Advanced laser techniques for filler-induced complications.

BACKGROUND: The increasing use of injectable fillers has been increasing the occurrence of disfiguring anaerobic infection or granulomas. This study presents two types of laser-assisted evacuation of filler material and inflammatory and necrotic tissue that were used to treat disfiguring facial nodules after different types of gel fillers. MATERIALS AND METHODS: Infectious lesions after hydrogels were drained using a lithium triborate laser at 532 nm, with subsequent removal of infected gel and pus (laser assisted evacuation). Granuloma after gels containing microparticles were treated using an 808-nm diode laser using intralesional laser technique. The latter melted and liquefied the organic and synthetic components of the granulomas, facilitating subsequent evacuation. Both lasers had an easily controllable thin laser beam, which enabled the physician to control tissue damage and minimize discomfort and pain. RESULTS: All 20 patients experienced reduction or complete resolution, the latter increasing with repeated treatments. CONCLUSION: Laser-assisted treatment offers a successful solution for patients who have been suffering from disfiguring nodules from injected fillers-often for many years. The procedure broadens the range of treatment options in cases of untoward reactions to fillers, in line with surgical removal but with lower morbidity and less cosmetic disfigurement.

The immediate effects of endovenous diode 808-nm laser in the greater saphenous vein: morphologic study and clinical implications.

BACKGROUND: We conducted this study to evaluate the immediate venous morphologic alterations produced in the great saphenous veins by the endovenous diode 808-nm laser used for the treatment of superficial venous insufficiency and varicose veins of the lower limbs and to clarify the clinical implications of the histologic findings. METHODS: Chosen for the study were 24 limbs of 16 patients with CEAP classification 3 to 6, ultrasound-documented greater saphenous insufficiency, and venous diameters between 3.9 mm and 17 mm (mean, 8.04 mm) without phlebitis, saphenous aneurysms, congenital malformations, or deep venous insufficiency. All limbs underwent surgical saphenofemoral disconnection, and the greater saphenous vein was treated with an endovenous diode 808-nm laser by continuous emission at 8 to 12 W and variable retraction speed (1 mm/s). Spinal or local, but not tumescent, anesthesia was used. Twenty-nine specimens (3 to 5 cm long) of 24 proximal greater saphenous and five anterior accessory saphenous veins were excised and studied by light microscopy for diameter and thickness of the venous wall, extent of injury into the intima, media, and adventitia, as well as penetration of thermal damage. RESULTS: The histologic evaluation showed thermal injury to the intima in all specimens and full-thickness intimal injury in 22 specimens (75%); the average penetration of thermal injury in 29 specimens was 194.40 microm (range, 10 to 900 microm; 14.61% of the mean wall thickness); complete intimal circumference injury occurred in 8 specimen veins <10 mm in diameter (27.5%), full thickness damage in 6 (20.7%), and perforation in 2 (6.9%). CONCLUSIONS: Saphenous ablation using 808-nm laser by variable retraction speed, combined with saphenofemoral interruption, leads to sufficient vein wall injury to assure venous occlusion. Full thickness thermal injury or perforation is infrequent. Optimal results can be obtained in veins <10 mm in diameter.