Continuum: Late Onset Complications Secondary to Polyacrylamide Hydrogel-Based Filler for Rehabilitation of HIV-Related Facial Lipoatropy

Rauso, Raffaele; Albani, Giada; Salini, Chiara; Rugge, Luigi; Chirico, Fabrizio; Tartaro, Gianpaolo

doi:10.1093/asj/sjz030

Cited by 6 publications

(7 citation statements)

References 8 publications

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“…complications, as systemic antibiotic therapy, intra-lesional injections of corticosteroid and/or 5fluorouracil, needle aspiration, surgical drainage and laser therapy [7][8][9][10][11] ,although none of those techniques is able to totally remove previously injected permanent fillers. he mainstay for a proper preoperative filler-removal evaluation is represented by the Magnetic Resonance Imaging (MRI) 13 .Ultrasonographic evaluation may give infos related to the facial location of the filler and regarding the type of filler injected, although only the MRI let the surgeon to clearly evaluate the relationship between the fillers and the surrounding tissues such as muscles, fat compartments and fascia layers 13,14 .A careful preoperative evaluation is mandatory to reduce the risk of facial nerve damaging, a main issue why surgeons usually refuse to perform these surgical procedures.Although non-surgical procedures may solve and/or mitigate permanent fillers complications, the only way to remove the filler previously injected is represented by surgical excision [15][16][17][18][19][20] . A very poor literature is present about this topic, only some reports of permanent filler surgical removal have been published, especially focusing on lips area 3,5,19,20 .Permanent filler removal with direct excision induce visible and unpleasant scar.We present a pathway of facial surgical accesses to be performed in order to remove permanent fillers previously injected with hidden access achieving two goals: permanent filler removal and facial aesthetic balance restoration.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Although nonsurgical procedures may solve and/or mitigate permanent fillers complications, the only way to remove the filler previously injected is represented by surgical excision. 8,[15][16][17][18][19] A very poor literature is present about this topic, only some reports of permanent filler surgical removal have been published, especially focusing on lips area. 3,5,18,19 Permanent filler removal with direct excision induce visible and unpleasant scar.…”

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confidence: 99%

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Aesthetic Surgical Pathway in Permanent Facial Filler Removal

Pascali

Chirico

Rugge³

et al. 2023

Facial Plast Surg

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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.

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Section: Accepted Manuscriptmentioning

confidence: 99%

mentioning

confidence: 99%

Aesthetic Surgical Pathway in Permanent Facial Filler Removal

Pascali

Chirico

Rugge³

et al. 2023

Facial Plast Surg

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“…Although, some cases of significant complications, such as cold and hot abscesses 10 years following the injections, have been reported [40,41].…”

Section: Discussionmentioning

confidence: 99%

Polyacrylamide Injection vs. Polylactic Acid in HIV Related Lipodystrophy: A RCT Systematic Review

et al. 2021

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Lipodystrophy is an alteration of fat metabolism that commonly affects HIV-1 positive patients treated with antiretroviral therapy (ART). The facial area is most commonly affected by peripheral lipoatrophy, thus becoming a social stigma related to chronic HIV. Several treatments have been proposed, such as modification of diet, lifestyle and both surgical and nonsurgical procedures. The goal of our systematic review is to examine published clinical studies involving the use of polyacrylamide filler for the treatment of HIV FLA, and to provide evidence-based recommendations based on published efficacy and safety data. Our research was performed on published literature until April 2021. Polyacrylamide gel is a volumetric gel that has been proven stable, nontoxic, nonallergenic, nonembryotoxic and nonabsorbable. Poly-l-lactic acid (PLA) is a biocompatible, biodegradable, synthetic polymer derived from lactic acid. We believe it is essential to draft a pre- and post-injection and operative protocol to define an even setting for the clinical condition. It is desirable that such specifications are included in a large randomized controlled trial and the follow up is longer than the studies that we found, because as we have seen in the literature there are reported adverse events even 3 or 5 years after the injections.

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“…Although HA injections are excellent tools utilized in facial cosmetic improvements, they could also be applied to treat facial deformities resulting from traumatic events, orbital and periorbital surgeries, tumor resections, congenital deformities, burns, scars, and facial palsy [8][9][10][11]. Injective techniques could also be utilized for HIV-related facial lipoatrophy or progressive hemifacial atrophy [12][13][14][15][16][17]. Although hyaluronic acid is widely used for cosmetic purposes, in the literature, little is known about this procedure in reconstructive approaches [8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…Injective techniques could also be utilized for HIV-related facial lipoatrophy or progressive hemifacial atrophy [12][13][14][15][16][17]. Although hyaluronic acid is widely used for cosmetic purposes, in the literature, little is known about this procedure in reconstructive approaches [8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery

Chirico¹,

Colella

Cortese

et al. 2021

Applied Sciences

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The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.

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Continuum: Late Onset Complications Secondary to Polyacrylamide Hydrogel-Based Filler for Rehabilitation of HIV-Related Facial Lipoatropy

Cited by 6 publications

References 8 publications

Aesthetic Surgical Pathway in Permanent Facial Filler Removal

Aesthetic Surgical Pathway in Permanent Facial Filler Removal

Polyacrylamide Injection vs. Polylactic Acid in HIV Related Lipodystrophy: A RCT Systematic Review

Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery

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