Aesthetic Surgical Pathway in Permanent Facial Filler Removal

Abstract

Although permanent fillers have been introduced in order to get long lasting results, many studies have shown numerous severe and disfiguring complications. Non-surgical procedures may mitigate those adverse events but the only way to remove the filler previously injected is represented by surgical excision. We present a pathway of facial surgical accesses to be performed achieving two goals: permanent filler removal and restore facial aesthetic balance. The proposed surgical accesses are already standardized in aesthetic surgical practice in order to avoid direct excision and unpleasant facial scar. 231 patients underwent surgery for permanent filler removal and aesthetic restoration of the involved facial area, represented by forehead, glabella, nose, cheeks, eyelids, chin, jawline and lips. Magnetic resonance evaluation was performed with the exception of lip patients evaluated with ultrasound. Postoperative follow-up was 12months to 6years. Subjective and objective methods were used to outcome evaluation according to FACE-Q questionnaire. Functional and aesthetic correction was scored using the patient-graded Global Aesthetic Improvement Scale(GAIS), overall patient satisfaction was assessed by a five-point scale questionnaire. Functional and aesthetic restoration was globally recognized as improved according to the Global Aesthetic Improvement Scale. Patients reported high levels of satisfaction assessed by a five-point scale questionnaire. A very good satisfaction level was registered in both subjective and objective judgment scores. To the best of our knowledge, we present the largest case series regarding surgical removal of permeant facial fillers. A proper pre-operative evaluation, filler removal followed by restorative facial aesthetic surgery technique is paramount to approach challenging cases.

Histological, Clinical Assessment, and Treatment of a Permanent Filler Complication in the Upper Lip: A Case Report with 16-Year Follow-Up

“…In our study, we performed a different surgical approach, with a chalazion clamp and diode laser for hemorrhagic control and then a simple suture. Pascali et al [50] declared that nonsurgical procedures might not be enough to treat problems as our case reported, and they confirmed that the only way to remove the filler previously injected was represented by surgical excision. The authors presented a pathway of facial surgical accesses to treat 231 patients, achieving permanent filler removal and restoring facial esthetic balance.…”