Use of ultrasound to provide overall information on facial fillers and surrounding tissue.

BACKGROUND: Information on fillers and their behavior over time in the different layers of tissue is limited. Ultrasound may be used to visualize these fillers and their surrounding tissue to broaden knowledge. OBJECTIVE: To evaluate the use of ultrasound as a diagnostic and research tool to obtain information on facial fillers and their behavior in human tissue. METHODS AND MATERIALS: Patients with a history of facial filler treatment were examined using ultrasound in an outpatient setting. RESULTS: Seventy-two patients were examined. Hydrophilic fillers were echo visible, whereas tissue-generating fillers, permanent and resorbable, could be detected according to their tissue-generating reaction within the tissue. Filler characteristics such as longevity and reaction within the tissue and complications such as migration and granulomas could be visualized. CONCLUSION: The use of ultrasound may provide information to broaden our knowledge of facial fillers and may improve the performance and safety of filler treatments. The authors have indicated no significant interest with commercial supporters.

Complications after treatment with polyalkylimide.

BACKGROUND: Polyalkylimide is a nonresorbable, biocompatible polymeric filler that has been used for several years to treat soft tissue deficits. The literature has shown a minor complication rate. We noticed that complications typically appear several years after injection. OBJECTIVE: To evaluate the complications reported after treatment with polyalkylimide. METHODS AND MATERIALS: We describe a retrospective evaluation, reported by members and candidate members of the Dutch Society of Cosmetic Medicine, of complications after use of polyalkylimide. RESULTS: In total, 3,196 patients were treated, and 4,738 treatments were performed, from which 154 complications (patient complication rate 4.8%, treatment complication rate 3.3%) were reported. The most common complication was inflammation; other complications were hardening, migration, and accumulation of the product. In some patients, skin biopsy followed by histologic examination was performed. CONCLUSION: Treatments with polyalkylimide have been reported to give rise to complications years after treatment. Even though the study described is a retrospective evaluation, we consider an overall complication rate of 4.8%, the severity of the complications, and the difficulty in treating them too high a risk for a cosmetic treatment. The Dutch Society of Cosmetic Medicine advises against the use of polyalkylimide.