Dermal fillers and biofilms: implications for aesthetic clinicians

In recent years, a great deal of attention has been paid to the diagnosis and management of complications arising from the use of dermal fillers. However, alongside the clinical factors, professional considerations must not be neglected, because to do so can lead to often avoidable claims

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Toward Physicochemical and Rheological Characterization of Different Injectable Hyaluronic Acid Dermal Fillers Cross-Linked with Polyethylene Glycol Diglycidyl Ether

Polymers ◽

10.3390/polym13060948 ◽

2021 ◽

Vol 13 (6) ◽

pp. 948

Author(s):

Nicola Zerbinati ◽

Sabrina Sommatis ◽

Cristina Maccario ◽

Maria Chiara Capillo ◽

Giulia Grimaldi ◽

...

Keyword(s):

Hyaluronic Acid ◽

Polyethylene Glycol ◽

Biological Activities ◽

Diglycidyl Ether ◽

Dermal Filler ◽

Cross Linking ◽

Matrix Structure ◽

Dermal Fillers ◽

Rheological Characterization

(1) Background: Injectable hyaluronic acid (HA) dermal fillers are used to restore volume, hydration and skin tone in aesthetic medicine. HA fillers differ from each other due to their cross-linking technologies, with the aim to increase mechanical and biological activities. One of the most recent and promising cross-linkers is polyethylene glycol diglycidyl ether (PEGDE), used by the company Matex Lab S.p.A., (Brindisi, Italy) to create the HA dermal filler PEGDE family. Over the last few years, several studies have been performed to investigate the biocompatibility and biodegradability of these formulations, but little information is available regarding their matrix structure, rheological and physicochemical properties related to their cross-linking technologies, the HA content or the degree of cross-linking. (2) Methods: Seven different injectable HA hydrogels were subjected to optical microscopic examination, cohesivity evaluation and rheological characterization in order to investigate their behavior. (3) Results: The analyzed cross-linked dermal fillers showed a fibrous “spiderweb-like” matrix structure, with each medical device presenting different and peculiar rheological features. Except for HA non cross-linked hydrogel 18 mg/mL, all showed an elastic and cohesive profile. (4) Conclusions: The comparative analysis with other literature works makes a preliminary characterization of these injectable medical devices possible.

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Dermal Filler Complications from Unknown Biomaterials

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e3182827741 ◽

2013 ◽

Vol 131 (4) ◽

pp. 597e-603e ◽

Cited By ~ 3

Author(s):

Paolo Persichetti ◽

Dario Palazzolo ◽

Stefania Tenna ◽

Igor Poccia ◽

Franca Abbruzzese ◽

...

Keyword(s):

Dermal Filler ◽

Filler Complications

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Anatomical Variations in the Course of Labial Arteries: A Literature Review

Aesthetic Surgery Journal ◽

10.1093/asj/sjy235 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1225-1235 ◽

Cited By ~ 5

Author(s):

Souphiyeh Samizadeh ◽

Ali Pirayesh ◽

Dario Bertossi

Keyword(s):

Literature Review ◽

Anatomical Variation ◽

Anatomical Variations ◽

Great Variability ◽

Dermal Filler ◽

Functional Importance ◽

Dermal Fillers ◽

Cutaneous Necrosis ◽

Complex Anatomy ◽

Vascular Compromise

AbstractBackgroundNonsurgical lip enhancement using dermal fillers is a very popular procedure. The trend for enlarged lips has been popularized by media and social media. The lips have considerable aesthetic and functional importance, in addition to having a complex anatomy. Serious complications, including vascular compromise or occlusion leading to cutaneous necrosis and blindness, can occur as the result of lip enhancement using dermal fillers. Therefore, aesthetic practitioners require an in-depth understanding of the anatomy and vasculature of the lips and the perioral area prior to providing lip enhancement using dermal fillers.ObjectivesThis literature review aimed to summarize existing data describing the origin, path, and depth of the superior and inferior labial arteries, and to help aesthetic practitioners in providing safer injections to the lips.MethodsA literature search was carried out to summarize the available data describing the origin, path, and depth of the labial arteries.ResultsAnalysis of the literature revealed that the labial arteries display great variability with respect to path (distribution), presence, and location.ConclusionsIncreasing the volume of lips through injections of dermal filler needs to be undertaken with caution, and awareness of the anatomical variation in artery location and path is a crucial concept that is essential when injecting the lips.

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Adjuncts to Facial Rejuvenation

10.2310/ps.10038 ◽

2020 ◽

Author(s):

Heather R. Faulkner

Keyword(s):

Soft Tissue ◽

Facial Rejuvenation ◽

Dermal Filler ◽

Nasolabial Fold ◽

High Quality ◽

The Past ◽

Appropriate Treatment ◽

Soft Tissue Filler ◽

Facial Anatomy ◽

Filler Complications

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail. This review contains 2 tables, and 52 references. Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold

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Cetuximab associated dermal filler reaction

BMJ Case Reports ◽

10.1136/bcr-2018-228882 ◽

2019 ◽

Vol 12 (8) ◽

pp. e228882 ◽

Cited By ~ 1

Author(s):

Shivanshan Pathmanathan ◽

Marcin Dzienis

Keyword(s):

Epidermal Growth Factor Receptor ◽

Radiation Therapy ◽

Hyaluronic Acid ◽

Growth Factor ◽

Epidermal Growth Factor ◽

Growth Factor Receptor ◽

Dermal Filler ◽

Dermal Fillers ◽

Epidermal Growth ◽

Receptor Inhibitor

A 52-year-old male patient with hyaluronic acid-based dermal fillers injected in his cheeks was diagnosed with glossotonsillary malignancy, and managed with concurrent cetuximab (epidermal growth factor receptor inhibitor) and radiation therapy. He developed significant inflammation around the dermal filler sites after first cycle of cetuximab which improved with dissolution of the dermal fillers with hyaluronidase. This suggests that cetuximab can lead to inflammation around the dermal filler sites, which can be treated with dissolution of the filler.

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Dermal filler migration complications following lip augmentation procedures

Journal of Aesthetic Nursing ◽

10.12968/joan.2020.9.7.276 ◽

2020 ◽

Vol 9 (7) ◽

pp. 276-281

Author(s):

Danielle Davy

Keyword(s):

Hyaluronic Acid ◽

Rare Complication ◽

Post Treatment ◽

The Body ◽

Dermal Filler ◽

Dermal Fillers ◽

Short Term ◽

Lip Augmentation ◽

Permanent Fillers

Filler migration is a rare complication of dermal filler treatment. Although most research has found that more permanent fillers, such as silicone, are more likely to migrate due to their long-term presence in the body, there have also been reported cases of filler migration from short-term hyaluronic acid-based dermal fillers. As lip augmentation procedures are fast becoming one of the most frequently requested treatments in medical aesthetics, this article looks at the longevity of hyaluronic acid lip dermal fillers, while also aiming to assess the cause of dermal filler post-treatment migration and evaluating how to minimise its risk.

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HA-based dermal filler: downstream process comparison, impurity quantitation by validated HPLC-MS analysis, and in vivo residence time study

Journal of Applied Biomaterials & Functional Materials ◽

10.1177/2280800019867075 ◽

2019 ◽

Vol 17 (3) ◽

pp. 228080001986707 ◽

Cited By ~ 2

Author(s):

Cristian Guarise ◽

Carlo Barbera ◽

Mauro Pavan ◽

Susi Panfilo ◽

Riccardo Beninatto ◽

...

Keyword(s):

Residence Time ◽

Rabbit Model ◽

Diglycidyl Ether ◽

In Vitro Cytotoxicity ◽

Dermal Filler ◽

Dermal Fillers ◽

Process Comparison ◽

Hygroscopic Properties

The success of hyaluronic acid (HA)-based dermal fillers, with more than 2 million minimally invasive procedures conducted in 2016 in the US alone, is due to their hygroscopic properties of biocompatibility and reversibility. The type and density of HA cross-linkage, as well as the manufacturing technology, may influence not only the in vivo persistence but also the safety profile of dermal fillers. 1,4-Butanediol diglycidyl ether (BDDE) is the cross-linker used in most market-leading HA fillers; 1,4-butanediol di-(propan-2,3-diolyl) ether (BDPE) is the major impurity obtained from the HA–BDDE cross-linking (HBC) process. In this work, a new process to obtain high purity HBC fillers was developed. A new HPLC-MS method was validated for the quantification of BDPE content in HBC dermal fillers. In vitro cytotoxicity of BDPE was evaluated in fibroblasts (IC50 = 0.48 mg/mL). The viscoelasticity was monitored during the shelf-life of the HBC-10% hydrogel and was correlated with in vitro hyaluronidase resistance and in vivo residence time in a rabbit model. This analysis showed that elasticity is the best parameter to predict the in vivo residence time. Finally, a series of parameters were investigated in certain marketed dermal fillers and were compared with the results of the HBC-10% hydrogel.

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