Evaluation of Current Literature on Complications Secondary to Lip Augmentation Following Dermal Filler Injection.

Background: The current popularity of dermal filler treatments as an alternative to invasive surgical cosmetic procedures has led to an increase in filler-related complications. Lip filler treatments are among the most sought-after injectable treatments and a thorough understanding of the complications of lip filler injections, and their management, is essential for any practitioner. Objective: The aim of this review is to evaluate the current literature on complications secondary to lip augmentation following non-permanent dermal fillers. Methods: A thorough MEDLINE literature search of keywords, including lip filler, augmentation, injection, filler, dermal filler, and complications, was completed to collate cases of complications secondary to lip filler injections. Results: Of our 53 cases that were studied, 82 complications were reported. Our review and evaluation of these cases showed that HA filler was most commonly used in this region, alone or in combination with other soft tissue fillers. The majority of complications resulted from HA involvement, however its frequency of use likely accounts for this. Across all three filler types, the most common complication was nodule formation. Other complications, such as migration, discoloration and herpetic outbreaks, have been linked with filler placement in the lip area. Conclusion: It is clear that filler treatments carry a variety of risks, thus it becomes of utmost importance to truly understand the product we are working with, its properties, its associated risks, and how to manage those risks. We have to ensure that patients are adequately informed about the risks associated, and understand what those risks entail.

Using Virtual Reality to Reduce Anxiety and Improve Hospital Experience in Paediatric Orthopaedic Patients and Their Parents.

The hospital environment can be a stressful environment for paediatric patients and their parents, which is often characterised by heightened levels of pain and anxiety. To address these challenges, many innovative intervention methods has been explored. For example, immersive virtual reality (VR) headsets as a distraction method has become an increasingly popular intervention in recent years. This study aimed to evaluate the effectiveness of VR using 'Rescape DR.VR Junior' in reducing pain, anxiety, and enhancing the overall hospital experience for paediatric orthopaedic patients and their parents. A total of 64 patients aged 4-18 years were included in this study, which utilised a control group (interacting with a play specialist) and a VR intervention group (including pre-operative patients and fracture clinic patients). Anxiety and pain levels were measured using a 10-point Likert scale before and after the intervention, and validated questionnaires were used to assess parental anxiety and overall hospital experience. The results indicated that VR intervention significantly reduced patient and parental anxiety both before surgery and in the fracture clinic setting (p < 0.5). However, no significant reduction in pain scores was observed in either environments. Comparatively, VR intervention was found to be comparable to traditional play methods in terms of reducing anxiety in the pre-operative environment. All patients and parents agreed that the use of VR distraction methods significantly improved their hospital experience. In conclusion, VR is an effective method for reducing child and parental anxiety and enhancing the hospital experience and can be used alone or in conjunction with a play specialist.

Case Series and Review on Managing Abscesses Secondary to Hyaluronic Acid Soft Tissue Fillers with Recommended Management Guidelines.

With the number of aesthetic soft tissue filler treatments rapidly increasing, we have witnessed an increase in complications associated with such treatments. While rare, abscesses can arise as a result of these treatments, and current detailed guidelines do not exist detailing exactly how to manage them. OBJECTIVE: Our aim was to develop evidence-based and experience-based guidelines on how to, specifically, manage abscesses secondary to hyaluronic acid dermal fillers. METHODS: A thorough MEDLINE literature search of keywords, including abscess, abscess management/treatment, hyaluronic acid, dermal fillers, and soft tissue fillers, was completed to collect specific cases of abscesses secondary to soft tissue filler. Inclusion criteria involved papers published from 2010 to 2020 that focused specifically on soft tissue fillers in the face. In addition, we looked at papers that discussed abscesses secondary to soft tissue fillers in general and their management. We also reported three cases of abscesses secondary to hyaluronic acid dermal fillers that have been described by three different practitioners, detailing their history, examination, management, and outcomes. Experience and evidence have been collated to produce management guidelines. RESULTS and CONCLUSION: It is clear that each case is unique, but there is no current universal consensus on the risk assessment before treatment nor general management of abscesses secondary to soft tissue filler. The majority of the reports and cases discussed in the paper suggested the use of co-amoxiclav along with a macrolide or quinolone for at least two weeks. Incision and drainage are universally accepted as gold standard management. Microbiology, sensitivities, and cultures are also recommended. Hyaluronidase use, while controversial, is encouraged in effectively managing abscesses secondary to hyaluronic acid dermal filler.