Fig 11 - uploaded by Gottfried Lemperle
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(Left) Acute allergic swelling of both cheeks 4 days after injection of hyaluronic acid in both tear trough deformities. (Right) Recovered 2 days after administration of Celestamine and antihistamines.
Source publication
All fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of and accept these risks. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., too superf...
Citations
... The number of performed filler procedures increases, and the chance of adverse events also increases [25]. These occurrences can be divided into acute and delayed adverse events [26,27]. Early events include edema, erythema, redness, swelling, ecchymosis, bruising, pain, discoloration, infection, embolism, blindness, and skin necrosis (glabella and nasolabial folds). ...
... The most common occurrences of post-filler injections are inflammatory reactions, inadequate training, and technical injection faults. To avoid or treat this problem, the professional must know the composition of the filler biomaterial, possible tissue reaction, absorption capability, and filler persistence [26]. In the 2000s, the first evidence of the adverse effects inherent to this material appeared, namely in the form of foreign body granulomas [29,30]. ...
... Post-filler injection problems happen due to infection (probably caused by biofilm), granuloma as a response to body foreign material, inflammatory nodule due to immune system activation without granuloma formation (sterile abscess), and Tyndall effect (misapplication of the filler) [27]. Then, the result from the body's response to foreign material or due to phagocytosis of the material is granulomatous inflammations, mostly found between 6-and 24-months post-filler treatment [26,27,32]. The material in the defense cells (macrophages and monocytes) stimulates cytokines and inflammatory mediators in order to attract more defense cells to form multinucleated foreign body giant cells, which is visibly and mainly observed in the histopathological images of granuloma. ...
There is a considerable increase in the use of substances and medical procedures aimed at changing the esthetics of the face, particularly the appearance of the lips. Permanent fillers such as polydimethylsiloxane, also called liquid silicone, are widely used, but their application for facial esthetics is currently obsolete. Silicone belongs to this polymer family; its viscosity is determined by its degree of polymerization. Liquid injectable silicone is odorless, colorless, non-volatile, and oily to the touch. The substance is not altered by storage at room temperature and is not carcinogenic or teratogenic. However, the long-term complications remain a reality, as they can occur decades after the application. Thus, the goal of this case report was to present a complication after 16 years of treatment using liquid silicone. This case report involved a 52-year-old male with a complication of bilateral permanent filler in the upper lip performed 16 years ago, its surgical removal, and histological analysis. The patient had the first appointment at
... The number of performed filler procedures increases, and the chance of adverse events also increases [26]. These occurrences can be divided into acute and delayed adverse events [27,28]. Early events include edema, erythema, redness, swelling, ecchymosis, bruising, pain, discoloration, infection, embolism, blindness, and skin necrosis (glabella and nasolabial folds). ...
... The most common causes of post-filler injections are inflammatory reactions, inadequate training, and technical injection faults. To avoid or treat this problem, the professional must know the composition of the filler biomaterial, possible tissue reaction, absorption capability, and filler persistence [27]. In the 2000s, the first evidence of the adverse effects inherent to this material appeared, namely in the form of foreign body granulomas [30,31]. ...
... Post-filler injection problems happen due to infection (probably caused by biofilm), granuloma as a response to body foreign material, inflammatory nodule due to immune system activation without granuloma formation (sterile abscess), and Tyndall effect (misapplication of the filler) [28]. Then, the result from the body's response to foreign material or due to phagocytosis of the material is granulomatous inflammations, mostly found between 6-24 months post-filler treatment [27,28,33]. The material in the defense cells (macrophages and monocytes) stimulates cytokines and inflammatory mediators in order to attract more defense cells to form multinucleated foreign body giant cells, which is visibly and mainly observed in the histopathological images of granuloma. ...
There is a considerable increase in the use of substances and medical procedures aimed at changing the esthetics of the face, particularly the appearance of the lips. Permanent fillers such as polydimethylsiloxane, also called liquid silicone, are widely used, but their application for facial esthetics is currently obsolete. However, the long-term complications remain a reality, as they can occur decades after the application. Thus, the goal of this case report was to present a complication after 16 years of treatment using liquid silicone. This case report involved a 52-year-old male with a complication of bilateral permanent filler in the upper lip performed 16 years ago, its surgical removal, and histological analysis. Histologically, it was possible to identify a chronic inflammatory, lymphoplasmacytic, and granulomatous reaction, with foreign body giant cells’ reaction, in relation to non-polarizable exogenous material due to the reaction to silicone. The most common complications are granulomas' appearance and material displacement. The case report shows these granulomas are characterized as chronic low-caliber inflammation around the silicone. They have an unknown etiology but are probably multifactorial, from continuous trauma, friction or irritation, iatrogenic factors, infection, immunological mechanisms, and genetic and molecular variations, and can be highly related to the impurity of the injected material.
... Simultaneously, the utilization of antibiotics is also imperative. In cases that local administration of hyaluronidase and antibiotic therapy prove to be ineffective, the administration of intralesional corticosteroids is recommended for patients (Lemperle et al., 2006;Beleznay et al., 2015). ...
Introduction
Biofilm formation is a major cause of delayed-graft complications. Similarly to implants, dermal fillers carry the risk of biofilm formation, which can lead to the development of nodules, chronic inflammatory reactions, abscesses and other complications. In this study, we investigated the late or delayed complications associated with biofilm formation on dermal fillers.
Methods
In this retrospective analysis, we analyzed all cases of complications caused by filler injections at a single center between January 2017 and December 2022, the majority of which comprised nodule formation and chronic persistent inflammatory reactions. The risk of biofilm formation with fillers was summarized and analyzed based on the results of bacterial culture and pathological examination.
Results
Sixty-one patients were enrolled, including 42 cases of nodule formation, 15 of chronic inflammatory reactions, and 4 of active infection. Bacterial culture of the tissue samples obtained from seven patients after surgical treatment were positive, and comprised four cases of Staphylococcus aureus, one case of Staphylococcus epidermidis, one case of Staphylococcus saprophyticus and one case of Mycobacterium abscessus. The corresponding histopathological results indicated extensive mononuclear lymphocyte infiltration, with a giant cell reaction in the fibrous connective tissue.
Conclusion
The results of this study suggest that biofilm formation is a significant risk factor for late and delayed complications following filler injection, and is caused by the contamination of resident bacteria and recessive infection at the injection site.
... Alternatively, some authors suggested that dermal fillers are not contraindicated in patients in whom wound healing is normal, even though they may have an underlying systemic disease [4,5]. In addition, Lemperle et al. have not found immunosuppression to delay wound healing, because fibroblasts need an approximately tenfold higher concentration of immunosuppressive drugs to be affected than do immunocytes [4]. ...
... Alternatively, some authors suggested that dermal fillers are not contraindicated in patients in whom wound healing is normal, even though they may have an underlying systemic disease [4,5]. In addition, Lemperle et al. have not found immunosuppression to delay wound healing, because fibroblasts need an approximately tenfold higher concentration of immunosuppressive drugs to be affected than do immunocytes [4]. Table 1 Patients' characteristics with autoimmune inflammatory rheumatic diseases (AIRD) within study group AIRD autoimmune inflammatory rheumatic diseases, AM esthetic medicine a Patients with more than one diagnosis were present Group 1-patients with AIRD without AM procedure history (n = 450) Group 2-patients with AIRD with a history of AM procedure (n = 47) Content courtesy of Springer Nature, terms of use apply. ...
... While some studies have indicated a potential link between esthetic procedures and autoimmune diseases involving the injection of fillers, breast implants, or tattoo ink [4,5,[17][18][19][20][21][22][23], others showed that there was no evidence of an association between AM procedures and AIRD [24]. Controlled epidemiological studies have not shown an actual link between silicone and systemic autoimmune diseases [25][26][27][28]. ...
The popularity of esthetic medicine is growing every year, also among patients with autoimmune inflammatory rheumatic diseases (AIRD). The objective of this study was to evaluate the safety of esthetic medicine (AM) procedures in patients with AIRD. A semi-structured, anonymous questionnaire regarding rheumatic and concomitant diseases and AM procedures was distributed among adult patients hospitalized in the rheumatology department or attending outpatient clinic in the National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw. The main outcome was the occurrence of an adverse event. A number of 512 patients took part in the survey and 15 were excluded (AM procedure preceded the diagnosis of AIRD). The study group consisted of 497 patients, of whom 47 had undergone AM procedures. The procedures performed included: tattooing (22 patients), piercing (16 patients), hyaluronic acid (7 patients), botulinum toxin (5 patients) injections, laser procedures (6 patients), plastic surgery (4 patients), mesotherapy (3 patients) and others. The vast majority of patients had these performed during remission or low disease activity. 70.2% of patients received treatment with disease-modifying antirheumatic drugs (DMARDs) during the AM procedure, with TNF-alfa inhibitors being the most common (63.6%). Adverse events occurred in 15% of patients. All were mild and transient site reactions. Most patients would like to repeat the AM procedure in the future. The use of esthetic medicine procedures in patients with AIRD, including those treated with biologic DMARDs, was associated with a risk of mild site reactions. Most of the patients expressed satisfaction with the results of the AM procedure.
... The face comprises 21 separate areas when considered from the point of view of filler use: "frontal 1 , temporal 2 , glabellar 3 , eyebrow 4 , upper eyelid 5 , lower eyelid 6 , nasociliary 7 , nasojugal sulcus 8 , eyelid lateral sulcus 9 , nasal 10 , malar 11 , zygomatic 12 , canine fossa 13 , nasolabial sulcus 14 , upper lip 15 (Figure 1A-B), lower lip 16 , cheek 17 , preauricular 18 , labiomental sulcus 19 , mentonian 20 , posterior mandibular region 21 (anterior border of the masseter as far as the angle of the jaw) and the anterior mandibular region (between the melolabial fold and the anterior border of the masseter) 1,[5][6][7][8][9][10] . ...
OBJECTIVE: The aim of this paper is to investigate the efficacy of filler applications which were evaluated in terms of nasal deformity and quality of life of the patients, and to review the fillers around the nose.
PATIENTS AND METHODS: Forty patients who underwent filler application were included into the study and were divided into Group 1 (Deep Radix), Group 2 (Minor irregularities due to rhinoplasty), Group 3 (Shallow dorsum) and Group 4 (Dorsal irregularity). There were 10 patients in each of the groups. In all groups, nasal deformity score was evaluated with a 1 to 5 scale as following: 1- No deformity, 2- Hardly visible deformity, 3- Visible deformity, 4- Moderate deformity, 5- Apparent deformity. Quality of life was evaluated by a 1 to 10 scale, 1 showing very low and 10 showing very high.
RESULTS: Our results showed that there were statistically significant improvements (decreased) in nasal deformity evaluation scores after the procedure compared to the before the procedure scores in Group 1 (Deep Radix), Group 3 (Shallow dorsum) and Group 4 (Dorsal irregularity) (p0.05). For nasal deformity evaluation after the procedure, Group 1 (Deep Radix), Group 3 (Shallow dorsum) and Group 4 (Dorsal irregularity) scores were significantly lower (better) than Group 2 (Minor irregularities due to rhinoplasty) scores (padjusted
... Although non-severe adverse reactions are neither life nor health threatening and thus are not of medical significance, they are cosmetically unacceptable. Nowadays, several tricks and improvements of the injection techniques have been made in order to avoid reactions caused by materials and procedures as much as possible [233]. Hypersensitive reactions are historically defined as the most common. ...
... Regardless of materials safety, appropriate handling and adequate experience are mandatory for minimizing the risk of complications and achieving the desired effect. An accurate guide on how to avoid and treat dermal filler complications has been developed by Lemperle et al. [233]. ...
Soft tissues diseases significantly affect patients quality of life and usually require targeted, costly and sometimes constant interventions. With the average lifetime increase, a proportional increase of age-related soft tissues diseases has been witnessed. Due to this, the last two decades have seen a tremendous demand for minimally invasive one-step resolutive procedures. Intensive scientific and industrial research has led to the recognition of injectable formulations as a new advantageous approach in the management of complex diseases that are challenging to treat with conventional strategies. Among them, collagen-based products are revealed to be one of the most promising among bioactive biomaterials-based formulations. Collagen is the most abundant structural protein of vertebrate connective tissues and, because of its structural and non-structural role, is one of the most widely used multifunctional biomaterials in the health-related sectors, including medical care and cosmetics. Indeed, collagen-based formulations are historically considered as the "gold standard" and from 1981 have been paving the way for the development of a new generation of fillers. A huge number of collagen-based injectable products have been approved worldwide for clinical use and have routinely been introduced in many clinical settings for both aesthetic and regenerative surgery. In this context, this review article aims to be an update on the clinical outcomes of approved collagen-based injectables for both aesthetic and regenerative medicine of the last 20 years with an in-depth focus on their safety and effectiveness for the treatment of diseases of the integumental, gastrointestinal, musculoskeletal, and urogenital apparatus.
... 8,[12][13][14] If these complications persist, intralesional steroids, or incision and drainage may be indicated. [15][16][17] If left untreated, it is possible that these nodules can lead to a more difficult dissection during surgery or unfavorable outcomes. Furthermore, there is a possibility that in some patients with ptotic skin or thicker subcutaneous tissue, nodules or granulomas may not be evident until the facelift surgery. ...
Background
Facial soft-tissue filler injections are being performed in the United States with increasing popularity.f
Objectives
This study aimed to characterize the observations of The Aesthetic Society members regarding the potential impact of repetitive panfacial fillers on the outcomes of subsequent facelift surgery.
Methods
A survey containing closed and open-ended questions was sent to The Aesthetic Society members through email.
Results
The response rate was 3.7%. The majority of the respondents (80.8%) believed that less than 60% of their facelift patients had previous repetitive panfacial filler injections. One half (51.9%) reported that a history of panfacial filler injections increased the difficulty of performing facelifts. A large subset (39.7%) of respondents believed that a history of panfacial fillers increased postoperative complication rates, while the remaining either disagreed (28.9%) or were unsure (31.4%). The most common complications following the facelift surgery included undesirable palpability or visibility of filler (32.7%), compromised flap vascularity (15.4%), and decreased longevity of the lifting effect (9.6%).
Conclusions
This study identified a potential association with repetitive panfacial filler injections and outcomes following facelift surgery, although the exact effect on postoperative outcomes remains unclear. Large prospectively designed studies are needed to capture objective data comparing facelift patients with a history of repetitive panfacial fillers with those facelift patients who have never had injectables. Given the results of The Aesthetic Society members’ survey, the authors encourage careful history-taking to elicit an accurate filler injection record including complications after filler injections, as well as engaging patients in a thorough preoperative discussion regarding the potential of panfacial fillers on the facelift procedure and postoperative outcomes.
Level of Evidence: 5
... So many surgeons will introduce the technique they use during the procedure to avoid the complications. However, serious complications such as dermal necrosis due to vascular obstruction are rare but still reported (39). Cluster 6 mainly concentrates on outcome and patient satisfaction of the rhinoplasty. ...
Background
As rhinoplasty (RP) with different requirements is becoming more and more popular in the latest decade, this study aims to quantitatively and qualitatively explore the trends in RP research, depict research hotspots, and point out the future direction with a bibliometric analysis.
Methods
All RP literature studies in the last decade (from 2012 to 2021) were retrieved from the Web of Science Core database. Annual output, institutions, authors, journals, and most-cited literature studies were analyzed by bibliometric tools, including CiteSpace, bibliometric online platform, bibliometrix R language kit, BICOMB, and gCLUTO.
Results
A total of 2,590 RP research studies dated between 2012 and 2021 were included according to our criterion. As for the country, the United States, Turkey, and Korea maintained the top three in RP research. As for the institutions, the University of California, Irvine, Stanford University, and University of Ulsan ranked top three in RP research publications based on article counts. Professor Rhorich RJ, Most SP, and Jang YJ were the most contributed authors according to article counts and citation number. The top journals were The Plastic and Reconstructive Surgery, JAMA Facial Plastic Surgery , and Aesthetic Surgery Journal . The 10 most-cited literature studies were also listed explicitly in this study. Finally, biclustering analysis on the most frequent keywords were conducted which helped us to identify seven hotspot clusters in RP research.
Conclusions
We comprehensively summarized the publication information of RP literature studies in the past decade, highlighted the current status and trends over time, and provide guidance for in-depth research direction on RP for the future.
... The association between 5-fluorouracil and betamethasone seems to have a more potent anti-inflammatory effect 3 and a lower risk of atrophy than intralesional corticosteroids alone. 3,4 Bleomycin, from experience with keloids and hypertrophic scars, may also work on granulomas. Systemic corticosteroids should be used for recurrent granulomas. ...
... Face filler or dermal filler refers to a small injection gel that adds volume to soft tissue and new non-surgical pathways to offer new facial life. All injectable dermal fillers can cause complexity [195]. Cosmetic injectable dermal fillers underneath the skin are generally reducing wrinkles of facial aging and provide facial enhancement. ...
... Bovine collagen, silicone, and Restylane have been used worldwide as dermal fillers. Thereafter, within the injectable to injectable materials pathologic nonallergic reactions differ but can always be classified into one of three separate forms of external body chronic inflammation [195]. An easily administered long-lasting filling agent should be non-toxic, not allergenic, carcinogenic, etc., and can be stored at room temperature without major changes. ...
Essentially cell forming and vigorous conjunctive tissues such as skin, joints, ligaments, and bones are expressed as fibril forming the most abundant protein collagen in the human body substantially about one-quarter by weight. Additionally, amongst the biopolymers, the collagen macromolecule is serving humanity in myriad ways. Although it has been used in cosmetics for a long time, nowadays its biological characteristics like nontoxic, biocompatible, biodegradable, structural integrity, cellular affinity and weak antigenicity have encouraged using of it significantly in biomedical and pharmaceutical applications. Its excellent biodegradability and notable bioactivity by endogenous collagenases enzyme convert exogenous collagen for biomedical use. Triple helix 29 collagen composed of three α-chain characteristic variants, type I is the most suitable extracellular matrix (ECM) macromolecule gradually consumed thickness and strength with time being, can be correlated with skin aging phenomena. This review focuses on the sources, structures, extractions, and properties (e.g., bioactive, mechanical, viscoelastic, tensile, etc.) of collagen proteins for use in biomedical applications. The abundance of collagen protein from a natural source can be effectively used in human tissue scaffolds, cardiac implantation, wound healin g, cornea membranes, dental membrane, dermal filler, cosmetic surgery, etc. as highlighted in this review. The application-based advantages and disadvantages of body-suits collagen are also discussed with prospects.
