• Archives of Plastic Surgery
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• v.44 no.4
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• pp.340-343
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• 2017

Performing rhinoplasty using filler injections, which improve facial wrinkles or soft tissues, is relatively inexpensive. However, intravascular filler injections can cause severe complications, such as skin necrosis and visual loss. We describe a case of blepharoptosis and skin necrosis caused by augmentation rhinoplasty and we discuss the patient's clinical progress. We describe the case of a 25-year-old female patient who experienced severe pain, blepharoptosis, and decreased visual acuity immediately after receiving a filler injection. Our case suggests that surgeons should be aware of nasal vascularity before performing an operation, and that they should avoid injecting fillers at a high pressure and/or in excessive amounts. Additionally, filler injections should be stopped if the patient complains of severe pain, and appropriate measures should be taken to prevent complications caused by intravascular filler injections.

• Tuberculosis and Respiratory Diseases
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• v.77 no.2
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• pp.90-93
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• 2014

Hyaluronic acid is widely used in medical procedures, particularly in cosmetic procedures administered by physicians or nonmedical personnel. The materials used for cosmetic procedures by physicians as well as illegally by non-medical personnel can cause nonthrombotic pulmonary embolism (NTPE). We report the case of a woman with acute respiratory failure, neurologic symptoms and petechiae after an illegal procedure of hyaluronic acid dermal filler performed by an unlicensed medical practitioner 3 days before symptom onset. Although a few cases of NTPE after injection of hyaluronic acid have been reported yet, this is the first typical case showing a NTPE manifestation after the facial injection of hyaluronic acid.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.148-152
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• 2023

Soft tissue filler injection is the second most common nonsurgical cosmetic procedure. Despite the safety of fillers, as use has grown, so has the number of patients affected by adverse events. Ophthalmoplegia following cosmetic filler injection is a rare complication, mostly occurring after injection to the glabella, nasolabial fold, periorbital, and lateral nasal site. In all cases where ophthalmoplegia has been reported following fillers, patients have simultaneously experienced vision loss and other ocular symptoms. We report a case of isolated acute ophthalmoplegia following hyaluronic acid injection solely in the temple region. A 40-year-old woman, 3 hours after the procedure, presented to our hospital with left eye ophthalmoplegia, ptosis, and hypotropia. Treatment started with hyaluronidase, steroids, and anticoagulants. After 4 weeks, left eye ophthalmoplegia remained unchanged, and through a 10-week follow-up, all left ocular movements improved, and only mild hypotropia and ptosis persisted. This case report shows that ophthalmoplegia may also happen with temple region filler injections. We also review available prevention techniques and treatments to avoid such complications when performing soft tissue fillers for gaunt appearance correction.

• Journal of Microbiology and Biotechnology
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• v.25 no.3
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• pp.399-406
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• 2015

In this study, we developed a composite filler comprising cross-linked hyaluronic acid (HA) and human collagen (COL) derived from the human umbilical cord with the aim of improving its biocompatibility and longevity compared with commercially available fillers. After HA/COL composite fillers were made in two different ratios (10:1 and 5:1), the physical properties of the fillers were evaluated. The interior morphologies and in vivo weight change of these hydrogels were also characterized at 1-16 weeks after injection into mice. To evaluate their biocompatibility and durability in vivo, we injected the composite fillers into nude mice subcutaneously. The variations of injected gel weight were measured and compared with the commercial dermal fillers (Restylane and TheraFill). The composites showed improved or similar physical properties (complex viscosity of 19-22 × 10⁵ cP, and injection force of 10-12 N) over the commercial dermal fillers. Sixteen weeks following the injection, the ratio of remaining composite filler weight to initial weight (75.5 ± 16.9%; 10:1) was shown to be greater than that of the commercial fillers (43.2 ± 8.1%, Restylane; 12.3 ± 5.3%, TheraFill). In addition, immunohistochemical analysis with angiogenesis-related markers such as isolectin and vWF revealed newly formed blood vessels and cellular influx into the composite filler, which were not observed in the other fillers. These results clearly suggest that the HA/COL composite filler is a superior candidate for soft tissue reconstruction. The filler we developed may be a suitable candidate as an injectable dermal filler for tissue augmentation in humans.

• Imaging Science in Dentistry
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• v.50 no.2
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• pp.175-180
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• 2020

Purpose: In this study, we used ultrasonography to monitor the use of hyaluronic acid (HA) as a filler in the face for esthetic reasons. We monitored changes in the filler shape, distribution, and relationship with adjacent anatomical structures over a 180-day period. Materials and Methods: Two patients each received an ultrasound-guided injection of HA, with different products and application sites for each patient. In 1 patient, the injection was administered in the angle of the mandible, while in the other, it was administered in the zygomatic region. The injection sites were monitored via ultrasonography at 24 hours, 30 days, and 180 days, at which times the imaging characteristics of the filler were observed. All injections were performed by the same professional, as were the ultrasound exams, which were conducted using the same equipment. Results: In both cases, the HA fillers were visualized using ultrasound at all time points. Some differences were observed between the cases in the images and the distribution of the pockets of filler. In 1 case, the filler appeared as a dark hypoechoic region with well-defined contours, and the material was observed to have moved posteriorly by the 180-day mark. In the other case, the material appeared hyperechoic relative to the previous case and presented no noticeable changes in its anteroposterior distribution over time. Conclusion: Based on these 2 cases, ultrasonography can be a complementary tool used to monitor facial fillers over the long term, allowing for the dynamic observation of different fillers.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.64-67
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• 2018

Varying degrees of complications can occur after hyaluronic acid filler injections. Tissue necrosis due to interruption of the vascular supply is an early complication that can be severe. If the site of tissue necrosis due to the filler injection is the forehead, successfully reconstructing the region without distorting the key landmarks is challenging. We describe the case of a 50-year-old man who experienced widespread forehead skin necrosis after hyaluronic acid filler injection in the glabellar area. We successfully covered the forehead area with a $3{\times}4-cm^2$ midline necrotic tissue using the modified double-opposing rotation-advancement flap method. Although modified double-opposing rotation-advancement flap closure has the disadvantage of leaving a longer scar compared to conventional double-opposing rotation-advancement flap closure, the additional incision line made along the superior border of the eyebrow aids in camouflaging the scar and decreases eyebrow distortion. Therefore, it is believed that the modified double-opposing rotation-advancement flap technique is an excellent tool for providing adequate soft tissue coverage and minimal free margin distortion when reconstructing widespread skin necrosis in the central mid-lower forehead that can occur after filler injection in the glabellar area.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.479-481
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• 2022

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.51-54
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• 2012

With the gradual increase of cases using fillers, cases of patients treated by non-medical professionals or inexperienced physicians resulting in complications are also increasing. We herein report 2 patients who experienced acute complications after receiving filler injections and were successfully treated with adipose-derived stem cell (ADSCs) therapy. Case 1 was a 23-year-old female patient who received a filler (Restylane) injection in her forehead, glabella, and nose by a non-medical professional. The day after her injection, inflammation was observed with a $3{\times}3cm$ skin necrosis. Case 2 was a 30-year-old woman who received a filler injection of hyaluronic acid gel (Juvederm) on her nasal dorsum and tip at a private clinic. She developed erythema and swelling in the filler-injected area A solution containing ADSCs harvested from each patient's abdominal subcutaneous tissue was injected into the lesion at the subcutaneous and dermis levels. The wounds healed without additional treatment. With continuous follow-up, both patients experienced only fine linear scars 6 months postoperatively. By using adipose-derived stem cells, we successfully treated the acute complications of skin necrosis after the filler injection, resulting in much less scarring, and more satisfactory results were achieved not only in wound healing, but also in esthetics.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.588-593
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• 2014

Lymphedema is a chronic disorder characterized by lymph stasis in the subcutaneous tissue. Lymphatic fluid contains several components including hyaluronic acid and has many important properties. Over the past few years, significant research has been performed to identify an ideal tissue to implant as a filler. Because of its unique composition, fat harvested from the lymphedema tissue is an interesting topic for investigation and has significant potential for application as a filler, particularly in facial rejuvenation. Over a 36-month period, we treated and assessed 8 patients with lymphedematous limbs who concurrently underwent facial rejuvenation with lymphedema fat (LF). We conducted a pre- and postoperative satisfaction questionnaire survey and a histological assessment of the harvested LF fat. The overall mean general appearance score at an average of 6 months after the procedure was $7.2{\pm}0.5$, demonstrating great improvement. Patients reported significant improvement in their skin texture with a reading of $8.5{\pm}0.7$ and an improvement in their self-esteem. This study demonstrates that LF as an ideal autologous injectable filler is clinically applicable and easily available in patients with lymphedema. We recommend the further study and clinical use of this tissue as it exhibits important properties and qualities for future applications and research.

• Archives of Craniofacial Surgery
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• v.20 no.4
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• pp.246-250
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• 2019

Recently, there is a growing interest of hyperbaric oxygen therapy in many fields of medicine. We had a 43-year-old female patient presented with severe necrosis of the nose, philtrum, and upper lip due to retrograde arterial occlusion after nasolabial fold hyaluronic acid filler injection. Our patient went through 43 sessions of systemic hyperbaric oxygen therapy from December 2, 2017 to January 18, 2018. We administered 2.8 atmosphere absolute (ATA) for 135 minutes in the first session and the remaining sessions consisted of 2.0 ATA for 110 minutes. In reporting this case, we wish to provide a warning regarding the latent risk of filler injections and share our experience about minimizing soft tissue damage in the early stages with systemic hyperbaric oxygen therapy.