Complications associated with facial cosmetic filler injection should not be ignored / 中华整形外科杂志

Facial cosmetic filler injection is a hot field in the development of plastic surgery in recent years, which is considered as minimally invasive and safe. However, its adverse reactions are not as simple as we expected. This article analyzes the complications related with filler injection, thus hoping to provide inspiration and reference for the development of future disciplines.

Sentinel vein and middle temporal vein in Chinese: an anatomic study / 中华医学美学美容杂志

Objective@#To study the characteristics of sentinel vein (SV) and middle temporal vein (MTV) and influence in surgery of periorbital and temporal areas.@*Methods@#From January 2018 to August 2019, 20 donated fresh/frozen head specimens (12 males and 8 females) were collected in various regions of China, with an average age of 47.2 (21 to 88) years. Temporal region of 29 hemi-facial area was dissected in layers, and the occurrence rate, route, geometric parameters, branchesand correlation of SV and MTV were observed and measured.@*Results@#Occurrence rate of SV was 96.6% (28/29), the subcutaneous subordinate branches of SV were 2.5±1.0 in average, with both joining together in 6 kinds of mode. The horizontal section length was (5.8±3.8) mm, and outside diameter was (1.0±0.1) mm. The vertical section length was (8.2±4.3) mm, and outside diameter was (1.2±0.4) mm, steering vertically to the deep through the superficial temporal fascia, middle temporal fascia (MTF) and superficial layer of deep temporal fascia (SDTF), continuing to the MTV. The minimal average distance between the SV and TFN was (6.0±2.7) mm. Occurrence rate of MTV was 96.6% (28/29). The first half of MTV was parallel to the zygomatic arch and ran across the superficial temporal fat pad, then turned down near the upper pole of the external ear wheel, and run vertically in front of the ear, and 5.9±2.7 peripheral branches were collected along the way. The length of temporal middle vein was (82.3±8.6) mm, and outer diameter of the thickest point was (3.6±0.7) mm.@*Conclusions@#Sentinel vein is the main branch of middle temporal vein. It passes through several layers of soft tissue vertically and directly into the MTV. Position of sentinel vein is relatively constant, which is an important localization marker in the operation of the temporal region. The middle temporal vein has large diameter, fixing in the superficial temporal fat pad, collecting the venous reflux of the temporal area at both superficial and deep, which may be the main cause of pulmonary infarction produced by the temporal fat transplantation, and injury should be avoided.

Clinical practicability and safty of the filler injective plane of posterior temporalis myofascia space for temporal hollows / 中华医学美学美容杂志

Objective To introduce our clinical method of filler injection with the posterior space of temporalis myofascia for temporal hollows,and to discuss the practical practicability,safety and aesthetic outcomes.Methods From Jan.2014 to Jan.2016,female patients with temporal hollows who had underwent the filler injecting into the posterior space of temporalis myofascia were involved in our study.The patients with previous history of surgery or trauma on temporal region were excluded.Hyaluronic acid or autologous fat was selected as filler material based on patients' preference.Then,aesthetic outcomes were followed up.120 cases were selected in this study.Among them,52 cases preferred hyaluronic acid,and the average follow-up time was 7.5 months.68 cases acceped autologous fat grafting with average follow-up for 9.5 months.Results All patients got aesthetic and safe outcome.No serious complications were noted,such as infection,embolism,uneven appearance and so on.The satisfactory rate was high in both patients and surgeons.Conclusions The posterior temporalis myofascia space that is relatively closed,stable,lack of vessels has proved to be the safe plane for temporal injection.Not only our injection method could meet the need for injection procedure safety,but also it could ensure the aesthetic outcomes.In clinical practice,the aesthetic surgeons should be well familiar with the temporal anatomy.

Prevention and management of vision loss relating to facial filler injections

<p><b>INTRODUCTION</b>With the increased use of filler and fat injections for aesthetic purposes, there has been a corresponding increase in the incidence of complications. Vision loss as an uncommon but devastating vascular side effect of filler injections was the focus of this paper.</p><p><b>METHODS</b>A review committee, consisting of plastic surgeons, aesthetic medical practitioners, ophthalmologists and dermatologists from Singapore, was convened by the Society of Aesthetic Medicine (Singapore) to review and recommend methods for the prevention and management of vision loss secondary to filler injections.</p><p><b>RESULTS</b>The committee agreed that prevention through proper understanding of facial anatomy and good injection techniques was of foremost importance. The committee acknowledged that there is currently no standard management for these cases. Based on existing knowledge, injectors may follow a proposed course of action, which can be divided into immediate, definitive and supportive. The goals were to reduce intraocular pressure, dislodge the embolus to a more peripheral location, remove or reverse central ischaemia, preserve residual retinal function, and prevent the deterioration of vision. Dissolving a hyaluronic acid embolus remains a controversial option. It is proposed that injectors must be trained to recognise symptoms, institute immediate actions and refer patients without delay to dedicated specialists for definitive and supportive management.</p><p><b>CONCLUSIONS</b>Steps to prevent and manage vision loss based on current evidence and best clinical practices are outlined in this paper. Empirical referral to any emergency department or untrained doctors may lead to inordinate delays and poor outcomes for the affected eye.</p>

Two Cases of Injection Complication Following an Illegal Practice / 대한피부과학회지

No abstract available.

The Clinicopathologic Study of Foreign Body Granuloma Induced by Injection of Filler / 대한피부과학회지

BACKGROUND: With the popularization of soft tissue augmentation with dermal fillers, filler-related complications such as foreign body granuloma (FBG) are increasing. However, there has been no comprehensive study performed on FBG induced by dermal fillers in Korea to date. OBJECTIVE: The purpose of this study was to investigate the clinicopathologic findings of FBG induced by injection of filler. METHODS: Eighteen biopsy-proven cases of FBG due to injection of filler were reviewed and analyzed by their clinicopathological findings. In addition, the severity of granulomatous inflammation was graded by the classification proposed by Duranti. RESULTS: Two patients were injected with silicone, one with collagen and fifteen with unknown materials; they were treated by unlicensed practioners. The interval time between the injection and the presence of FBG ranged from 2 months to 30 years (mean: 2 years). Most of the lesions presented as skin-colored or erythematous subcutaneous nodules. In one patient, concomitant infection was discovered and the cultured organisms were coagulase negative staphylococcus and Mycobacteria chelonae. The histopathologic findings showed variable infiltrations of inflammatory cells, predominantly lymphohistiocytes and in fifteen patients (83.3%) multinuclear giant cells were also seen. In ten patients (55.6%), marked foreign body granulomatous inflammation of Duranti grade II were observed. In ten cases (55.6%), 'Swiss cheese appearance' representing granuloma due to lipoid materials such as silicone and paraffin were observed. CONCLUSION: This study shows various clinical presentations and histopathologic findings of FBGs incurred by filler injections, although most of the injected materials were not identified. Further investigations on different injectable products are necessary to identify the nature of the injected filler.

A Case of Mycobacteria chelonae Infection after Injection of Filler / 대한피부과학회지

Mycobacterium chelonae is a rapidly-growing, atypical mycobacterium that can cause both systemic and cutaneous infections as a human pathogen. This saprophyte is ubiquitous in the environment and has been found in water, soil, and dust particles. Clustered outbreaks usually occur after inoculation with contaminated fluids or injectable medications. We report a case of M. chelonae infection in a 53-year-old female, who presented with multiple, tender, firm, erythematous nodules and plaques on the face which occurred 2 months after a filler injection. Culture demonstrated coagulase negative staphylococcus and atypical mycobacterium, which was identified as M. chelonae by polymerase chain reaction.