Sara Carella1, Giulia Ruggeri2,3, Raffaele La Russa4,5, Gianpietro Volonnino6, Paola Frati5,6, Maria Giuseppina Onesti1. 1. Department of Surgery "P. Valdoni", Unit of Plastic Surgery "P. Valdoni", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. 2. Department of Surgery "P. Valdoni", Unit of Plastic Surgery "P. Valdoni", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. giulia.ruggeri@uniroma1.it. 3. Department of Surgery "P. Valdoni", Unit of Plastic Surgery "P. Valdoni", Sapienza University of Rome, Via Franco Sacchetti 19, 00137, Rome, Italy. giulia.ruggeri@uniroma1.it. 4. Departement of Clinical and Experimental Medicine, University of Foggia, 71122, Foggia, Italy. 5. IRCSS Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077, Pozzilli, Italy. 6. Departement of Anatomical, Histological, Forensic and Orthopedic Science, Sapienza University of Rome, Viale Regina Elena 336, 00161, Rome, Italy.
Abstract
AIM: Dermal fillers have been progressively used for cosmetic procedures. Concurrently, the rates of filler complications have also increased. The aim of this study is to describe the clinical management and treatment we performed in patients with complications occurred after filler injection. METHODS: From March 2000 to February 2020, 197 patients have been evaluated for complications due to filler injection. For each patient type of material, symptoms and signs were recorded. Ultrasound evaluation was used to obtain information about the type, amount and location of the injected material. Magnetic Resonance Imaging was performed in those patients who were candidate for surgery. Based on the clinical manifestations, we performed a targeted therapy. RESULTS: The local and systemic medical therapy allowed us a complete remission of the clinical signs and symptoms in all patients presented with edema and erythema. We obtained optimal results with surgery, where a complete removal of the injected material was possible. In all the cases in which the complete removal of the infiltrated area could have led to functional impairments, we performed partial removal with poor outcomes. CONCLUSION: We observed complex clinical manifestations in the patients subjected to permanent fillers. An accurate knowledge upon the effects of the materials on tissues, a specific instrumental evaluation and a targeted therapy are crucial. We suggest the use of absorbable fillers. Patient should be subjected to filler implant in authorized structures by an expert specialist with experience in filler injection and with a thorough knowledge of the anatomical structures. LEVEL OF EVIDENCE IV: 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 .
AIM: Dermal fillers have been progressively used for cosmetic procedures. Concurrently, the rates of filler complications have also increased. The aim of this study is to describe the clinical management and treatment we performed in patients with complications occurred after filler injection. METHODS: From March 2000 to February 2020, 197 patients have been evaluated for complications due to filler injection. For each patient type of material, symptoms and signs were recorded. Ultrasound evaluation was used to obtain information about the type, amount and location of the injected material. Magnetic Resonance Imaging was performed in those patients who were candidate for surgery. Based on the clinical manifestations, we performed a targeted therapy. RESULTS: The local and systemic medical therapy allowed us a complete remission of the clinical signs and symptoms in all patients presented with edema and erythema. We obtained optimal results with surgery, where a complete removal of the injected material was possible. In all the cases in which the complete removal of the infiltrated area could have led to functional impairments, we performed partial removal with poor outcomes. CONCLUSION: We observed complex clinical manifestations in the patients subjected to permanent fillers. An accurate knowledge upon the effects of the materials on tissues, a specific instrumental evaluation and a targeted therapy are crucial. We suggest the use of absorbable fillers. Patient should be subjected to filler implant in authorized structures by an expert specialist with experience in filler injection and with a thorough knowledge of the anatomical structures. LEVEL OF EVIDENCE IV: 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 .
Authors: Murad Alam; Hayes Gladstone; Edward M Kramer; Jack P Murphy; Keyvan Nouri; Isaac M Neuhaus; James M Spencer; Elizabeth Spenceri; Susan Van Dyke; Roger I Ceilley; Ken K Lee; Gregg Menaker; Gary D Monheit; David S Orentreich; Benjamin Raab; Kevin C Smith; Nowell J Solish Journal: Dermatol Surg Date: 2008-06 Impact factor: 3.398