Like any other invasive intervention, contouring may be accompanied by adverse events and complications. One of these are fibrous tissue changes in the area of injection of hyaluronic acid preparations.
The main reason for the formation of pathological fibrosis is the development of the inflammatory process. The main method of preventing this complication is the correct choice of dermal filler.
More information about modern studies on the safety of hyaluronic acid fillers to readers of estet-portal.com was told by a combustiologist of the highest category, Ph.D. Natalia Golovina.
Why does fibrosis occur after hyaluronic acid fillers
The factors that provoke inflammation and fibrosis in the area of contour plastics with hyaluronic acid preparations are:
• fillers with pH and osmolarity values different from those of the dermis;
• excessive amount of the drug, provoking edema and tissue ischemia in the injection area;
• excessive tissue trauma with instruments (needles, less often — cannulas), vascular injuries, petechiae and hematomas;
• frequent injections of drugs in one zone;
• filler density that does not correspond to the depth or quality of the dermis (hypoderm).
The common thing for all these reasons is the aftereffect — aseptic (and sometimes septic) inflammatory process with different periods of flow and as a result — formation of a connective tissue capsule around the filler.
The formed capsule, on the one hand, prevents the action of its own enzymes for the biodegradation of the filler, and, on the other hand, is an active participant in inflammatory processes in the area of drug administration.
The development of an inflammatory process in the area of filler injection leads to both subjective manifestations: soreness, swelling (permanent or intermittent), density to the touch, visibility of disturbed tissue relief, and objective manifestations: local persistent edema, the appearance of strands of varying density, skin discoloration — Tyndall syndrome and cyanosis.
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Contouring without fibrosis: is it possible
In June 2018 — In January 2019, a study was conducted in which 16 patients took part. Age: 25-65 years old. Gender Female. Areas of application of fillers: nasolabial and nasolabial grooves, lips, cheekbones, chin. The preparations presented by company Hyalual were used: Alexa Smooth, Alexa Medium, Alexa Volume.
The results of the study were evaluated using the GAIS Patient Satisfaction Scale (immediately after injection, after 14 days and after 6 months from the moment of drug administration).
Dynamic photo fixation was also carried out with the VisiaFace apparatus and with the help of photography (before the injection, after 14 days and after 6 months).
To assess the state of tissues in the area of filler implantation, an ultrasound scan was performed on the Esaote device using a 22 MHz probe 6 months after the implantation of fillers.
A patient with lip contouring: on ultrasound, a clear separation of skin layers is visible and subcutaneous lesions are observed. The filler is visible at a depth of 1.7 mm - 3.92 mm in the form of hypoechoic formations without signs of blood flow.
At a depth of 2.12 mm and deeper (up to 5.4 mm), anechoic formations with a thickness of 1.12 mm, 2.57 mm, 1.63 mm are determined. The tissue structure is preserved. All layers of the skin are clearly visible.
On ultrasound, all layers of the skin can be traced well, the structure of the tissues is not changed. In the depths of the tissues, a linear formation 1.1 mm thick without signs of blood flow.
Results of a study on the effect of hyaluronic acid fillers
Analysis of patient satisfaction scores on the GAIS Patient scale showed:
- 75% of patients reported a very good result immediately after the injection and 25% of patients were completely satisfied.
- 100% of patients on the 14th day after the injection noted complete satisfaction with the procedure.
Photo fixation of the results of contouring with the VisiaFace device before the procedure, after 14 days and after 6 months demonstrates the preservation of the effect of the procedures performed in all patients for 6 months.
Ultrasound of the skin and soft tissues of all areas of filler implantation 6 months after the procedure confirms, on the one hand, the presence of drugs in the patient's tissues at the points of primary injection, and, on the other hand, no signs of fibrous tissue changes were detected. All these features testify to the effectiveness of contouring with the drugs used for at least 6 months and their safety in relation to fibrous transformation of tissues in the implantation zones.
Thus, Alexa Smooth, Alexa Medium, Alexa Volume products presented by Hyalual are effective and absolutely safe.
Working algorithm and practical cases on the example of specific clinical cases
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