screened the mental ultrasound images from November 2014 to November 2021 in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences, identified different filling injection materials, and summarized and classified the ultrasonic characteristics of each filling material. A total of 244 cases were included, involving 62 cases of hyaluronic acid, 126 cases of polyacrylamide hydrogel, 19 cases of growth factor, 16 cases of calcium hydroxyapatite, 15 cases of silicone oil and 6 cases of fat. The ultrasonic manifestation of hyaluronic acid was anechoic area, which could be divided into six types according to the distribution characteristics. The ultrasonography of polyacrylamide hydrogel showed fine punctate echo, which could be divided into nine types. The ultrasonographic appearance of growth factor was similar to the echo of the surrounding tissue, and the boundary was not clear. Calcium hydroxyapatite was characterized by uneven hyperechoic area, which was spread in the tissue space, with unclear boundary with surrounding tissues. Sonographic patterns of silicone oil were hyperechoic and cloudy on high-frequency ultrasound. The deep tissue and periosteum layer were not clear. Transplanted fat showed isoechoic area or uneven low-echo area, with clear boundary and peripheral adipose tissue acoustic enhancement. High-frequency ultrasound is safe and reliable for identification and typing of chin filling injection materials, which can be applied in clinical practice. 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 .

Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal.

Introduction: Autologous fat is ideal soft tissue filler. It is easily accessible, biocompatible, cheap, and it provides both volume augmentation and skin quality improvement. Fat grafting has been used since 1893, but it has only gained widespread popularity since the development of modern liposuction by Colemann and Illouz in the 1980s. Every year more than half a million facial fat grafting procedures are carried out worldwide and the trend is rapidly increasing. Overall, general complications associated with facial fat grafting are assumed to be around 2%. Is that true? Material and Methods: Until July 2021, a systematic search of the literature was performed interrogating PubMed search engines. The following algorithm was used for the research: (fat graft OR lipofilling) AND face AND complications. Exclusion criteria applied hierarchically were review articles, not reporting recipient site complications; not in English and paediatric population. s were manually screened by LS, GS, JM and PDS separately and subsequently matched for accuracy. Pertinent full-text articles were retrieved and analysed and data were extracted from the database. The flow chart of article selection is described following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: In total, 462 papers were identified by PubMed search. A total of 359 were excluded: 38 papers were not in English, 41 were review articles, 279 articles did not report recipient site complications and 1 was not on human subjects. Average complication rate ranged from 1.5% to 81.4%. A total of 298 adverse events were identified: 40 (13.4%) intravascular injections, 13 (4.3%) asymmetry, 57 (19.1%) irregularities, 22 (7.4%) graft hypertrophy, 21 (7%) fat necrosis, 73 (24.5%) prolonged oedema, 1 (0.3%) infection, 6 (2%) prolonged erythema, 15 (5%) telangiectasia and 50 (16.8%) cases of acne activation. Conclusions: FFG related side effects could be resumed in three categories: severe, moderate, and minor. Severe (13.4%) side effects such as intravascular injection or migration require neurological or neurosurgical management and often lead to permanent disability or death. Moderate (38.3%) side effects such as fat hypertrophy, necrosis, cyst formation, irregularities and asymmetries require a retouch operation. Minor (48.3%) side effects such as prolonged oedema or erythema require no surgical management. Despite the fact that the overall general complication rate of facial fat grafting is assumed to be around 2%, the real complication rate of facial fat grafting is unknown due to a lack of reporting and the absence of consensus on side effect definition and identification. More RCTs are necessary to further determine the real complication rate of this procedure.

A Comparative Study on Two Types of Porcine Acellular Dermal Matrix Sponges Prepared by Thermal Crosslinking and Thermal-Glutaraldehyde Crosslinking Matrix Microparticles.

Common commercial porcine acellular dermal matrix (PADM) products take the form of a thin membrane. Given its dense structure, delaying vascularization after implantation remains an issue to be solved. In addition, overlaying multiple sheets to address deep wounds and large tissue defects that are difficult to repair by self-tissues could hinder tissue ingrowth, angiogenesis, and integration. Here, we creatively prepared PADM microparticles through a homogenizing treatment and crosslinked them to ADM sponges by thermal crosslinking (VT-ADM) and thermal-glutaraldehyde crosslinking (GA-ADM). The resulting VT-ADM was thicker than GA-ADM, and both maintained the natural dermal matrix microstructure and thermal stability. The porosity of GA-ADM (mean 82%) was lower than that of VT-ADM (mean 90.2%), but the mechanical strength and hydrophilicity were significantly higher. The two types of ADM sponges showed no obvious difference in cell adhesion and proliferation without cytotoxicity. Furthermore, the human adipose stem cells were co-cultured with ADM sponges which promoted proliferation, tube formation, and migration of endothelial cells, and the GA-ADM group exhibited better migration behavior. There were no markable differences among expressions of pro-angiogenesis genes, including vascular endothelial growth factor, insulin-like growth factor-1, and epidermal growth factor. In a nude mouse model, the VT-ADM and GA-ADM pre-cultured with human adipose stem cells for 1 week in advance were implanted subcutaneously. The VT-ADM and the GA-ADM showed great histocompatibility without local redness, swelling, or necrosis. The vascular density of the local skin flap above the material was visualized using indocyanine green and showed no statistical difference between the two groups. The collagen tissue deposition in the pores and vessel formation within the sponges increased with time. Although VT-ADM had a higher degradation rate in vivo, the integrity of the two scaffolds was preserved. Collectively, the VT-ADM and the GA-ADM retained a natural matrix structure and presented biocompatibility. Thus, the above-mentioned two crosslinking methods for ADM sponges are safe and practicable. The novel ADM sponges with good physicochemical and biological properties are no longer limited to membrane tissue regeneration but could also realize structure remodeling where they act as scaffolds for a soft tissue filler and three-dimensional reconstruction of the tissue with strength requirements.

Calcium Hydroxylapatite Soft Tissue Fillers: Expert Treatment Techniques

Calcium Hydroxylapatite Soft Tissue Fillers: Expert Treatment Techniques

Treating Sunken Upper Eyelid With Hyaluronic Acid: Recommendations and Results.

Supraorbital hollowness is a feature that gives an unesthetic, aged, and cadaveric aspect to the eyelids. This complex anatomic area is affected by different variables. Treating this area with fillers poses a real challenge in terms of reducing risks and predicting natural results. We aimed to report outcomes observed in patients treated with injections of hyaluronic acid (HA) soft tissue fillers. Additionally, we have reviewed sunken upper eyelid (SUE) anatomy, etiology, and pathophysiology with the objectives of describing a new classification of SUE, showing a lower risk technique to fill the area, and explaining the importance of using a high cohesivity HA product. We included 32 adults (96.9% female) without previous fillers in the area, who were injected with HA (Belotero Balance) with a 25 G, 40 mm blunt cannula. The procedure was fractionated in 2/3 visits. The assessment was performed at day 0, day 14, day 30, and day 365 with standard camera and Vectra H2 (Canfield). All patients treated with HA showed natural results without significant edema on day 30. Only 1 patient (3.1%) required hyaluronidase injections to dissolve overcorrection of the area on day 14. No severe complications were observed. For most patients, obtained results remained stable on day 365. As SUE is one of the most prominent signs of aging, the desire for rejuvenation and the popularity of non-surgical solutions have increased. We present our results with a cohesive HA as a highly suitable filler for SUE. Given the high patient satisfaction, long-lasting results, and reduced complication risk, our presented approach may represent a safe and effective novel treatment strategy.J Drugs Dermatol. 2022;21(9):1002-1008. doi:10.36849/JDD.6745R1.

No association found between late-onset inflammatory adverse events after soft tissue filler injections and the adaptive immune system.

To date, it is unknown why some individuals develop late-onset inflammatory adverse events after treatment with fillers. These events may result from various factors, including an immunological response of the adaptive immune system. In a pilot study, we looked for evidence that is there a relation between late-onset inflammatory adverse events and the presence of immune cells surrounding the injected filler. We included 47 patients, of whom 20 experienced late-onset inflammatory adverse events to different fillers (inflammatory group) and 27 who did not (reference group). A biopsy was taken from the area of the adverse event. Hematoxylin-eosin staining and immunohistochemistry analysis with CD3 (T-cells) and CD68 (macrophages) on paraffin tissue sections was used to assess the biopsies. Immune cells were found in biopsies obtained from 18 of 47 patients: Nine biopsies from the inflammation group and nine from the reference group. All these 18 cases showed CD68-positive immune cells. Virtually no CD3-positive immune cells were found. Our results indicate that there is no T-cell activity in biopsies from areas with late-onset adverse events after filler injections. The macrophages found in the biopsies are probably not responsible for the inflammatory response.

Comparative Preclinical Study of Lidocaine and Mepivacaine in Resilient Hyaluronic Acid Fillers.

Background: Hyaluronic acid-based filler injections are now well-established aesthetic procedures for the correction of skin tissue defects and volume loss. Filler injections are becoming increasingly popular, with a growing number of injections performed each year. Although classified as a minimally invasive procedure, the introduction of a needle or a canula may remain painful for the patient. A major improvement was achieved with the incorporation of local anesthetics into the formulation for pain relief. Methods: In this study, two well-known anesthetics, lidocaine and mepivacaine, were systematically compared to assess their influence on filler mechanical and biological features. The impact of each anesthetic was monitored in terms of gel rheological properties, stability, durability, and degradation. The release profiles of each anesthetic were also recorded. Finally, the pharmacokinetics of each anesthetic in rats were assessed. Results: For all the rheological and biological experiments performed, lidocaine and mepivacaine influences were comparable. The addition of either anesthetic into a soft-tissue filler showed no significant modifications of the stability, durability, and degradability of the gel, with similar release profiles and pharmacokinetics at an equivalent concentration. Conclusions: Substituting lidocaine with mepivacaine does not impact the properties of the gels, and thus both can be equally incorporated as anesthetics in soft-tissue fillers.

LB985 A three-dimensional analysis of the collagen network in rats treated with hyaluronic acid-based soft tissue filler

This study evaluates the tissue integration and collagen network effects of the HA-based soft tissue filler Juvéderm Voluma XC in a rat model using a novel three-dimensional (3-D) imaging platform and image analysis algorithms. Rats were injected subcutaneously with 125 μL of Juvéderm Voluma XC. After 4- or 12-weeks post-injection, the second harmonic generation (SHG) signal of collagen and tissue autofluorescence within the entire filler bolus was assessed using the TissueVision TissueCyte Serial Two-Photon Plus (STP2) imaging platform.

LB984 Intralesional sodium thiosulfate as a reversal agent for calcium hydroxylapatite soft tissue filler: An in vitro and ex vivo comparison

CaHA microspheres are the active component of an injectable filler material commonly used to correct fat and dermal atrophy. While use of CaHA in soft tissue augmentation is generally safe and well-tolerated, dissolution may be required for unwanted nodule formation or, rarely, for vascular occlusion. Though there is no approved reversal agent, preliminary reports have suggested STS may be considered. In this translational study, we sought to understand the effect of sodium thiosulfate (STS) on calcium hydroxylapatite (CaHA) microsphere size and dispersion.

In vitro inflammatory and immune response to uncrosslinked hyaluronic acid (HA) and HA fillers

IntroductionDelayed-onset nodules are a complication associated with soft tissue filler products, including hyaluronic acid (HA) fillers; however, the etiology of these events remains unclear. The role of uncrosslinked HA and crosslinked HA fillers in the response of immune cells (dendritic cells, B cells, and T cells) was evaluated with and without concurrent bacterial stimulation. MethodsUncrosslinked HA of varying molecular weights and crosslinked HA fillers were tested in a series of in vitro assays to evaluate 1) human monocyte activation; 2) activation, maturation, and migration of human monocyte-derived dendritic cells (MoDC); 3) T-cell activation and associated skin damage; and 4) T-cell–mediated B-cell response. For the latter assay, the HA test articles were also evaluated following stimulation by bacteria. ResultsWhen treated with lipopolysaccharide (LPS) as a positive control, inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-10, IL-12p70, and tumor necrosis factor [TNF]-α) released by MoDC were significantly upregulated. Treatment of the MoDC with HA (0.776, 150, and 485 kDa) did not result in stimulation of IL-1β, IL-6, IL-10, and IL-12p70, although increased TNF-α was observed with all HA test samples. The TNF-α increase was significantly lower for HA samples (1.5–2.64 pg/mL) compared with LPS (966.96–4834.18 pg/mL). Similarly, treatment of MoDC with HA samples did not result in expression of surface markers indicative of dendritic cell maturation. MoDC treated with 0.776 and 150 kDa HA, but not with 485 kDa HA, had significantly increased migration toward fetal bovine serum, but not C–C motif chemokine ligand 21 (CCL21). In the T-cell activation and skin damage assay, VYC-15L, degraded VYC-15L, HYC-24L+, and oligosacharride HA samples were negative in the T-cell proliferation and interferon-γ assays at all tested concentrations. The degraded HYC-24L + sample was borderline at the highest concentration and negative at the middle and low concentrations. Skin damage was determined to be negative for all HA samples at all concentrations. In the human monocyte activation assay, all tested uncrosslinked HA samples (5, 150, and 731 kDa) were determined to be non-sensitizing (i.e., did not activate monocyte cells). In the T-cell–mediated B-cell activation assay, treatment with HA oligosaccharides, uncrosslinked HA, and crosslinked HA fillers did not result in any consistent stimulation of any cytokines measured. A molecular weight–dependent decrease in the secreted immunoglobulin G (IgG) was observed, and this effect was more pronounced with the crosslinked HA fillers. Addition of heat-inactivated Cutibacterium acnes bacteria (HIB) to uncrosslinked HA and crosslinked HA fillers resulted in increased cytokine production similar to when HIB was tested alone. The decrease in secreted IgG observed for crosslinked HA filler samples without HIB was maintained with addition of HIB to VYC-20, VYC-25, SGD-30XP, and HYC-24+ samples. The reduction of secreted IgG observed for RSQ and VYC-15 alone was no longer apparent when HIB was added to these cultures (i.e., returned to control levels but were not upregulated). ConclusionThe results from this study suggest that uncrosslinked HA and HA fillers themselves do not stimulate an inflammatory/immune response, regardless of molecular weight or crosslinking. However, the immune response following HIB stimulation may be impacted by the presence of HA fillers, suggesting a potential initiating role of contaminating factors such as bacteria and a modulating role of HA.

The Use of the FACE-Q Aesthetic: A Narrative Review

IntroductionIn the past decade there has been an increasing interest in the field of patient-reported outcome measures (PROMs) which are now commonly used alongside traditional outcome measures, such as morbidity and mortality. Since the FACE-Q Aesthetic development in 2010, it has been widely used in clinical practice and research, measuring the quality of life and patient satisfaction. It quantifies the impact and change across different aspects of cosmetic facial surgery and minimally invasive treatments.We review how researchers have utilized the FACE-Q Aesthetic module to date, and aim to understand better whether and how it has enhanced our understanding and practice of aesthetic facial procedures.MethodsWe performed a systematic search of the literature. Publications that used the FACE-Q Aesthetic module to evaluate patient outcomes were included. Publications about the development of PROMs or modifications of the FACE-Q Aesthetic, translation or validation studies of the FACE-Q Aesthetic scales, papers not published in English, reviews, comments/discussions, or letters to the editor were excluded.ResultsOur search produced 1189 different articles; 70 remained after applying in- and exclusion criteria. Significant findings and associations were further explored. The need for evidence-based patient-reported outcome caused a growing uptake of the FACE-Q Aesthetic in cosmetic surgery and dermatology an increasing amount of evidence concerning facelift surgery, botulinum toxin, rhinoplasty, soft tissue fillers, scar treatments, and experimental areas.DiscussionThe FACE-Q Aesthetic has been used to contribute substantial evidence about the outcome from the patient perspective in cosmetic facial surgery and minimally invasive treatments. The FACE-Q Aesthetic holds great potential to improve quality of care and may fundamentally change the way we measure success in plastic surgery and dermatology.Level of Evidence IIIThis 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.

Expert recommendations on the assessment and management of complications due to hyaluronic acid soft tissue filler injections in Asians.

The use of hyaluronic acid (HA) fillers for medical aesthetic purposes is increasing worldwide. Nonetheless, adverse events do occur because of patient-specific issues, injection technique, or product factors. It would be mandatory to consider cultural and anatomical features of Asians in preventing and managing the complications of HA injections. Literature search of studies looking at current evidence and guidelines on the management of complications following HA filler injections in Asian patients was conducted. This was followed by an expert group discussion that was convened to reach consensus recommendations on the best clinical practices. The expert panel provided specific recommendations focusing on the safe use of soft tissue fillers in Asian patients, including early identification of adverse events and how to prevent and comprehensively manage these outcomes. Here, we provide consensus statements of Asian experts in dermatology, plastic surgery, ophthalmology, and aesthetic medicine mainly focusing on AEs with higher risk for Asians and can be used to guide physicians in treating Asian population.