Descriptive Analysis of 213 Positive Blood Aspiration Cases When Injecting Facial Soft Tissue Fillers

2020 ◽  
Author(s):  
Fang Wen Tseng ◽  
Kanthi Bommareddy ◽  
Konstantin Frank ◽  
Claudio DeLorenzi ◽  
Jeremy B Green ◽  
...  
Keyword(s):  
Soft Tissue ◽  
False Negative ◽  
Case Series ◽  
Facial Soft Tissue ◽  
Level Of Evidence ◽  
Injection Angle ◽  
Filler Injections ◽  
Soft Tissue Filler ◽  
Blood Aspiration

Abstract Background Pre-injection aspiration procedures could increase safety during soft tissue filler injections. However, various influencing factors have been detected in vitro that could result in false negative aspiration results. Objective A case series was retrospectively investigated to identify factors contributing to positive blood aspiration procedures in vivo. Methods This study evaluated 213 clinical cases positive for blood aspiration documented in an Asian population: 208 females (43.8 ± 7.2 years old) and 5 males (46.8 ± 7.8 years old) during soft tissue filler injections. Injection location, layer (depth) of injection, product injected, size of utilized needle (gauge), length of needle (inch), priming of needle (yes/no), injection angle (degree), and time until blood was visible in the needle hub (seconds) were evaluated. Results The most frequent location where a positive aspiration was observed was the pyriform fossa (n = 56; 26.3%), the most frequent plane was the supra-periosteal plane (n = 195; 91.5%), and the most frequent needle utilized was a 27G needle (n = 125; 58.7%). Statistically significantly more positive cases were identified when the needle was primed compared with an unprimed needle (P < 0.001, which was independent of the product). The estimated incidence rate was 0.04% to 0.9% for having positive aspiration procedures per total performed injection procedures. Conclusions Pre-injection aspiration could be a valuable tool to prevent accidental intravascular injection of soft tissue filler. The results of the present investigation show that aspiration can be performed with an acceptable aspiration time, that is, less than 2 seconds, if a suitable product/needle combination is chosen. Level of Evidence: 4

Quantitative Analysis of the Lifting Effect of Facial Soft-Tissue Filler Injections

2021 ◽  
Vol 147 (5) ◽  
pp. 765e-776e
Author(s):  
Rami Haidar ◽  
David L. Freytag, M.D. ◽  
Konstantin Frank ◽  
Christina Rudolph ◽  
Hassan Hamade, B.Sc. ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Soft Tissue ◽  
Facial Soft Tissue ◽  
Filler Injections ◽  
Soft Tissue Filler

Subperiosteal injections during facial soft tissue filler injections—Is it possible?

2019 ◽  
Vol 19 (3) ◽  
pp. 590-595 ◽  
Author(s):  
Tatjana Pavicic ◽  
Mariya Yankova ◽  
Thilo L. Schenck ◽  
Konstantin Frank ◽  
David L. Freytag ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Facial Soft Tissue ◽  
Filler Injections ◽  
Soft Tissue Filler

How to best utilize the line of ligaments and the surface volume coefficient in facial soft tissue filler injections

2019 ◽  
Vol 19 (2) ◽  
pp. 303-311 ◽  
Author(s):  
Gabriela Casabona ◽  
Francesco P. Bernardini ◽  
Brent Skippen ◽  
Gianna Rosamilia ◽  
Hassan Hamade ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Facial Soft Tissue ◽  
Volume Coefficient ◽  
Filler Injections ◽  
Soft Tissue Filler

Deformation of Needle Tips during Facial Soft Tissue Filler Injections: An Electron-Microscopic Study

2021 ◽  
Author(s):  
Mildred Lopez Pineiro ◽  
Jeremy B Green ◽  
Joely Kaufman ◽  
Patricia L Blackwelder ◽  
David L Freytag ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Improve Patient Safety ◽  
Influencing Factor ◽  
Global Scale ◽  
Facial Soft Tissue ◽  
Electron Microscopic ◽  
Needle Size ◽  
Objective Evidence ◽  
Filler Injections ◽  
Soft Tissue Filler

Abstract Background Injectable soft tissue fillers are used on a global scale for a variety of aesthetic indications. Despite their widespread use, there is a dearth of information regarding the potential repeated injections into tissue have to cause needle deformation. Repeated injections with the same needle result in an increase in force used by the injector to achieve dermal penetration, potentially resulting in decreased precision and increased patient discomfort. Objectives The objective of this study is to quantify the magnitude of needle tip deformation utilizing Scanning Electron Microscopy (SEM) image analysis. Methods An observational study was performed evaluating four differently sized needles following soft tissue filler injections for five different aesthetic indications (zygomatic arch, infraorbital, mid cheek, nasolabial sulcus and perioral) in patients aged 36-64 years old. Following treatment, each needle was visualized and imaged through SEM, and the percentage of deformation in relation to the total amount of needle tip surface was calculated. Results The most influencing factor for needle tip damage was revealed to be the number of injection passes, ie, dermal transitions. Per injection procedure, an increase in needle tip damage of 4.7% occurred. Touching the bone deformed the needle tip by 9.6% and the increase in needle size allowed for 0.13% more damage. Conclusions To the authors’ knowledge, this is the first SEM investigation to provide objective evidence for the deformation of needle tips after repeated facial soft tissue filler injections. This data may help improve patient safety and comfort during these minimally invasive procedures.

Surgeon's Guide to Facial Soft Tissue Filler Injections: Relevant Anatomy and Safety Considerations

2017 ◽  
Vol 75 (12) ◽  
pp. 2667.e1-2667.e5 ◽  
Author(s):  
Elie M. Ferneini ◽  
Steven Hapelas ◽  
James Watras ◽  
Antoine M. Ferneini ◽  
Drew Weyman ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Facial Soft Tissue ◽  
Filler Injections ◽  
Soft Tissue Filler ◽  
Safety Considerations

scholarly journals Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097434
Author(s):  
Daniel F. O’Brien ◽  
Lilah Fones ◽  
Victoria Stoj ◽  
Cory Edgar ◽  
Katherine Coyner ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Case Series ◽  
Graft Fixation ◽  
Level Of Evidence ◽  
Lateral Cortex ◽  
Suture Button ◽  
Suspensory Fixation

Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

scholarly journals Arthroscopic treatment of anteromedial ankle impingement

2020 ◽  
Vol 14 (3) ◽  
pp. 260-263
Author(s):  
Guillermo Arrondo ◽  
Daniel Gómez ◽  
Germán Joannas ◽  
Xavier Martín-Oliva ◽  
Matías Iglesias ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Case Series ◽  
Functional Results ◽  
Level Of Evidence ◽  
Bony Impingement ◽  
Soft Tissue Impingement ◽  
Arthroscopic Removal ◽  
Physical Impact

Objective: Impingement syndromes are recognized as an important cause of chronic ankle pain, which results from the entrapment of an inflamed soft-tissue component between the osteophytes. The predominant site of occurrence is the anterolateral aspect of the ankle for soft-tissue impingement, and anteromedial aspect for bony impingement. Symptoms related to the physical impact of bone or soft-tissue pain often result in limited ankle range of motion. Methods: We conducted a retrospective study of 34 patients (34 ankles) with anteromedial bony impingement. All patients underwent arthroscopy, with a mean follow-up of 34 months. Results: All osteophytes were removed, and the ankle range of motion improved. The AOFAS score improved from 73 preoperatively to 95 postoperatively. Conclusion: The arthroscopic removal of the anteromedial osteophytes of the ankle had excellent functional results. It is an effective procedure that allows rapid patient recovery. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals In Vitro Evaluation of the Sensitivity of a Hyaluronic Acid PEG Cross-Linked to Bovine Testes Hyaluronidase

2018 ◽  
Vol 6 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Nicola Zerbinati ◽  
Torello Lotti ◽  
Damiano Monticelli ◽  
Virginia Martina ◽  
Giovanna Cipolla ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Soft Tissue ◽  
Chemical Reaction ◽  
Time Course ◽  
Soft Tissue Augmentation ◽  
Facial Soft Tissue ◽  
Microplate Reader ◽  
Kinetics Of

Neauvia Intense is biocompatible, injectable hyaluronic acid (HA) filler PEG cross-linked for facial soft-tissue augmentation that provides volume to tissues. The aim of the present study is to evaluate the sensitivity of Neauvia Intense in hyaluronidase from bovine testes in a time-course analysis. The test is based on the colourimetric determination of the N-acetyl – D - glucosamine (NAG) released by the hyaluronidase in standardised conditions. The in vitro conditions involve the treatment of Neauvia Intense with a known concentration of the enzyme (6080U/ml). The NAG content was determined at different times to assess the kinetics of the degradation (1h, 3h, 6h, 24h, 48h, 72h, 120h, and 168h); the Ehrlich’s reagent was used for the colourimetric quantification, by the method described by Reissing and colleagues. The intensity of the violet colour developed after the chemical reaction was proportional to the NAG present in each sample. A microplate reader at 585 nm read the absorbance. The amount of NAG released by the product was proportional to the time of incubation with bovine hyaluronidase, reaching a plateau after 168 hours.

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