Adverse reactions to the injection of face and neck aesthetic filling materials: a systematic review

Background: Adverse reactions, caused during the inflammation and healing process, or even later, can be induced by the injection of dermal filler and can present a variety of clinical and histological characteristics. In this study we aimed to review the adverse reactions associated with the injection of aesthetic filling materials in the face and neck. Material and methods: The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies published that mentioned adverse reactions in patients with aesthetic filling materials in the face or neck were included. Risk of bias was assessed using the Joanna Briggs Institute appraisal tool. After a 2-step selection process, 74 studies were included: 51 case reports, 18 serial cases, and five cohorts. Results: A total of 303 patients from 20 countries were assessed. Lesions were more prevalent in the lip (18%), nasolabial folds (13%), cheeks (13%), chin (10%), submental (8%), glabella (7%), and forehead (6%). Histopathological analysis revealed a foreign body granuloma in 87.1% of the patients, 3% inflammatory granuloma, 3% lipogranuloma, 2.3% xanthelasma-like reaction, 1% fibrotic reaction, 0.7% amorphous tissues, 0.7% xanthelasma, 0.3% sclerosing lipogranuloma, 0.3% siliconoma, and 0.3% foreign body granuloma with scleromyxedema. In addition, two patients displayed keratoacanthoma and two others displayed sarcoidosis after cutaneous filling. The most commonly used materials were silicone fillers (19.7%), hyaluronic acid (15.5%), and hydroxyethyl methacrylate/ethyl methacrylate suspended in hyaluronic acid acrylic hydrogel (5.6%). All patients were treated, and only 12 had prolonged complications. (AU)

3D stereophotogrammetry quantification for tissue repositioning using Botulinum toxin A: a case report / Quantificação por estereofotogrametria 3D para reposicionamento tecidual com Toxina botulínica A: relato de caso

Hereby, we objectively assessed the outcomes of a facial-lifting procedure with Botulinum toxin type A (BoNT-A) using a 3D stereophotogrammetry quantification (3D-SQ). A 46-year-old female patient received a full face BoNT-A treatment in a total dose of 180 Speywood Units (sU). Frontal, lateral and oblique photographs were taken before and 20 days after treatment, at rest and during mimic movements. Also, a facial scanning was performed before and 20 days after BoNT-A injections. The results were analyzed using a 3D-SQ software. The photographs showed a decrease in expression lines and dynamic wrinkles. In addition, a better-defined jawline and volume gain in the midface area with improvement of the profile appearance, due to the reduction of the sagging skin under the chin, was observed. The 3D-SQ showed volume gains of 1.17 ml on the right and of 1.59 ml on the left cheekbone areas, due to the cranially soft-tissue repositioning. In addition, a decrease in the volume of melomental folds areas (0.27ml on the right and 0.41 ml on the left side) was reported, compatible to the above-mentioned volume gain. Measurements considering cephalometric points showed a decrease in the total facial height (distance from Trichion to Mental points), suggesting a soft tissue dislocation in an upward direction. Finally, this case report showed quantitative results that can evidence the role of BoNT-A in facial- lifting procedures. These results reinforce the importance of using a 3D-SQ to assess the outcomes of BoNT-A and, probably, other aesthetic procedures.(AU)

No presente estudo avaliamos objetivamente os resultados de um procedimento de lifting facial com toxina botulínica tipo A (BoNT-A) usando uma quantificação de estereofotogrametria 3D (3D-SQ). Uma paciente do sexo feminino de 46 anos recebeu um tratamento facial completo com BoNT-A em uma dose total de 180 unidades Speywood (sU). Fotografias frontais, laterais e oblíquas foram tomadas antes e 20 dias após o tratamento, em repouso e durante os movimentos mímicos. Além disso, um escaneamento facial foi realizado antes e 20 dias após as injeções de BoNT-A. Os resultados foram analisados por meio de um software 3D-SQ. As fotografias mostraram uma diminuição das linhas de expressão e rugas dinâmicas. Além disso, observou-se um maxilar mais bem definido e ganho de volume na região média da face com melhora da aparência do perfil, devido à redução da flacidez da pele sob o queixo. O 3D-SQ apresentou ganho de volume de 1,17 ml à direita e 1,59 ml à esquerda, devido ao reposicionamento do tecido mole. Além disso, foi relatada diminuição do volume das áreas do sulco mentual (0,27 ml à direita e 0,41ml à esquerda), compatível com o ganho de volume acima citado. As medidas considerando os pontos cefalométricos mostraram uma diminuição da altura facial total (distância dos pontos Triquion ao Mentual), sugerindo um deslocamento superior dos tecidos moles. Em conclusão, este relato de caso mostrou resultados quantitativos que podem evidenciar o papel da BoNT-A em procedimentos de lifting facial. Esses resultados reforçam a importância da 3D-SQ para avaliar objetivamente os resultados de harmonização orofacial com BoNT-A e outros materiais. (AU)

No deleterious effect of low dose methotrexate on titanium implant osseointegration in a rabbit model.

OBJECTIVE: To evaluate the effect of low dose methotrexate alone or in combination with glucocorticoid treatment on titanium implant osseointegration. METHODS: Groups of 6-8 adult New Zealand White rabbits were treated for 18 weeks with saline (control), methotrexate, glucocorticoid, or methotrexate plus glucocorticoid. The animals received a titanium implant in the tibia at week 6. Lumbar spine and tibia bone mineral densities were analyzed before and after treatment. Histomorphometric analysis of bone cortical thickness, total bone area around the implant, and % of bone to implant contact was performed. RESULTS: After 18 weeks, the change in the bone mineral density in the lumbar spines and tibias in the methotrexate group was comparable to the control group (0.035 vs. 0.055 g/cm² and 0.021 vs. 0.041 g/cm², respectively). In contrast, both the glucocorticoid group and glucocorticoid plus methotrexate group had significant reductions at both sites. Histomorphometric analysis of the tibia in the control and methotrexate groups revealed no significant changes in cortical thickness (133 vs. 126 µm), total bone area around the implant (33 vs. 30%), or bone to implant contact (40 vs. 38%). In contrast, glucocorticoid group had significant reductions compared to controls in tibia cortical thickness (99 vs. 133 µm), total bone area around the implant (24 vs. 33%), and bone to implant contact (27 vs. 40%). Similar reductions were observed in the glucocorticoid plus methotrexate group. CONCLUSIONS: Our results demonstrate that low dose methotrexate treatment does not affect titanium implant osseointegration, suggesting that this therapy is safe for surgical procedures requiring a titanium implant.

No deleterious effect of low dose methotrexate on titanium implant osseointegration in a rabbit model

OBJECTIVE: To evaluate the effect of low dose methotrexate alone or in combination with glucocorticoid treatment on titanium implant osseointegration. METHODS: Groups of 6-8 adult New Zealand White rabbits were treated for 18 weeks with saline (control), methotrexate, glucocorticoid, or methotrexate plus glucocorticoid. The animals received a titanium implant in the tibia at week 6. Lumbar spine and tibia bone mineral densities were analyzed before and after treatment. Histomorphometric analysis of bone cortical thickness, total bone area around the implant, and percent of bone to implant contact was performed. RESULTS: After 18 weeks, the change in the bone mineral density in the lumbar spines and tibias in the methotrexate group was comparable to the control group (0.035 vs. 0.055 g/cm² and 0.021 vs. 0.041 g/cm², respectively). In contrast, both the glucocorticoid group and glucocorticoid plus methotrexate group had significant reductions at both sites. Histomorphometric analysis of the tibia in the control and methotrexate groups revealed no significant changes in cortical thickness (133 vs. 126 μm), total bone area around the implant (33 vs. 30 percent), or bone to implant contact (40 vs. 38 percent). In contrast, glucocorticoid group had significant reductions compared to controls in tibia cortical thickness (99 vs. 133 μm), total bone area around the implant (24 vs. 33 percent), and bone to implant contact (27 vs. 40 percent). Similar reductions were observed in the glucocorticoid plus methotrexate group. CONCLUSIONS: Our results demonstrate that low dose methotrexate treatment does not affect titanium implant osseointegration, suggesting that this therapy is safe for surgical procedures requiring a titanium implant.