Despite the simplicity and reliability of minimally invasive procedures for the introduction of fillers, complications can occur even for experienced specialists. Early recognition of complications is very important in the prevention of severe and long-term consequences.
Physicians dealing with minimally invasive procedures and practitioners of filler injections must be well trained, well versed in the features of the introduction of each drug they work with, in order to provide patients the most high-quality and effective procedures.
Subdermal fillers are regarded as products that have excellent ability to stop aging, eliminate age-related skin problems with minimal side effects. There are many FDA*(Food and Drug Administration) approved fillers for facial wrinkle correction and consist of various materials including hyaluronic acid, polylactic acid, calcium hydroxyapatite and polymethyl methacrylate.
Although not FDA-approved for facial aesthetics, silicone is used "off-label" for cosmetic purposes such as treating acne scars.
Possible complications after minimally invasive cosmetic procedures
Minimally invasive procedures are generally performed safely and effectively. However, there are complications associated with them that are important to be aware of in order to prevent their occurrence or ensure timely appropriate treatment.
Infection rates after vehicle administration are low. However, reactivation of the herpes simplex virus can occur. Thus, either prophylactic antiviral treatment is needed for those who suffer from frequent outbreaks of the disease, or a delay in the procedure for those who have active herpes.
Biofilm development is defined as a collection of microorganisms, encapsulated and inert, adhering to each other by cell walls. They may present as deep erythematous nodules lasting weeks to years after filler. Practitioners should maintain a high level of suspicion regarding this complication. It is likely that its development occurs due to insufficient cleansing of the skin or excessive injection of the filler, which creates an ideal environment for bacterial growth.
Proper preparation of the skin with an antiseptic is a necessary condition for the prevention of biofilm. Although filler injections are considered minimally invasive procedures, they should be considered as surgical procedures and patients should have as clean skin as possible. Also, avoiding injecting large volumes, different types of fillers in a single session, and avoiding injections in the presence of inflammatory skin lesions (such as acne or eczema) may prevent infections.
Vascular occlusion is a devastating, rare complication that can lead to tissue necrosis and permanent scarring. Blockage can occur due to disruption of the blood supply to the skin by excessive filler pressure, due to enous stasis, or direct intra-articular injection. The glabella region is considered to be an extremely high risk area due to the small but significant vessels in this area.
There are still quite a few dangerous areas. Thus, extensive knowledge of facial anatomy and superior injection technique can help limit the potential for skin necrosis.
Most fillers are designed to be injected at medium depths.
If injected too superficially, complications such as nodules, hypertrophic scarring and the Tyndall effect occur. Local massage, aspiration and the use of hyaluronidase are methods used to treat defects caused by superficial filler injection. The latest trend is the use of blunt cannulas, which allow the product to be dispensed in the correct plane without the need for multiple needle pricks.
Persistent erythematous nodules are granulomatous reactions and are associated with each type of filler. Treatment of persistent inflammatory nodules is a challenge. The algorithm assumes antibiotic therapy with clarithromycin, if there is no improvement, steroids are prescribed. Incision and drainage combined with oral antibiotic therapy is essential for any fluctuating lesion.
The clinical presentation includes subcutaneous nodules that may progress to cellulitis, ulcers and nodules.
The pathogenesis of granuloma formation is not fully understood, but is suspected to occur as a result of T cell activation after injection, secondary infection, or extraneous additions to the fill material.
Granulomas are notoriously difficult to treat, so proper technique with a known sterile product is critical. Injections should only be performed by medical practitioners with special training.
Filler hypersensitivity and allergies are currently considered very rare complications. Original bovine collagen products have fallen out of favor due to possible allergic reactions and the need to perform several skin tests before administration. PMMA, the only remaining filler containing bovine collagen, requires testing for skin, and patients with a positive test (erythema or induration) or two questionable tests (systemic reactions such as rash, joint pain or myalgia) should refuse treatment.
*FDA - Food and Drug Administration — agency of the US Department of Health and Human Services, one of the federal executive departments. The department is engaged in quality control of food products, medicines, cosmetics, tobacco products and some other categories of goods, and also monitors compliance with legislation and standards in this area.
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