Autologous Fat Injection for Soft Tissue Augmentation in the Face: A Safe Procedure?

Autologous fat injection for soft tissue augmentation in the face is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction following fat injections into the face. Acute visual loss after injection of various substances into the face is a well-known complication of such interventions. We report two further patients who suffered from ocular and cerebral embolism after fat injections into the face. For the intravasation of fat particles there are three preconditions: well-vascularized tissue, fragmentation of parenchyma, and, especially, a local increase in pressure in the affected tissue. Fat injections into the face lead to an acute local increase in pressure in highly vascularized tissue. We assume that fragments of fatty tissue reach ocular and cerebral arteries by reversed flow through branches of the carotid arteries after they are introduced into facial vessels. The manifestation of fat embolism appears either immediately after the fat injection or after a latency period. Fat embolism can remain subclinical and may not be recognized, or the clinical features may be misinterpreted. To minimize the risk of such a major complication, fat injections should be performed slowly, with the lowest possible force. One should avoid fat injections into pretraumatized soft tissue, for example, after rhytidectomy, because the risk of intravasation of fat particles may be higher. Metabolic disturbances such as hyperlipidemia may also contribute to the clinical manifestation of fat embolism. Routine funduscopic examinations after fat injections into the face could help to provide data for future estimation of the patient's general risk.     

Combined Use of Hair and Fibrin Glue for Soft Tissue Augmentation: Experimental Study

A vast variety of alloplastic materials together with autogenous grafts have been used for the correction of contour deformities related to aesthetic and reconstructive purposes. Despite a number of well-tolerated materials, the ideal has not yet been reached, although well-tolerated autogenous grafts have higher rates of resorption and distortion. The limited volume of autogenous grafts and concerns about donor-site morbidity may obligate the surgeon to use implantation materials. Covering almost every property of an ideal implantation material, hair, an organic autogenous nonvital tissue, was used for soft tissue augmentation in this experimental study. Hair pellets of 10 New Zealand rabbits were prepared and shaped as 1 × 1 × 1-cm cubes with the help of fibrin sealant, then inserted subcutaneously. The materials were evaluated 4 months later. No complications such as infection or extrusion were seen. The materials were intact, with no signs of resorption, but the shapes were distorted due to the pressure of the surrounding tissues. Histopathologic findings also demonstrated that the hair was well tolerated by the adjacent tissues. Different processes may enable hair to be used as a filler material in clinical practice. Well-tolerated, nonresorbable injectable materials or shaped implants may be obtained at low cost using hair.     

Use of Hyaluronic Acid for Soft Tissue Augmentation of HIV-Associated Facial Lipodystrophy

BACKGROUND: Lipodystrophy syndrome is a devastating complication of antiretroviral therapy in individuals with human immunodeficiency virus (HIV). The appearance of the associated facial lipoatrophy can be demoralizing and stigmatizing for the affected individuals to a point at which it may compromise their compliance with antiretroviral medication. OBJECTIVE: We describe the use of hyaluronic acid as an intradermal filler for correction of this disfiguring problem. METHODS: We treated five patients with grade 2 to 3 facial lipoatrophy. Each patient received approximately 5 to 6 cc in total of hyaluronic acid in the malar area via intradermal injection. RESULTS: There were no adverse events. We found that this technique provided a good cosmetic result with high patient satisfaction. At 6-month follow-up, sustained longevity was observed. CONCLUSIONS: We propose the use of hyaluronic acid for HIV-associated facial lipoatrophy as an efficacious and safe, but temporary, option for this problem until a more cost-effective option is available.     

Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation

An increasing number of soft tissue filler substances have been introduced to the beauty market outside the U.S. which lack experimental and clinical data in support of their claim. Ten commercially available filler substances were examined for biocompatibility and durability: 0.1 cc of each substance was injected deep intradermally into the volar forearm of one of the authors and observed for clinical reaction and permanence. At 1, 3, 6, and 9 months the test sites were excised, histologically examined, and graded according to foreign body reactions classification. Collagen (Zyplast) was phagocytosed at 6 months and hyaluronic acid (Restylane) at 9 months. PMMA microspheres (Artecoll) had encapsulated with connective tissue, macrophages, and sporadic giant cells. Silicone oil (PMS 350) was clinically inconspicuous but dissipated into the tissue, causing a chronic foreign body reaction. Polylactic acid microspheres (New-Fill) induced a mild inflammatory response and had disappeared clinically at 4 months. Dextran microspheres (Reviderm intra) induced a pronounced foreign body reaction and had disappeared at 6 months. Polymethylacrylate particles (Dermalive) induced the lowest cellular reaction but had disappeared clinically at 6 months. Polyacrylamide (Aquamid) was well tolerated and remained palpable to a lessening degree over the entire testing period. Histologically, it dissipated more slowly and was kept in place through fine fibrous capsules. Polyvinylhydroxide microspheres suspended in acrylamide (Evolution) were well tolerated, slowly diminishing over 9 months. Calcium hydroxylapatite microspheres (Radiance FN) induced almost no foreign body reaction but were absorbed by the skin at 12 months.Host defense mechanisms react differently to the various filler materials, but all substances—resorbable or nonresorbable—appeared to be clinically and histologically safe, although all exhibit undesirable side effects. Since the mechanism of late inflammation or granuloma formation is still unknown, early histological findings are not useful in predicting possible late reactions to filler substances. Presented at the 33rd Annual Meeting of the Association of German Plastic Surgeons in Heidelberg, Germany, September 21, 2002     

Cryopreservation of Fat Tissue and Application in Autologous Fat Graft: In Vitro and In Vivo Study

Background

Absorption of the autologous fat graft results in repeated harvesting procedures. The cost and complications increase with repeated procedures, but cryopreservation is one way to solve the problem. The aim of this study was to find an optimal temperature at which to store fat tissue with or without cryoprotective agents for long-term use.

Methods

Fat tissues harvested by liposuction were stored in normal saline, frozen in the freezer following the preset program, and cryopreserved at ?20, ?80, and ?196°C. The other group of fat tissues was stored in hydroxyethyl starch using the same frozen procedure. Two and 7 days after cryopreservation, viability tests were conducted. The fat tissues were injected into nude mice 2 and 4 weeks after cryopreservation. Three months later the fat grafts were harvested for histologic examination.

Results

No significant differences in cell viability were found in either in vitro or in vivo experiments for the three preserving temperatures. The cryoprotective agent HES did not influence cell viability.

Conclusion

There were no differences in cell viability among the three temperatures and with the use of a cryoprotective agent. Cryopreservation for salvage management is a clinically practical method.     

A New ePTFE Soft Tissue Implant for Natural-Looking Augmentation of Lips and Wrinkles

BACKGROUND: Expanded polytetrafluoroethylene (ePTFE) implants have been used for augmentation of thinning lips and wrinkles due to aging for more than 10 years. The aesthetic results have often been excellent, but complications such as infection, extrusion, migration, shrinkage, and hardening have occurred in some patients. OBJECTIVE: To assess short-term results and complications in patients undergoing augmentation of the lips, nasolabial folds, and marionette lines with a newly designed ePTFE implant. METHODS: Thirty patients received 60 Advanta ePTFE implants for augmentation of the lips, nasolabial folds, or marionette lines. RESULTS: All patients received a natural-looking augmentation following 3-4 days of noticeable swelling. The only significant complications involved two upper lip implants that were removed for suspected infection. CONCLUSION: In a preliminary series, Advanta ePTFE implants provided effective, natural-looking augmentation of the lips and nasolabial folds with minimal complications.     

Vascular Compromise from Soft Tissue Augmentation: Experience with 12 Cases and Recommendations for Optimal Outcomes

The popularity of soft tissue fillers is, in part, due to their favorable side-effect profile. However, serious complications can occur. The authors describe their extensive clinical experience with soft-tissue augmentation and the rare complication of vascular compromise, which can lead to necrosis and scarring. Over a 10-year period between January 2003 and January 2013, the authors observed a total of 12 cases of vascular compromise. Eight patients in their clinical practice showed evidence of vascular compromise out of a total of 14,355 filler injections (0.05%). In addition, four patients treated with an experimental particulate filler had vascular complications. All cases were examined for filler type, location of complication, risk factors, treatment, and outcomes. Although treatment plans differed for each patient in their series, all cases of vascular compromise resolved fully. The authors believe that an office-based protocol for both immediate and ongoing care—including a thorough individualized assessment and treatment plan for each patient—is critical to timely and effective resolution of side effects. They propose key recommendations for the prevention and management of vascular compromise to improve patient outcomes and reduce the risk of permanent complications.Injectable fillers have become an integral part of aesthetic medicine for patients who want noninvasive rejuvenation. They are used to restore volume and to smooth and efface superficial wrinkles and deep folds of the face, among other indications. Widespread use began in the 1980s with the advent of bovine collagen. Since then, use has surged so that soft tissue augmentation is the second most popular nonsurgical aesthetic procedure in North America to botulinum toxin.1 In 2007, more than 1.5 million soft tissue filler procedures were performed in the United States, with hyaluronic acid (HA) being the most frequently used.2 As of 2010, more than 200 types of fillers were available for soft tissue augmentation worldwide.1The popularity of soft tissue fillers is in part due to their favorable side-effect profile. Adverse effects from soft tissue filler injection are generally mild and self-limited. However, there are some well-documented serious complications. The most feared and potentially serious complications are vascular in nature. Collectively referred to as vascular compromise, these complications include partial or complete interruption of vascular supply by extravascular compression, or a complete occlusion of vascular supply from intravascular injection. Subsequent necrosis and scarring are potentially permanent sequelae.2-4In the authors’ clinical practice, 14,355 filler injections were performed between January 2003, when they first instituted their computer database, and January 2013. Fillers that are used in their office include hyaluronic acid (HA) (Juv''derm Ultra, Ultra plus, Voluma [Allergan, Irvine, California] and Restylane [Medicis Aesthetics Inc., Scottsdale, Arizona]); poly-L-lactic acid (Sculptra, Sanofi-Aventis, Bridgewater, New Jersey); calcium hydroxylapatite (Radiesse, Merz USA, Greensboro, North Carolina); silicone oil; and collagen (Evolence Breeze, Ortho Dermatologics, Skillman, New Jersey). During this 10-year period, a total of 12 cases of vascular compromise were observed and managed, eight of which occurred in the authors’ clinical practice and four in their clinical trials practice. Those cases that developed vascular compromise after soft tissue augmentation are reviewed and treatment discussed (Appendix 1).Over a 10-year period between January 2003 and January 2013, eight patients in the authors'' clinical practice showed evidence of vascular compromise out of a total of 14,355 filler injections (0.05%). They observed four cases after injection with calcium hydroxylapatite (CaHA) (out of 1,482 total injections; 0.27%), four cases after injection with volumizing monophasic HA (Juvéderm Voluma) (out of 4,321 total injections; 0.09%), and one case resulting from treatment with biphasic HA (Restylane) (out of 3,348 injections; 0.03%). One patient was treated with both CaHA and volumizing monophasic HA, and is counted in both groups (

Safety Data of Injectable Nonanimal Stabilized Hyaluronic Acid Gel for Soft Tissue Augmentation

BACKGROUND: Nonanimal hyaluronic acid gel was recently developed for soft tissue augmentation and volume expansion and has been shown to offer several advantages in comparison to other augmentation materials. There are rare reports of adverse events believed to be secondary to trace amounts of proteins in the hyaluronic acid raw material. OBJECTIVE: To determine the safety profile of nonanimal stabilized hyaluronic acid gel (Restylane, Perlane, Restylane Fine Lines, Q-Med AB, Uppsala, Sweden) for soft tissue augmentation using a retrospective review of all adverse events data from Europe, Canada, Australia, South American, and Asia from 1999 and 2000. RESULTS: Data from an estimated 144,000 patients treated in 1999 indicated the major reaction to injectable hyaluronic acid was localized hypersensitivity reactions, occurring in approximately 1 of every 1400 patients treated. In 1999 there was an adverse event reported for 1 of every 650 patients (0.15%) treated. These were temporary events that included redness, swelling, localized granulomatous reactions, bacterial infection, as well as acneiform and cystic lesions. For 2000 there was an estimated 262,000 patients treated with hyaluronic acid gel. The total number of adverse events was 144, corresponding to one adverse event for every 1800 patients (0.06%) treated. The major adverse event was again hypersensitivity, occurring in 1 of every 5000 patients treated. CONCLUSION: According to the reported worldwide adverse events data, hypersensitivity to nonanimal hyaluronic acid gel is the major adverse event and is most likely secondary to impurities of bacterial fermentation. According to data from 2000, the incidence of hypersensitivity appears to be declining after the introduction of a more purified hyaluronic acid raw material.     

A 52-Month Summary of Results Using Calcium Hydroxylapatite for Facial Soft Tissue Augmentation

OBJECTIVES In this large-scale clinical review, we investigated the safety and efficacy of Radiesse, an injectable calcium hydroxylapatite (CaHA) implant, in treatment of nasolabial folds, marionette lines, and other areas of the face.
METHODS After obtaining informed consent from the subjects, CaHA was injected in 1,000 patients (886 women and 114 men, ranging in age from 21 to 85 years) for a variety of facial aesthetic applications over a period of 52 months. Typically, CaHA was administered with a 27-gauge 1/2, or 1 1/4-inch needle.
RESULTS The nasolabial folds were the most frequently treated site, followed by the marionette lines/oral commissure. More than 80% of patients reported persistence of results at 12 months. The most frequently reported adverse events were erythema and ecchymosis. The formation of nodules was rare and was chiefly confined to the lips. Only two patients experienced nodule formation outside the lips.
CONCLUSIONS Over a period of more than 4 years, we found that CaHA performed well, with a favorable safety profile, high patient satisfaction, and good durability.     

Staged Stem Cell-enriched Tissue (SET) Injections for Soft Tissue Augmentation in Hostile Recipient Areas: A Preliminary Report

Background  

Autologous fat transplantation is frequently used for a variety of cosmetic treatments and difficult reconstructive indications such as involutional disorders, hemifacial atrophy, sequelae of radiation therapy, or similar problems. However, the limitations of fat transplantation are well known in such difficult cases, particularly the long-term unpredictability of volume maintenance. The ideal method of preparing autologous fat grafts optimizes tissue survival and reduces the variability of outcomes. We propose that enriching traditionally prepared fat grafts with adipose-derived regenerative cells (ADRCs) represents one such method.     

Soft Tissue Augmentation With Artecoll: 10-Year History,Indications, Techniques, and Complications

Most of the biologic filler materials that increase the thickness of the corium in a wrinkle line are phagocytosed within a certain time. Therefore, a lasting effect can only be achieved with nonresorbable synthetic substances. Artefill consists of 20 volume percent microspheres of polymethyl-methacrylate and 80 volume percent of bovine collagen. Beneath the crease, the microspheres with their exceptional surface smoothness stimulate fibroblasts to encapsulate each individual one of the 6-million microspheres contained in 1 mL of Artefill. Collagen is merely a carrier substance that prevents the microspheres from agglomerating during tissue ingrowth. The 20 volume percent of microspheres in Artefill provides the scaffold for the 80% volume of connective tissue deposition, a complete replacement of the injected collagen. The filler material beneath a crease acts like a splint and prevents the possibility of its further folding, thereby allowing the diminished thickness of the corium in a crease to recover. This recovery process is well known even in older patients with facial paralysis or after a stroke, whose facial wrinkles and furrows on the paralyzed side disappear over time.     

Blood Transfer: The Use of Autologous Blood as a Chromophore and Tissue Augmentation Agent

BACKGROUND: Atrophic scars, whether traumatic, postsurgical, or postacne, are distressing and difficult to treat. A freely available autologous agent that provides medium- to long-term correction of this problem would be welcome. There are very few endogenous chromophores in the skin for laser or light energy to target. A benign exogenous pigment implanted in superficial scars may be useful in presenting such a target for light energy, allowing selective injury to these scars and the possibility of new collagen formation. OBJECTIVE: To report five representative case reports that describe elements of two new techniques that may be useful in the management of atrophic acne scarring. METHODS: After drawing blood from the patient, this was immediately reinjected into premarked areas of atrophic scars. If there was substantial tissue deficit, this was either followed by repeated injections of whole blood at monthly intervals on three occasions or until adequate correction was attained and oral antifibrinolysis medication dispensed in addition to the blood transfer (hematogenous augmentation of tissue or the HAT technique). In the other circumstance, where the deficit was superficial, blood was implanted high in the tissue and used as a target for vascular laser or intense pulsed light in a technique termed the blood augmentation (with or without) stimulation of tissues by irradiation with light or laser energy or the Bastille technique. This is again repeated as required. RESULTS: Reasonable short- to medium-term correction has been attained in all five cases and there seemed to be a progressive improvement with each injection session. With the Bastille technique case there seemed to be progressive improvement with time, with the result at 4 weeks being substantially better than that at 2 weeks or at baseline. CONCLUSION: These case reports suggest that blood may be a worthwhile augmentation agent and chromophore. Both these techniques deserve further investigation to determine the optimum parameters. They are so simple in their concept and technique that should they help to provide a medium- to long-term correction for atrophic scars and other depressions, such as expression lines and wrinkles, they would be worthwhile additions to existing dermatologic techniques.     

异种胶原蛋白基质与自体结缔组织移植瓣在牙周软组织增量效果的研究

目的 研究异种胶原蛋白基质与自体结缔组织移植瓣对牙周软组织增量效果的影响。方法 选取 2022年7月-2023年12月于我院行种植修复治疗或种植术后复查的80例牙周病患者为研究对象,采用随机 数字表法分为对照组和观察组,各40例。对照组采用自体结缔组织移植瓣,观察组采用异种胶原蛋白基 质与自体结缔组织移植瓣联合治疗,比较两组创面愈合时间、临床疗效、美观满意度、牙周健康指标[改 良龈沟出血指数（mBI）、改良菌斑指数（mPI）]以及并发症发生情况。结果 观察组创面愈合时间为 （14.01±2.10）d,短于对照组的（16.28±3.21）d（P ＜0.05）;观察组治疗总有效率为97.50%,高于对照 组的82.50%（P ＜0.05）;观察组美观满意度高于对照组（P ＜0.05）;观察组mBI、mPI均小于对照组,并 发症发生率低于对照组（P＜0.05）。结论 异种胶原蛋白基质与自体结缔组织移植瓣联合治疗可提高临床 疗效,降低并发症发生率,缩短创面愈合时间,改善牙周健康指标,提升患者美观满意度。     

Clinical Trial of a Novel Filler Material for Soft Tissue Augmentation of the Face Containing Synthetic Calcium Hydroxylapatite Microspheres

BACKGROUND: The ideal injectable filler should yield great, long-lasting results, be biocompatible, reliable, safe, easy to use, and inexpensive. Radiesse (Bioform Inc., Franksville, WI) is a synthetic calcium hydroxylaptic filler that has all of the above qualities. OBJECTIVE To evaluate the effectiveness of Radiese as an injectable filler. METHODS: Eighty-two patients who underwent facial soft tissue augmentation using Radiese from April 2003 to 2004 were enrolled in this study. Pre-filled sterile syringes were used to inject the material into the soft tissues of the face. At the 3 month and six month visits, the physicians and the patients were asked to evaluate the result. RESULTS: Eighty-two patients were injected with Radiesse. The most common area of injection was the melolabial folds. All patients were evaluated during the 3 month follow up visit. There was an overwhelmingly positive response to the look and feel of the implant, averaging 4.6 on a grading scale from 1 to 5, for the patients as well as the injecting physicians. Similar responses were found at the 6 month follow up visit. CONCLUSION: Preliminary data indicate that Radiesse is easy to use and effective with little or no associated morbidity.