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.

Actinomyces Infection after Permanent Fillers Lip Augmentation: Diagnosis and Treatment

Background: Although dermal filler injections are a widespread and secure practice, early or late complications may nonetheless occur. Objective: In this paper, the authors report an unusual asymptomatic late filler infection caused by Actinomycetes in a patient having received liquid silicone and acrylate filler injections for lip enhancement, seeking treatment for upper lip macrocheilia. Methods: The case report is about a patient who complained of recurrent lip region edema and denied any infective episodes. Preoperative analysis was in the normal range. Sonographic exam showed two fillers in the upper lip, suggestive of silicone and polyacrylamide gel. A conservative macrocheilia reduction was performed; healing was uneventful. Results: Histology report confirmed the preoperative sonographic diagnosis, together with an actinomycetes infection, clinically unsuspected. Many microorganisms have been reported to cause abscesses or granuloma after dermal filler treatments, sterile abscesses were reported as well, suggesting a biofilm infection as causative granuloma origin. Conclusion: This study differs from previous filler complication reports because of the occasional finding of a silent actinomyces infection, a commensal of the oral cavity but responsible for suppurative diseases in the soft tissues. This occasional finding seems to support the biofilm origin of dermal filler granuloma.

Dermal filler migration complications following lip augmentation procedures

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.

Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples

Background Autologous fat is known for a reliable and natural safety profile, but complications do occur—even serious vascular adverse events. Objectives The authors sought to examine doppler-ultrasound (DUS) imaging for the harvesting and subsequent facial implantation of autologous fat tissue. Methods All patients underwent lipofilling treatment of the temporal fosse of the face. DUS examination was performed for preprocedural vascular mapping and imaging of previously injected (permanent) fillers. In addition, the injection of autologous fat was performed DUS-guided. Results Twenty patients (all female; mean age, 57.9 years; range, 35-64 years). DUS examination showed that 16 of the 20 patients (80%) had been injected with resorbable or nonresorbable fillers elsewhere in the past. The temporal artery could be visualized and avoided in all cases. An average of 1.1 cc of autologous fat was injected in the temporal fossa per side. One case of edema and nodules was described, but no other adverse events were reported. Conclusions The utilization of DUS can add valuable information to a lipofilling procedure and should be considered an integral part of a safe lipofilling treatment. Level of Evidence: 4

Analysis of Natural Frequencies of Voided Biaxial Concrete Slabs

Voided slabs using voids formed by permanent fillers or removable forms have been used in reinforced concrete floor systems for more than 100 years. In this article we will focus on the natural frequency of voided biaxial slabs system Cobiax. Cobiax void former modules are synthetic hollow spheres or rotational ellipsoids mounted in the relevant spaces between the upper and lower reinforcement. We have analyzed the slabs of different thicknesses with adequate void former modules and spans following the manufacturer's recommendations. All models were considered as simply supported slabs. Natural frequencies calculated using simplified analytical methods have been compared with those obtained by numerical methods. Numerical calculation was done using the 2D elements with reduced properties and using the accurate 3D model of a structure.