• Archives of Plastic Surgery
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• v.51 no.1
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• pp.20-26
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• 2024

The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient's immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient's immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.297-300
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• 2020

Hyaluronidase, an enzyme that breaks down hyaluronic acid, has long been used to increase the absorption of drugs into tissue and to reduce tissue damage in cases of extravasation of a drug. With the increasing popularity of hyaluronic acid filler, hyaluronidase has become an essential drug for the correction of complications and unsatisfactory results after filler injection. For this reason, when performing procedures using hyaluronic acid filler, a sufficient knowledge of hyaluronidase is required. In order for hyaluronidase to dissolve a hyaluronic acid filler, it must interact with its binding sites within the hyaluronic acid. The reaction of a filler to hyaluronidase depends on the hyaluronic acid concentration, the number of crosslinks, and the form of the filler. Hyaluronidase is rapidly degraded and deactivated in the body. Therefore, in order to dissolve a hyaluronic acid filler, a sufficient amount of hyaluronidase must be injected close to the filler. If the filler is placed subcutaneously, injection of hyaluronidase into the filler itself may help, but if the filler is placed within a blood vessel, it is sufficient to inject hyaluronidase in the vicinity of the vessel, instead of into the filler itself. Allergic reactions are a common side effect of hyaluronidase. Most allergic reactions to hyaluronidase are local, but systemic reactions may occur in infrequent cases. Since most allergic responses to hyaluronidase are immediate hypersensitivity reactions, skin tests are recommended before use. However, some patients experience delayed allergic reactions, which skin tests may not predict.

• Archives of Plastic Surgery
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• v.50 no.4
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• pp.348-353
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• 2023

Doppler ultrasound can be used to detect almost all arteries of the face before injecting the hyaluronic acid (HA) filler. The relatively more dangerous sites of filler injection are the glabellar wrinkle, forehead, temple, nose, and nasolabial fold area, and it is recommended to map the vasculature of these areas by Doppler ultrasound before performing filler injection. The Doppler ultrasound detection method is included as a video. Internal carotid arterial branches, the supratrochlear, supraorbital, and dorsal nasal arteries, and external carotid arterial branches, the superficial temporal and facial arteries, are very important arteries when injecting HA filler; thus, Doppler ultrasound detection is recommended.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.14-19
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• 2024

Background Hyaluronic acid fillers can be manufactured using various processes. They have multiple properties, including their concentration, degree of modification, and rheological data. Cohesion is one such property to evaluate gel integrity; however, there is no standardized method for calculating this parameter. This study aimed to evaluate different tests for calculating hyaluronic acid cohesion and discuss the importance of hyaluronic acid cohesion as a consideration when selecting fillers. Methods The cohesion levels of five different hyaluronic acid fillers with different rheological properties were evaluated and compared using the drop weight, compression, tack, and dispersion time tests. Results The cohesion tests yielded different results in the samples. Samples 2 and 4 showed approximately two times the number of droplets when compared with Sample 5 in drop weight test. Samples 1, 2, 3, and 4 were superior to Sample 5 in tack test. Samples 1, 2, and 3 showed cohesive appearances at 95 seconds in most cases in dispersion test. Rheological test results did not reflect the measures of cohesion. Conclusion Although there are no definite standardized tests to evaluate the cohesion of hyaluronic acid fillers, our proposed tests showed similar results for different hyaluronic acid filler products. Further studies are needed to evaluate the cohesion of hyaluronic acid fillers and determine the clinical use of this distinguishing characteristic for clinicians selecting the product of choice. Level of evidence statement: These data are Level IV evidence.

• Journal of Veterinary Clinics
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• v.37 no.5
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• pp.292-294
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• 2020

A 14-year-old castrated male Persian cat presented with epiphora, blepharospasm, brownish ocular discharge, corneal neovascularization, and corneal opacity in the left eye. Medial lower eyelid entropion was diagnosed through an ophthalmic examination. Since the cat was old and suffered from chronic kidney disease, we decided to perform a hyaluronic acid (HA) subdermal filler injection without general anesthesia rather than surgical correction. After topical anesthesia by lidocaine jelly and disinfection, HA filler was injected into the medial lower eyelid under minimal physical restraint. At the last follow-up 139 days later, lower eyelid entropion was not observed and related clinical signs disappeared. Therefore, HA subdermal filler can be an effective intervention for the treatment of entropion in cats.

• Journal of Biomedical Engineering Research
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• v.40 no.4
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• pp.137-142
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• 2019

Numerous efforts are being made to develop an ideal dermal filler that should be bio-compatibility, non-immunogenicity, long-lasting and biodegradable without a toxic secretion. Biomaterials of dermal fillers are hyaluronic acid filler, calcium filler, PMMA filler and collagen filler depending on the ingredient. Although hyaluronic acid (HA) is most widely used, it has shortages such as short shelf life and low mechanical strength compare to extracellular matrix (ECM). The cartilage ECM composed of collagen type II, proteoglycans, glycosaminoglycans (GAGs) and in a minor part with glycoproteins. In this study, we developed a cartilage ECM injectable filler capable of improving biocompatibility and longevity compared with hyaluronic acid (HA) fillers. The ECM hydrogel was cross-linked by the reaction of N-(3-Dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride (EDC)/N-hydroxysuccinimide (NHS) for mechanical enhancement. Prepared ECM filler was compared with cross-linked HA by butanediol diglycidyle ether (BDDE), which is the most widely used natural polymers for dermal filler. In the results, the articular cartilage ECM hydrogel has great potential as a dermal filler to improve the biophysical and biological performance.

• Archives of Plastic Surgery
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• v.47 no.4
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• pp.301-304
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• 2020

Dermal injectables are the most popular material for facial enhancement, including volumizing and wrinkle correction. However, although hyaluronic acid is the most common component of dermal injectables, the character of hyaluronic acid products is quite variable. These materials can be described in terms of their viscoelastic properties using four parameters. In this article, the author would like to describe these properties in detail. Although many physicians consider this material to be convoluted, thoroughly understanding the characteristics of various injectables enables us to tailor procedures accordingly and to enhance the final results.

• Journal of Biomedical Engineering Research
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• v.38 no.1
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• pp.1-8
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• 2017

The successful synthesis of hyaluronic acid micro-threads is very promising approach for the broad application in tissue engineering such as dermal fillers. Because hyaluronic acid has the excellent biocompatibility and ability to maintain the moisture of up to several hundred times its own weight. In order to generate the hyaluronic acid micro-threads in microfluidic system, we employed two-phase flow microfluidic chip to make a rapid synthesis of the hyaluronic acid hydrogel. Hyaluronic acid was mixed with 0.02N NaOH solution and 1, 4-Butanediol diglycidyl ether (BDDE) solution and then injected into core channel. The ethanol was used for the 3-dimensional micro-thread formation in sheath channel. We manipulated the diameter of HA micro-threads using controlling of flow rates in microfluidic chip, and showed the feasibility of immobilization in HA micro-threads with florescent substances. Also, the generated HA micro-threads were evaluated and showed the suitable properties with tensile strength, bending property, and swelling profiles for dermal fillers. As a result, we suggested an innovative method for microfluidic chip-based HA micro-threads which could safely be applied as dermal filler in tissue engineering.

• Annals of dermatology
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• v.30 no.6
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• pp.704-707
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• 2018

Parry Romberg Syndrome (PRS), also known as idiopathic progressive hemifacial atrophy, is a rare neurocutaneous disorder characterized by loss of skin and subcutaneous fat of face, muscles, and bones causing unilateral atrophy. Most patients require only soft tissue augmentation although syndrome has varying grades of severity. In the majority of reported cases, it has been treated with surgical flap or autologous fat transplantation. However, these treatments need complicated surgical skills which take a lot of time and cost. Herein we report the first case of PRS augmented by hyaluronic acid (HA) filler in a 42-year-old female patient to suggest that HA filler could be a safe, simple, and even rational economic alternative to surgical treatment.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.1-6
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• 2011

Purpose: Currently, soft tissue filler products based on hyaluronic acid are widely used. They are safe, effective, and convenient to use compared with bovine collagens. However, all commercially available hyaluronic acid based fillers in Korea are imported ones. The purpose of this study is to evaluate efficacy of a new hyaluronic acid filler (HyaFilia; CHA bio&Diostech Co., Seoul), which has been recently developed in Korea. Methods: Three kinds of soft tissue fillers, including Restylane (Q-Med, Uppsala, Sweden), HyaFilia (CHA bio & Diostech Co., Seoul), Juvederm (Allergan, CA, USA), were injected subdermally into the back of hairless mice at six sites. The 2 cephalic sites composed Restylane groups, the 2 middle sites HyaFilia groups, and the 2 caudal sites Juvederm groups. Six hairless mice were included in the study, therefore, a total of 12 injections per group were performed. After 16 weeks after injection, the nodular swellings that resulted from the injections were excised wide enough to include skin beyond the swelling points down to the panniculus carnosus layer using 8mm punches. Volumes and weights were measured using a stereoimage optical topometer system and a weighting machine. Histologic comparisons were also carried out. Results: The mean volumes of the Restylane, HyaFilia and Juvederm groups were $3698{\times}103$, $4820{\times}103$, and $1435{\times}103$ PI, respectively. The mean weights of the Restylane, HyaFilia and Juvederm groups were 36.08, 37.83, and 24.66 mg, respectively. Histologic examination between the 3 groups showed no significant difference in tissue compositions and inflammatory reactions. Conclusion: The results of this study shows that HyaFilia is superior to Restylane and Juvederm in longavity of filling effect. Therefore, HyaFilia may be an effective replacement for the imported materials including Restylane and Juvederm.