RESUMO
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.
RESUMO
BACKGROUND: Tear trough (TT) treatment with hyaluronic acid soft tissue fillers is an increasingly popular aesthetic procedure. The traditional needle technique is cited many times in the literature with no studies looking at the results, complications and satisfaction rate with the use of the cannula device instead. The aims of this study are to describe the experience of 4 aesthetic doctors in the treatment of TT deformity and assess complications and side effects, overall satisfaction and improvement. METHODS: Twenty-four patients were included (48 TTs) that fulfilled the inclusion and exclusion criteria and they were assessed over a 4-week period, looking at the complications, side effects, satisfaction rate, and others with the cannula technique for the medial TT. RESULTS: Twenty-two women and 2 men each had the medial TT filler supra-periosteally using a cannula device. They were all reviewed at the 2-week stage +/- the 4-week stage. 100% of patients noted an overall improvement to the TTs and 75% were satisfied with their results with the other 25% requiring further filler to be satisfied. There were no major complications and only a small number of minor side effects like mild bruising and swelling that lasted up to 4 weeks. CONCLUSIONS: TT treatment, if performed using a cannula with a maximum of 1ml used in one sitting between both eyes, according to this study, is a safe treatment with a very low pain rating and with no major complications and high patient satisfaction.