Complications and Disasters After Minimally Invasive Tissue Augmentation with Different Types of Fillers: A Retrospective Analysis

Background The interest in youthful appearance and rejuvenating procedures is unbroken in our society. Besides surgical procedures, permanent fillers are utilized. The incorrect and unprofessional use of these substances, auto-injections in particular, have devastating results for patients and are challenging for the plastic surgeon. The aim of this retrospective study was to delineate the differences between permanent and non-permanent filler complications and appropriate treatment options. Methods We conducted a retrospective study and researched the hospital information system in the time period from 2001 to 2020. Patients with unprofessional use of permanent fillers, auto-injections and injections of unformulated substances were determined. Age, gender, localization, complications, length of hospital stay, comorbidities, histopathological workups and surgical salvage procedures were noted. Descriptive statistics were calculated. Results Seventeen patients were identified from 2001 till 2020. In four cases, auto-injections by the patients were the cause, whereas in the other patients the injections were performed by medical staff. Ages range from 18 to 57 years. Fourteen patients were female and three were male. The injected substances could be recognized as synthol, silicone, vaseline, fat tissue, hyaluronic acid as well as non-medical substances. Surgical procedures were necessary in eleven cases. One patient died because of the underlying diseases. Conclusion Our results indicate different sequels of filler materials injected in an unprofessional way, possible complications, conservative and surgical techniques to resolve these rare complications. We suggest a staged therapy adjusted to the clinical symptoms. Milder symptoms can be handled conservatively, whereas severe infections, skin breakdowns or persistent granuloma are justifying indications for surgical treatment. Level of Evidence V 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.

FRI0238 AUTOLOGOUS FAT GRAFTING IN THE TREATMENT OF FACIAL SCLERODERMA: A SINGLE - CENTRE EXPERIENCE

Background:Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations are disabling and treatment options are limited. Fat Tissue Grafting (FTG) can be used for treating facial manifestations of the fibrosis.Objectives:In this study, we aimed to assess the safety and efficacy of FGT of our cohort of patients with SSc.Methods:We enrolled 20 SSc (18 W, 2 M) patients, from 2016 to 2019, suffering from facial sclerosis and restricted mouth opening capacity. FTG was carried out in accord with modified Colemans’ procedure (1): fat tissue was taken from periumbilical or trochanteric areas and was injected in 8 different points around the mouth. No side effects or adverse reactions have been documented. Evaluations included mouth opening capacity by measuring interincisal distance, oral functionality (MHISS scale) and patient global satisfaction (by Global Health scale).Results:A 11 mm (8 - 18mm range) median increase of interincisal distance was reported at month 6 and in 80% of patients at month 12, too (p<0.03). A significant improvement in MHISS scale was also observed (p<003). The patient satisfaction questionnaire showed 95% positive results and 80% of the patient replied affirmatively to the question about the repetition of FTG but only 2 patients required new FTG after 12 months.Conclusion:Our results showed that FTG improved mouth opening capacity and that aesthetic and functional results were satisfying to about 90% of the patients; long-term effects of this type of treatment are currently unknown. However, our and litterature data at 12 months follow-up seems to confirm the benefits in long term, despite the filling effect is over.This study – that’s one of the largest case series described right now (2) - supports the possible therapeutic role of autologous FTG in improving facial scleroderma both in aesthetic and in functional aspects.References:[1]Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg. 2006; 118: 108S-20S[2]Fat Grafting for the Treatment of Scleroderma.Strong AL, Rubin JP, Kozlow JH, Cederna PS. Plast Reconstr Surg. 2019 Dec;144(6):1498-1507. doi: 10.1097/PRS.0000000000006291.Disclosure of Interests:None declared

Purified Polydimethylsiloxane (Silicone) as Dermal Filler Resolving the Controversy?

Dermal fillers are widely used in Medical and Surgical Cosmetic practices. Temporary and semipermanent fillers are more commonly used for a wide variety of reasons; however, permanent fillers represent an excellent option in properly selected patients. The aim of this study is to evaluate the off-label use of Silikon 1000 (S1000) as a permanent filler analyzing safety, durability, and patient satisfaction. This was a retrospective chart review of prospectively collected data. The study included 25 patients who underwent S1000 injection in 32 treatment areas. The following parameters were assessed: age, gender, weight, height, body mass index (BMI), number of treatments, duration of treatments, follow-up, complications, and interventions. Patients who had other fillers injected into the same area within 1 year before or after the S1000 injection were excluded from the study. In all, 32 treatment areas in 25 patients (21 females, 4 males) were included in the study. Five female patients received S1000 in more than one area. Treatment areas included the following: nose (n = 4), lips (n = 16), glabella (n = 4), nasolabial folds (n = 3), scars (acne or others) (n = 2), orbital rim (n = 2), and perioral (n = 1). Extrusion of silicone, migration, cosmetic deformity, hematoma, seroma, and infection were considered as inclusive criteria for injection complications. None of the patients developed any complications along the course of follow-up that ranged from 8-38 months; therefore, no intervention or surgery was needed to treat any adverse outcomes. All patients reported high satisfaction with the cosmetic results. Off-label use of highly purified polydimethylsiloxane as dermal filler is safe and durable. Being conservative is key to optimize outcomes and avoid complications. Proper approach involves injection of small doses using microdroplet technique to augment the tissue gradually over sessions at 1-2 months apart. Complications as silicone migration and irregularities can be largely avoided by following proper techniques and understanding the unique mechanism of action of S1000 compared with traditional fillers.

Acute Inflammatory Reaction Following Removal of Hydrophilic Polyacrylamide Gel

Hydrophilic polyacrylamide gel (PAAG), although not approved for use in the United States, has been used throughout the world as a permanent filler for aesthetic applications since the 1980s. Numerous articles and case reports have been published highlighting complications arising from its use. In this case report, we present a 54-year-old woman who presented for surgical consultation, requesting removal of previously injected polyacrylamide gel with subsequent silicone implant breast augmentation who experienced an acute reaction following attempted removal of the gel. This report reviews the current use, complications, and management of complications in patient’s previously injected with PAAG.

Facial Gel Complication after Dental Injection: A Case Report

Injectable gel is becoming increasingly popular for cosmetic reasons. The polyacrylamide gel (PAAG) is a permanent filler material used worldwide. In spite of the fact that the filler materials used today are considered quite safe, various complications have been reported in the literature. Hence PAAG use in the United States is not popular. As the area is very close to the dental field, a large complication potential is relatively considered following buccal dental injections. The aim of this article is to highlight a rare complication observed following a local anesthetic administration of a simple molar restoration in a healthy 33-year-old woman who had history of a filler augmentation in her cheek approximately 6 years ago.