female measuring her thigh

The Non-Surgical Butt Lift: Achieving a Perky Butt without Surgery

Professionals / By  marketing_team

23 May

Throughout human history, numerous civilizations have revered prominent buttocks, with some even crafting fetishes dedicated to fertility goddesses characterized by their oversized posteriors. While we have stopped openly worshiping them, not a lot has changed since then.

Having a perky butt is still considered a positive beauty trait in both men and women, but not everyone can achieve it. We aren’t talking about a lack of training or commitment. We are talking about genetics, gravity, and the natural aging process. Those are the primary factors that motivate individuals to seek surgical or non-surgical butt lift procedures, also known as BBL.

How Does One Achieve a Successful Butt Lift Without Surgery?

There are three ways one can improve the look of their derrière without surgery:

  1. Dermal fillers
  2. Radiofrequency Based Treatments
  3. Ultherapy

Dermal Fillers

Dermal fillers like Radiesse, Sculptra, and Juvederm are the most common non-surgical methods used for everything from the face to the buttocks. 

Dermal fillers are known as biostimulators. They work by stimulating collagen production in the administered area, which rejuvenates the skin, hides cellulite and other skin imperfections, improves the appearance of sagging skin, lifts and contours the area, and adds volume to it.  

It’s a common misconception that Botox can also do all of this, but no. Botox is an excellent aging prevention method, but it can’t reverse the damage once it’s done. It’s not uncommon for both procedures to be used for a longer-lasting effect on the skin. 

Radiofrequency Based Treatments

This non-invasive BBL method also works by stimulating the production of collagen, but instead of injecting biocompatible acids like dermal fillers, it heats up the deeper layers of skin to induce the creation of heat-shock proteins, which in turn create new collagen fibers

While the process is virtually painless, it may be slightly disconcerting to some due to the deep layers of skin needing to reach between 122 and 167°F for the treatment to work. 

Ultherapy

Ultherapy is another non-invasive method used to stimulate collagen production and elastic tissue in deeper layers of skin. However, instead of using radiofrequency to heat up the skin, it uses ultrasound technology to achieve similar results. 

Unlike radiofrequency-based treatments, Ultherapy can precisely target deeper layers of the skin without causing any pain or discomfort.

It may come as a surprise that a Brazilian butt lift is not included on the list, but there are no non-surgical Brazilian butt lifts. While the process of injecting fat into the derrière is non-surgical, extracting fat with liposuction is not, and therefore the Brazilian BBL and other fat grafting procedures are surgical procedures. 

Why Do People Choose Non-Surgical Over Surgical Butt Lifts?

Simply put, there are three main reasons: risk, cost, and downtime.

Risk

Any surgical procedure, whether cosmetic or non-cosmetic, inherently carries a higher level of risk due to its invasive nature and potential complications. They include, but are not limited to: 

  • Infections: Surgical procedures carry a risk of infection at the incision site or in the surrounding tissues, which may require additional treatment or antibiotics.
  • Adverse Reactions to Anesthesia: Some individuals may experience adverse reactions to anesthesia, ranging from mild reactions like nausea and vomiting to more severe complications, such as allergic reactions or respiratory issues.
  • Bleeding and Hematoma: Excessive bleeding during or after surgery can lead to hematoma formation, where blood collects and forms a clot. It may necessitate drainage or surgical intervention. Non-surgical BBL uses anesthesia, but the topical anesthesia used during the procedure has mild side effects. 
  • Scarring and Poor Wound Healing: Surgical incisions can result in scarring, and in some cases, the healing process may be delayed or compromised, leading to poor wound healing or keloid formation.

It is important to note that these potential complications can vary depending on the specific surgical procedure and individual factors. 

Cost

It’s no secret that any medical procedure is costly, the same goes for cosmetic procedures, and it doesn’t help that most healthcare insurance policies don’t cover the costs of cosmetic surgery. 

According to the American Society of Plastic Surgeons, the average cost of buttock augmentation with fat grafting is $4,341. What isn’t included in that price are the surgeon’s fee, anesthesia fees, medical tests, facility costs, and other additional costs, which easily double the price of the procedure.  

Non-surgical butt lift costs are way lower. For example, the price of a dermal filler procedure depends primarily on how many vials are needed to achieve the desired results. The procedure can take anywhere between four and ten vials, with one vial costing, on average, $230.  

These prices are just averages. The actual cost will vary depending on the region and the individual doctor.

Downtime

Nobody likes to be stuck in bed, and patients want to get back to their everyday lives as quickly as possible. That simply isn’t possible if incisions are required during the procedure. Depending on the procedure, one must take different aftercare steps to ensure everything heals properly.

All non-invasive methods can be done during a lunch break and require little to no downtime. Once the patient is done, they can continue their daily lives with minimal aftercare needed. The same can’t be said for surgical procedures. 

Benefits of Buttock Lift Without Surgery

One of the key benefits is, naturally, a firmer and enhanced buttock contour and shape. While it is true that this outcome can also be achieved through surgical means, opting for a non-surgical approach offers a range of additional benefits. Those are: 

No incisions or scars – While corrective surgery scars are minimal, they do still exist. 

  • Low risk – With non-invasive methods, the risk is minimal to non-existent. 
  • No bed rest – All the non-surgical methods mentioned do not require any bed rest. 
  • Minimal aftercare – There is no need for special aftercare treatments or bandages to cover up the treated area. 
  • Quick – Treatments take between 30 and 90 minutes per appointment. 
  • Inconspicuous – Nobody will notice any sudden changes. It takes between three and six months for collagen to do its magic. 
  • Natural – But lift treatments harness the body’s natural processes, using technologies that stimulate collagen production and promote tissue tightening to achieve a naturally enhanced buttock appearance.

They also have one common drawback: they are all semi-permanent, so follow-up treatments will be required after two to four years, depending on the treatment.  

Who Is a Good Non-Surgical Buttock Lift Candidate?

The ideal candidate for a non-surgical alternative should possess the following characteristics:

Good Overall Health: Candidates should be in good overall health without any underlying medical conditions that could pose risks during the procedure or hinder the recovery process.

Mild to Moderate Sagging: Non-surgical buttock lift procedures are typically suitable for individuals with mild to moderate sagging or loss of firmness in the buttock area.

Realistic Expectations: It’s essential for candidates to have realistic expectations about the outcome of a non-surgical buttock lift. While butt lift injections can enhance the appearance, they may not achieve the same dramatic results as surgery.

Absence of Excess Weight: Non-surgical buttock lift procedures are generally more effective for individuals at or near their ideal body weight. Excess weight can affect the overall contour and may limit the effectiveness of the treatment.

It is important to consult with a qualified healthcare professional who can evaluate your specific situation and determine if you are a suitable candidate for a non-surgical buttock lift.

Conclusion

With advances in medical technology, everyone can achieve the butt of their dream. Butt lift, non-surgical and surgical, both deliver the desired results of a tighter and firmer posterior but use two different approaches. While one approach may not be suitable for everyone, the availability of non-surgical butt lift options provides a viable alternative for those who prefer a less invasive procedure.

However, it is essential for individuals to consult with qualified healthcare professionals to determine the most suitable option for their specific needs and goals. Factors such as skin elasticity, sagging severity, overall health, and individual preferences play a significant role in deciding whether a non-surgical buttock lift is the right choice.

FAQ

What are the risks of a non-surgical BBL?

Non-surgical alternatives can cause bruising and swelling, which can last up to three weeks.

What is the problem with the buttock lift?

The most common issue that can arise as a result of insufficient practitioner skill or filler migration is for the dermal filler to set incorrectly, resulting in an unnaturally lumpy appearance. If this occurs, there is nothing you can do but wait for the body to absorb it. 

What not to do after non-surgical BBL?

Avoid showering the treated area for 24 hours after the treatment. Refrain from going to the gym for a week, and avoid engaging in buttock exercises for six weeks. It is advisable to avoid sunbathing in any form. Additionally, try not to sleep on your back for a week. These guidelines serve as general recommendations, but following your practitioner’s specific aftercare instructions is crucial as they may vary depending on the procedure used.

References: 

  1. Bilateral Gluteal Augmentation With Hyperdilute Calcium Hydroxylapatite Microspheres Performed Using the Bella Vida Instant Brazilian Butt Lift (BBL); Iani Silveira and Brigitte Martinez; June 2022
  2. Adjustable Depth Fractional Radiofrequency Combined With Bipolar Radiofrequency: A Minimally Invasive Combination Treatment for Skin Laxity; Erez Dayan (MD), Christopher Chia (MD), A Jay Burns (MD), and Spero Theodorou(MD); April 2019
  3. Hyaluronic Acid Fillers: Science and Clinical Uses; Karol A Gutowski; July 2016
  4. Brazilian Butt Lift–Associated Mortality: The South Florida Experience; Pat Pazmiño (MD) and Onelio Garcia, Jr. (MD); February 2023
  5. Collagen Stimulators in Body Applications: A Review Focused on Poly-L-Lactic Acid (PLLA); Marie-Odile Christen; Jun 2022
injection placed into a person's chin

Aqualyx Injections: Procedure, Preparation & Aftercare

Professionals / By  marketing_team

15 May

The body may experience an increase in fat deposits due to changes in diet, decreased physical activity, or other conditions. While some types of fat deposits can be eliminated by dieting or active exercise, others are unfortunately not as easily corrected (chin, hips, inner knee surface).

Intralipotherapy is a good alternative for localized fat correction and offers new possibilities for patients and doctors. It is meant for patients who don’t want to have surgery (liposuction) or those for whom liposuction is contraindicated.

What Is Aqualyx?

Aqualyx is an injectable adipocytolytic agent for subdermal intralipotherapy. It destroys the fat cell’s membrane and causes fat tissue volume reduction. 

The name often refers to an instant procedure of local fatty deposit correction with Aqualyx fatdissolving injections in problem areas. The method was invented in Spain, has been used in Europe for a while, and is in great demand. Within a short time, this procedure has become one of the most demanded methods of body correction on the market. 

Such popularity is caused by several factors: immediate results, safety, and a localized effect on specific body parts. Due to the speed of the procedure and the lack of need for rehabilitation afterward, Aqualyx is sometimes called “office liposculpture,” as it is quick enough to be done during a lunch break.

How Does Aqualyx Work?

It works by using a compound called deoxycholic acid, a natural substance found in the body that helps break down and dissolve fat cells.

When Aqualyx is injected into the targeted zone, deoxycholic acid breaks down fat cell walls, causing them to rupture and release their contents. The body’s natural waste elimination processes then remove the released fat, metabolized and eliminated through the lymphatic system and liver.

Over time, the treated area becomes slimmer and more contoured as the fat cells get eliminated. The results of Aqualyx treatments are gradual and typically become visible several weeks after the initial fatdissolving injection.

Aqualyx is a non-surgical contouring treatment that can be performed in a clinic or a medical office. The procedure usually takes between 30 and 60 minutes, depending on the treated area. The number of fatdissolving injections depends on the amount of fat in the targeted area and the individual’s treatment goals.

It is important to note that Aqualyx is not a weight-loss treatment and is not suitable for individuals who are significantly overweight or have large areas of fat that need treatment. Instead, Aqualyx is designed to target small pockets of stubborn fat in areas that are difficult to treat with diet and exercise alone, such as the submental area (double chin), jowls, and hip fat or the so-called love handles.

Aqualyx Procedure

Aqualyx treatment is carried out as follows:

  • the area of injection is treated with antiseptic;
  • a marker is used to locate the site to be treated;
  • medicine is injected (one to five vials of 8 ml each);
  • a light local massage is performed to distribute the drug evenly;
  • the surface is re-treated with antiseptic.

This procedure requires the utmost precision and experience in knowing how to inject Aqualyx, as it is possible to traumatize muscles or mistakenly inject the medicine superficially. That is why it should only be performed by a qualified professional.

After intralipotherapy, the patient can return to everyday life. However, visiting baths and saunas, tanning salons, and vigorous physical exercise are not recommended during the first two weeks after the procedure. The injections may cause local reactions in the form of itching, burning, hyperemia, sensitivity changes, and subcutaneous thickening.

For the best effects, intralipotherapy can be combined with algae wraps, LPG massages, and pressure therapy. All these methods will complement each other and improve the overall effectiveness of the treatment. In addition, patients can wear compression garments to enhance the effect of Aqualyx.

Preparation

Aqualyx is a non-surgical liposuction, which means it does not require any special preparation by  the patient. It is only necessary to completely avoid aspirin-containing products – to minimize the risk of swelling and bruising. Immediately before the procedure, qualified specialists will perform a visual diagnosis, make a mark for the introduction of injections, and determine the amount of substance required. A local anesthetic in the form of a cream or gel is also applied.

Aftercare

There are a few simple rules after intralipotherapy with Aqualyx. Firstly, patients should avoid saunas, steam baths, and tanning salons for at least ten days. Secondly, several days after the procedure, one must drink not less than two liters of water daily. It will help to restore the water balance in the body. Also, it is worth reducing physical activity and excluding alcohol for a while.

Aqualyx vs. Kybella

Aqualyx and Kybella target similar body areas where fat is difficult to remove. In addition, they can both be used to define facial features such as the jawline by reducing the appearance of a double chin. Aqualyx and Kybella have similar active ingredients, with Aqualyx containing deoxycholate, derived from plant-based compounds, and Kybella containing synthetic deoxycholic acid. The primary difference between them is that Kybella has been approved by the FDA. As such, Aqualyx may be less well-known among Kybella users in the US.

In terms of price, Aqualyx is significantly more cost-effective than Kybella. For example, Aqualyx is available for $610 for 10 x 8 ml vials, while Kybella will set you back $1,750 for 4 x 2 ml vials. This means that the cost per ml of Aqualyx is less than $8, compared to nearly $219 per ml of Kybella.

Side Effects

Aqualyx injections have side effects that can be divided into two types: injection and product-related. Let’s discuss both:

1. Injection-related

  • Local hyperemia;
  • Mild tissue swelling around the injection;
  • Mild injection pain;
  • Itching;
  • Bruising.

These symptoms disappear within two to four days and do not require additional treatment.

2. Product-related:

  • Local hyperthermia;
  • Burning sensation at the injection site;
  • Swelling;
  • Hyperemia.

These symptoms subside on their own within 48-72 hours.

Conclusion

Aqualyx is an injectable adipocytolytic agent used in subdermal intralipotherapy to destroy fat cells and reduce the volume of fat tissue. The treatment is designed to target small pockets of stubborn fat in areas that are difficult to treat with diet and exercise alone. The procedure is non-surgical, and a local anesthetic is applied before the injections. 

The treated area gradually becomes slimmer and more contoured as the fat cells are eliminated, and the results typically become visible several weeks after the initial injection. 

It is important to note that Aqualyx is not a fatdissolving treatment and is not suitable for severely overweight individuals with large fat deposits. Compared to a similar product called Kybella, Aqualyx is a more cost-effective alternative that’s very popular in Europe. 

FAQ

How long do Aqualyx injections last?

If patients lead an active life after the treatment and do not abuse fatty, hard-to-digest foods, the effect of an Aqualyx procedure will last for an extended period.

Does Aqualyx really work?

Yes, Aqualyx effectively reduces unwanted pockets of fat under the skin in many individuals. Aqualyx uses deoxycholic acid to break down and dissolve fat cells in the treated area, which are then naturally eliminated by the body. In addition, clinical evidence and several scientific studies have proven the effectiveness of adipocytolytic substances for the non-surgical reduction of antiaesthetic subcutaneous fat [1],[2],[3],[4],[5].

Are Aqualyx injections safe?

Yes. Aqualyx injections can be effective in reducing undesirable subcutaneous fat deposits safely, as long as an appropriate adipocytolytic device is used by a medical professional and proper precautions are taken.

References

  1. Duncan D. Response to “injection lipolysis with phosphatidylcholine and deoxycholate”. Aesthet Surg J. 2013;33:1073–1075.
  2. Pinto H, Hernandez C, Turra C, et al. Evaluation of a new adipocytolytic solution: adverse effects and their relationship with the number of vials injected. J Drugs Dermatol. 2014;13:1451–1455.
  3. Klein SM1, Schreml S, Nerlich M, et al. In vitro studies investigating the effect of subcutaneous phosphatidylcholine injections in the 3T3-L1 adipocyte model: lipolysis or lipid dissolution? Plast Reconstr Surg. 2009;124:419–427. Accessed November 20, 2016.
  4. Hasengschwandtner F, Gundermann KJ. Injection lipolysis with phosphatidylcholine and deoxycholate. Aesthet Surg J. 2013;33:1071–1072.
  5. Salti G, Rauso R. Comments on “Injection lipolysis with phosphatidylcholine and deoxycholate”. Aesthet Surg J. 2014;34:639–640.
blonde girl getting a hair filler treatment

What Is a Hair Filler?

Dermal Fillers Professionals / By  marketing_team

28 Apr

Gorgeous hair is not a fashion or a passing trend but an all-time beauty standard. It is not only facial features that make a person beautiful but also healthy, well-groomed locks. Shiny, flowing locks are an integral part of a chic image.

The natural beauty of hair is lost under the influence of such factors as:

  • Weather conditions;
  • Hair styling products;
  • Numerous hair coloring;
  • Lack of vitamins;
  • Stresses;
  • Unhealthy lifestyle.

It used to seem difficult, if not impossible, to restore our hair to its former health and stop it from falling out. Striving for perfection and restoring hair to its former glory. Home care did not bring the desired result, and specialist beauty salons shrugged.

But now, with ‌hair fillers, restoring scalp health and stopping hair loss is possible.

What Is a Hair Filler?

Hair fillers are injectable treatments that add volume and stimulate hair growth in areas with thinning or sparse hair. They are a cosmetic solution for hair loss. They can also be used to enhance the hairline’s appearance or fill areas where hair has been lost due to scarring or injury. Hair fillers are temporary and usually last for several months to a year.

In addition, there are cosmetic products with a similar name – hair filler powders. These products claim to add volume and thickness to hair. They are typically made of microfibers or keratin fibers that adhere to hair strands to create the illusion of thicker hair.

Hair filler powders come in various colors to match different hair shades and can be applied directly to the scalp or hair using a brush or applicator. They are often marketed as a quick and easy solution for thinning hair or bald spots. It’s important to note that it’s just a temporary cosmetic fix that does not treat the underlying causes of hair loss.

Content of Hair Filler

The content of hair fillers can vary depending on the specific product used. However, common materials used in hair fillers include:

  • Hyaluronic acid: This is a natural body substance that helps to retain moisture and promote cell growth. When used in hair fillers, it can stimulate hair growth and add volume to the scalp.
  • Collagen: This is a protein found in the body that gives skin its elasticity and strength. When used in hair fillers, it can improve the texture and thickness of the hair.
  • Bioactive peptides: These are small chains of amino acids that can stimulate cell growth and collagen production. When used in hair fillers, they can improve hair growth and overall scalp and hair health.

Other ingredients that may be included in hair fillers include vitamins, minerals, and antioxidants, which can nourish the scalp and promote healthy hair growth. However, it’s important to note that the specific ingredients used in a hair filler will depend on the brand and product chosen.

How to Choose the Right Hair Filler

Choosing suitable hair filler products depends on several factors, including the severity of hair loss, the underlying cause, and personal preferences. Things to consider when choosing a hair filler:

  1. Consult with a dermatologist or hair restoration specialist: Before choosing a hair filler, it’s important to consult with a healthcare professional in hair loss and restoration. They can help you determine the underlying cause of your hair loss and recommend the best treatment options for your specific needs.
  2. Consider the type of filler: There are several types of hair fillers available, including hyaluronic acid, collagen, and bioactive peptides. Each type of filler has unique properties and benefits, so it’s essential to choose one best suited for your hair loss needs.
  3. Look for a reputable brand: Choose a hair filler from a reputable brand known for creating high-quality products. Look for brands with a good reputation and backed by scientific research.
  4. Read product reviews: Before choosing a hair filler, read reviews and testimonies from other customers who have used the product. It can give an idea of the product’s effectiveness and any potential side effects.
  5. Consider the cost: Hair fillers can vary in price, so choosing one within your budget is essential. It’s also important to note that the most expensive product isn’t always the best option.

Overall, choosing the suitable hair filler requires careful consideration and consultation with a healthcare professional.

The Hair Filler Procedure

Prepared hair fillers are injected under the skin with a syringe with very fine needles. It allows doctors to deliver the medication in the most precise way. 

The procedure can be performed manually or with a device. The depth of injections is usually 2-4 mm. First, the skin is pre-treated with an antiseptic. Then injections are made at predetermined points, moving along the hair growth line and along the strike.

Before the injection, the skin is slightly stretched. After that, it is treated with antiseptic. The procedure lasts from 30 minutes to an hour.

As a rule, the hair fillers mesotherapy treatment course comprises 7 to 10 procedures. Therefore, they should be carried out not more often than once every ten days. Then you can go through the consolidation course. It may include from 4 to 6 procedures. Each is carried out approximately once a month.

Advantages of Hair Fillers

Hair fillers offer numerous benefits, such as:

  • Supplying the hair with all the beneficial substances;
  • Hair structure regeneration;
  • Hair loss prevention;
  • Protection from external factors;
  • Making hair manageable;
  • Effective treatment of split ends;
  • Immediate results.

Preparation and Aftercare

Despite the procedure’s safety, hair filler mesotherapy has several contraindications. For example, pregnancy or scalp diseases. However, these are not the only ones. Unfortunately, there are quite a few contraindications. That is why it is crucial to consult a doctor and only then make a decision.

About a week before the mesotherapy, it is necessary to begin preparing for the appointment. As a rule, doctors recommend refraining from sunbathing, visiting the sauna, and taking certain medications or alcohol.

In addition, it is recommended to stop using styling products temporarily. Doing mesotherapy immediately after bleaching hair or a perm is not advised; at least 2–3 weeks should pass.

Finally, after hair filler treatment, you must not wash your hair for two days. It is also better to avoid visiting bathhouses, swimming pools, or saunas. A couple of days after the procedure, it is normal to feel a slight scalp burning. It may be accompanied by redness. Mild bruising on the injection site may persist for a week.

Fortunately, a filler for hair gives fast, visible results. After a few days, if there are no complications, you can return to your usual hair care.

Conclusion

A course of mesotherapy with hair fillers revitalizes the hair, making it dense and soft, more voluminous, and giving it shine and radiance. Thanks to nourishing the scalp and hair follicles with essential microelements and vitamins, hair growth increases, and curls become bouncier.

The result is visible after the first treatment and grows during the course. Patients will feel their hair is thicker and more beautiful within a month. The effect lasts for a long time.

When fighting hair loss with mesotherapy, it is possible to significantly slow down this process. 

During the procedure, there is also a mechanical stimulation of the blood supply of hair follicles by microinjections, which activates the growth of new hair. But the most crucial point: the procedure should be carried out by a cosmetologist using quality products. 

Only then can patients expect the desired result.

FAQ

Is hair filler treatment safe?

Hair filler treatments are generally considered safe when performed by a qualified healthcare professional. However, like any medical treatment, there are some potential risks and side effects associated with hair filler treatments.

The most common side effects of hair filler treatments include redness, swelling, and bruising at the injection site. Typically, these side effects are mild and self-resolve within a few days. 

What can I expect from a hair filler treatment?

Hair filler treatment can provide temporary results that include increased volume, improved hair texture, and stimulated hair growth. Still, the exact duration of the results will depend on the specific product used and individual factors. 

It’s important to note that hair filler treatment is not permanent, and patients may need multiple treatments to maintain the desired results.

How many sessions of hair filler do I need?

To achieve the best results, it’s recommended to undergo four sessions of hair filler treatment fortnightly. After the initial treatment, you can opt for maintenance sessions every six months, but even one treatment can stop the hair loss process.

Pretty lips gets a filler injection to show the migration of lip filler

Lip Filler Migration: Causes and Prevention Tips

Disclaimer: Only trained professionals should perform dermal filler injections to the lips to avoid risks to the patient’s health. Lip dermal fillers can only be sold to certified aesthetic doctors, plastic surgeons, or special beauty clinics.

Lip augmentation with fillers is one of the most popular non-surgical procedures worldwide.

The main aim of dermal lip fillers is to add volume and elasticity and smooth out wrinkles. Fillers help eliminate asymmetry, align the lip contours, make lips plumper, and raise drooping corners.

Modern fillers are based on collagen, hyaluronic acid, and calcium. The lips gain the desired shape and volume less than an hour after the filler injection. Depending on the chosen filler, the desired effect lasts six months to three years.

Lip fillers are divided into two categories: permanent, which do not dissolve, and biodegradable fillers, which dissolve over time.

Permanent fillers were commonplace when the world started doing aesthetic injection procedures. Such preparations are made from synthetic materials: mostly biopolymer and polyacrylamide gels.

These gels have many delayed side effects. They do not degrade naturally, can be absorbed unevenly in the tissues, and settle in lumps in different areas of the lips.

Lumps of permanent filler cannot be removed if they were inserted more than ten years ago, as filler grows into the tissues. If the gel has been in the lips for a few years, it can be removed surgically. However, after surgery, scars may remain on the lips.

Biodegradable fillers are used to increase and moisturize the lips. Most often, these are preparations of stabilized hyaluronic acid.

Hyaluronic acid is a natural moisturizer that exists in human tissues. The body produces hyaluronic acid until a certain age, but its quantity decreases as tissues degrade with age. Introducing filler improves the lips’ condition and makes them plumper.

The body eliminates collagen fillers at high speed.This is undeniably a drawback, but such injectables stimulate the production of the body’s collagen, leading to natural skin improvement.

Lip Filler Migration

Getting lip filler treatment for a fuller, puckered pout remains one of the most talked-about cosmetic trends, but what’s less talked about is one of its potential side effects: lip filler migration or swelling of the lips.

This refers to a condition where the filler gel used in the area of the lips moves from the injection site, creating unnatural volumes and reliefs.

This potential side effect isn’t harmful; it could scare a patient as it’s not the result they expect when undergoing this noninvasive procedure. Fortunately, it isn’t permanent, and you can take measures to avoid it.

Why Does Filler Migrate?

Most specialists believe that the migration of fillers occurs due to incorrect administration of the drug. Both the technique and the amount of the product play a role here.

Of course, there is no specific universal dosage, as various individual nuances take place here. However, hypercorrection is one of the frequent causes of gel migration. Over-injecting the lips can stretch them beyond their natural capacity to accommodate the additional volume.

This excessive stretching can cause the filler to migrate into neighboring areas, resulting in an unnatural or uneven appearance. Therefore, injectors need to exercise caution and avoid using too much filler. You can control the amount of filler injected into any area. A less-is-more approach helps to ensure the gel is properly contained within the intended location.

In addition, the gel may not stay where it is supposed to be due to its superimposition on top of the previous filler. As a result, it simply has nowhere to go and will flow along the path of least resistance – often a little higher than the lips.

Also, among lip filler migration causes are injections that are too superficial or too quickly performed – which leads to the filler getting into the wrong tissue layer.

An incorrect selection of the filler is equally a problem. Each cosmetologist has a personal arsenal of products with different compositions and properties. It’s necessary to clearly understand which drug is more suitable for which zone – or for these or other individual characteristics of the patient.

Thicker, dense textures are injected deep into the tissues to create a lifting effect and increase the cheeks or chin line volume. Whereas light, liquid textures are applied superficially to smooth out fine wrinkles or create a light, natural lip volume. Migration is likely if you use fillers not intended for the zone you treat, such as thick gels in delicate areas.

A small percentage of patients can also experience lip filler migration due to an immune system response triggered by an illness or allergic reaction.

How To Understand That The Filler Has Migrated?

The predominant signs are unnatural volume, swelling, and lumpiness. When the filler migrates, the lips’ upper border may become less clear, and bumps may form on the skin above the lip. Another indicator to look for is difficulty closing the lips.

Migration is easily confused with edema, so informing a patient about such symptoms is essential. The fact is that many fillers attract water, and because of that, they can cause temporary swelling.

If hypercorrection is the cause of lip filler migration, it manifests itself quickly. But if it happens due to incorrect technique or short intervals between injections, then it only becomes noticeable after a few months.

Prevention and Management of Lip Filler Migration

First, always discuss a patient’s health during the preliminary consultation to detect the contraindications to the procedure.

Here are some tips for you to prevent lip filler migration during the injection process:

• Understand facial anatomy. It is vital to thoroughly understand facial anatomy and, more specifically, the lips’ anatomy to determine the correct filler placement. The doctor must be aware of the different layers of the lip and the muscles that surround them.

• Use the appropriate injection technique for the area being treated. Slow and gentle injections are recommended to prevent lip filler migration.

• Place filler strategically where the lips need the most volume or contouring. Avoid injecting too close to the lip’s border or the mouth’s corners to prevent migration.

• Choose the suitable filler for the procedure – only use HA gels for lip augmentation, and ensure you select a filler with the appropriate viscosity.

• Use the appropriate amount of filler: Use the appropriate amount of gel for the patient’s desired outcome. Overfilling can cause the filler to migrate.

• Have the patient move their lips during the injection: Having the patient move their lips during the injection can help ensure the filler is placed in the correct area and prevent migration.

• Provide aftercare instructions to the patient to minimize swelling and promote healing. Advise them to stay out of the sun, avoid saunas, touch or massage their lips, and not to exercise intensely or take very hot showers for at least 24 hours after the procedure.

• Schedule follow-up appointments to monitor the patient’s healing process and address any concerns they may have.

Always remember to prioritize patient safety and satisfaction. If you have any concerns about filler migration, discuss this with the patient and adjust the treatment plan accordingly.

If a patient experiences lip filler migration, doctors have several options available on how to fix migrated lip filler:

• Hyaluronidase: You can eliminate migrated HA-based filler with a particular hyaluronidase enzyme. Injecting hyaluronidase can dissolve the filler and reduce migration. Hyaluronidase breaks down hyaluronic acid, the primary ingredient in most lip fillers. However, this substance must be introduced precisely where migration is present. Otherwise, it is possible to get a deficit in the patient`s volume of hyaluronic acid.

• Steroids: Injecting steroids into the affected area can reduce swelling and inflammation, which can cause the filler to migrate.

One of the natural ways to manage lip filler migration is massage. It can help redistribute the filler and encourage it to settle into the intended area.

• Cold compress: Applying a cold compress can reduce swelling and inflammation, which can contribute to filler migration.

• Wait it out: HA-based <ahref=”https: old.medicadepot.com=”” dermal-fillers.html”=””>dermal fillers dissolve over time. Yes, preparations based on hyaluronic acid require an average of 6 to 18 months to degrade. Therefore, even if migration is an unsightly cosmetic effect, it will disappear over time and generally pose no health risk.</ahref=”https:>

• Adjust the treatment plan: Work with the patient to adjust the treatment plan to address any issues with the lip filler migration.

Doctors must communicate with their patients about the potential risks and side effects of lip fillers, including migration. Proper technique, appropriate filler selection, and careful patient selection can help minimize lip filler migration risk.

If the patient does experience migration, the doctor can work with them to develop an appropriate plan to address the issue and achieve a satisfactory outcome.

Conclusion

To summarize, lip filler migration is a potential risk associated with lip augmentation procedures. To minimize the migration risk, doctors should prioritize patient safety by carefully selecting appropriate candidates, choosing the filler, using the correct injection technique, and providing clear post-treatment instructions to patients.

In the event of migrating lip filler, you can work with the patient to develop an appropriate treatment plan, including options such as hyaluronidase, massage, cold compress, steroids, or adjusting the treatment plan.

Ultimately, by taking a cautious approach and remaining attentive to potential complications, you help ensure your patients achieve natural-looking, satisfying outcomes from lip augmentation procedures.

FAQ

Does lip filler migration go away?

Migrated lip filler organically dissolves from the body with time. Still, it is possible to speed up this process by injecting hyaluronidase enzyme.

How long does it take for lip filler to migrate?

Lip fillers are not permeant, so after approximately 6-18 months (depending on the filler injected), the body will naturally metabolize the filler and break it down, so the migration stops.

How do you stop lip fillers from migrating?

To prevent lip filler migration, you must use the injection technique with the fewer injections possible. The more “holes” you make, the more likely lip filler will migrate above the lip.

References

Blandford A, Hwang C, Young J, Barnes A, Plesec T, Perry J. Microanatomical location of hyaluronic acid gel following injection of the upper lip vermillion border: comparison of needle and microcannula injection technique. Ophthal Plast Reconstruct Surg J. 2018; 34:(3)296-299 https://doi.org/10.1097%2FIOP.0000000000000960

Broder K, Cohen S. An overview of permanent and semipermanent fillers. Plast Reconstruct Surg J. 2006; 118:(3 Supp)7s-14s https://doi.org/10.1097/01.prs.0000234900.26676.0b

Cox S, Adigun C. Complications of injectable fillers and neurotoxins. Dermatol Ther. 2011; 24:(6)524-536 https://doi.org/10.1111/j.1529-8019.2012.01455.x

Demosthenous N. Lip augmentation. PMFA News Journal. 2017; 4:(3)1-3

De Boulle K. Management of complications after implantation of fillers. J Cosmet Dermatol. 2004; 3:(1)2-15 https://doi.org/10.1111/j.1473-2130.2004.00058.x

Eversole R, Tran K, Hansen D, Campbell J. Lip augmentation dermal filler reactions, histopathologic features. Head Neck Pathol. 2013; 7:(3)241-249 https://doi.org/10.1007/s12105-013-0436-1

*Disclaimer: The contents of this article are not to be constructed as medical advice but for informational purposes only. MedicaDepot staff does not review any of these articles for medical validity. Opinions and views expressed in this article are not endorsed by MedicaDepot. Please always consult your doctor for professional medical advice.

woman getting lip injection for her smile lines treatment

Botox for Smile Lines: Benefits & Risks

Botox is globally one of the most well-known products in cosmetics. An injectable solution that provides excellent results in a matter of days is one of the first choices people make when getting a non-surgical facelift. Today, we will discuss the use of Botox for smile lines and the benefits and risks involved in the procedure. In this article, you will also learn how the procedure compares to dermal fillers; and which is a better choice for your patients.

What Are Smile Lines?

Nasolabial folds, commonly known as smile lines or laugh lines, are wrinkles from the bottom of the nose to the corners of the mouth. They appear as we age and are common in both men and women.

Despite popular opinion, smile lines aren’t more prominent in any gender or race. While they get deeper and more visible with age, genetics and collagen production play the most significant part in how much an individual is prone to getting these wrinkles. Generally, after the age 25, a person can expect to notice these lines forming, as that’s roughly the time when natural collagen production slows down.

The biggest causes of nasolabial folds are sun damage and smoking. Gaining or losing weight faster can accentuate the smile lines, but aging is the most prominent cause.

Botox Treatment for Smile Lines

Treatment for smile lines is possible, and today there are many methods for revitalizing the skin around this area. One of the most popular methods is with botulinum toxin, or Botox as it’s more commonly known.

Botox is an injectable drug widely used to rejuvenate different areas of the face. It’s FDA-approved and very potent, restoring volume to the treated area, including the smile lines. It has also been used to treat various medical conditions like migraines and neck spasms.

Since Botox is an injectable product, treating smile lines with Botox is done through a non-invasive and non-surgical procedure. Little preparation is required, and the whole process takes less than half an hour.

How Botox for Smile Lines Works

As we’ve previously mentioned, Botox is an injectable product. The medical professional, a dermatologist or a plastic surgeon, inserts the product using a fine needle, targeting the muscle tissue underneath the skin.

Once injected, Botox relaxes the muscles in the treated area. This then causes tightening of the skin’s surface, smoothing it out and causing the smile lines to become less prominent.

The effect isn’t immediate, though. It usually takes three to five days for Botox to reach its full potential, and, in most cases, one procedure is enough to make the smile lines disappear.

The doses used for smile lines are significantly smaller compared to using Botox on the forehead area. A typical dosage involves 3 to 6 units per side, so a single appointment costs between $300 and $600.

It’s important to note that Botox doesn’t last indefinitely. The effects of Botox on smile lines last up to six months. Repeated procedures are necessary if the patient wishes to keep their new look over an extended period.

Benefits of Botox Treatment for Smile Lines

Patients decide to get Botox for several reasons, but especially for their smile lines.

Foremost, the procedure is quick and painless. After the medical practitioner numbs the area with topical anesthetic, the patient won’t feel the Botox injection. And it’s all done in about 15 to 20 minutes, allowing the patient to continue with their daily routine afterward.

The recovery period is just 24 hours. While those 24 hours are crucial and involve some precautions and changes to one’s routine, that’s it regarding aftercare.

The cost of getting Botox for smile lines is relatively low, usually only $600, and even that is in rare cases when the folds are highly exaggerated. Since the effects last for three to six months, the “maintenance costs” aren’t high, allowing more people to get their smile lines corrected.

And, lastly, it works. Botox relaxes the muscles in this area, and the patient will see the procedure’s results within a few days.

Risks and Side Effects of Botox Treatment for Smile Lines

Botox remains a type of toxin with certain precautions and risks to consider. Most importantly, only trained, licensed medical personnel should administer Botox injections. 

Proper injection technique is also essential, so the patient doesn’t suffer any pain or bruising in the treated area. This also ensures that Botox is evenly distributed throughout the muscle tissue.

The potential side effects of these injections for smile lines are:

  • – Headache
  • – Flu-like symptoms
  • – Redness in the treated area
  • – Nausea
  • – Drooping and facial weakness
  • – Bruising and pain at injection sites

 

Allergic reactions to Botox are rare but still possible even when used in such small doses. Hence, the importance of consultations with the patient before they undergo the procedure.

Additionally, certain people aren’t good candidates for Botox. These include pregnant or breastfeeding women, people suffering from severe reactions to injections, or if the patient has an infection at or near the treatment site.

The first 24 hours after injecting Botox around the mouth are when the patient should take the most care. Patients should avoid exercise and other strenuous activities during this period and also avoid consuming alcohol, nicotine, sugar, and salt. To avoid bruising, the patient shouldn’t rub the treated area and minimize exposure to the sun as much as possible.

Another thing to note is that the patient should avoid certain foods and products before the Botox treatment. This includes:

  • – Nicotine
  • – Caffeine
  • – Alcohol
  • – Blood-thinning medications
  • – Any supplements that affect blood-clotting
  • – Foods rich in antioxidants

 

These products should be avoided for two weeks before the scheduled appointment.

Botox vs. Fillers for Smile Lines

When treating smile lines, Botox and dermal fillers are the most common options. But which one is a better choice and which is more effective?

At a glance, they are very similar. They’re both injectables and non-invasive, restoring one’s youthful appearance. But, the indications aren’t the same, nor are their effects’ longevity.

Botox is mainly used to treat fine lines and wrinkles caused by facial expressions like smiling and frowning.

Dermal fillers, on the other hand, are meant to restore facial volume. They can also correct facial asymmetry and certain conditions like scars.

One significant difference is that dermal fillers are based on hyaluronic acid, a substance naturally produced by the human body. It’s an organic alternative for people unsure about getting Botox for laugh lines.

Regarding results, both products are very effective in treating smile lines; dermal fillers, however, produced proved a longer-lasting effect – up to 18 months compared to the 6 months that Botox lasts.

FAQ

Is Botox or filler better for smile lines?

Although Botox has been the injection of choice for many years, it’s recommended now to inject dermal fillers into the smile lines. The downside of using Botox in this area is that it may cause a “duck face” lip by lengthening the distance between the nose and mouth.

How many units of Botox are needed for smile lines?

Typically, this procedure requires 3 to 6 units of Botox. The exact amount depends on the skin’s elasticity, the patient’s age, and the desired effect.

What is the best treatment for smile lines?

Using Botox for smile lines remains the best choice alongside hyaluronic-based dermal fillers. These are also one of the few non-surgical procedures that proved highly effective and provided natural-looking results.

References

Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect; Bagus Komang Satriyasa, Apr 2019

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489637/

The Effect of Botulinum Toxin Injections on the Nasolabial Fold; Nov 2003

https://www.researchgate.net/publication/9085666_The_Effect_of_Botulinum_Toxin_Injections_on_the_Nasolabial_Fold

The effect of botulinum toxin injections on the nasolabial fold; Michael A C Kane, Oct 2003

https://pubmed.ncbi.nlm.nih.gov/14504487/

Tissue Fillers for the Nasolabial Fold Area: A Systematic Review and Meta-Analysis of Randomized Clinical Trials; Tomasz Stefura, Artur Kacprzyk, Jakub Droś, Marta Krzysztofik, Oksana Skomarovska, Marta Fijałkowska, and Mateusz Koziej, Jul 2021

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481177/

 

A beautiful woman under the sun shows her perfect skin Through the Seasons

Your Skin Through the Seasons

Professionals / By  John Adams

27 Sep

The skin covers the entire body, making it our largest organ. Due to its exposure to the elements, it comes as no surprise that the skin is largely affected by the environment and its changes. Temperature and humidity changes necessitate adjusting skincare routines to maintain skin health, as many skin-related diseases and issues—such as  acne, psoriasis, eczema, and rosacea—show seasonal variability. Fortunately, there are plenty of skincare products that differ in terms of moisture content, thickness, and strength, which means there are plenty of products to meet the skin’s needs. It is important to consider seasonal changes when planning clinical treatments as well.

Understanding the structure and function of skin

The skin can be divided into two main layers: the epidermis and dermis. The uppermost layer is the epidermis, which is composed of tightly packed epithelial cells. It is essentially the barrier that keeps out harmful substances such as bacteria, toxins, and UV light, among a number of others. The epidermis is primarily composed of keratinocytes, which form the stratum corneum on the outermost layer of the epidermis. Melanocytes, the cells responsible for producing melanin in response to UV radiation and hormonal stimulation, are mixed in.

The dermis is composed of connective tissue and is comprised of a mixture of nerve endings, blood vessels, hair follicles, sebaceous glands, and sweat glands. It is also a thicker layer due to collagen and elastin; these substances give the skin its strength and flexibility. Finally, below the dermis is the subcutaneous layer called the hypodermis. It is a layer of loose connective tissue made up of a number of fat cells.

Skin changes with seasons

Recently, the British Journal of Dermatology published a study suggesting that the barrier function of the skin changes between the summer and winter. Looking specifically at the skin on cheeks and hands in summer and winter, the researchers assessed the changes that occur in skin at the cellular level in 80 subjects. They analysed natural moisturizing factors (NMF) and skin texture. There are seasonal effects on NMFs in hands and cheeks, and there is also an increase in the breakdown of filaggrin, which is a protein that maintains the barrier’s function. Additionally, they found changes in the texture of corneocytes.

The heat of the summer often increases sebum production in the skin, and pigmentation increases due to UV exposure. On the contrary, trans-epidermal water loss occurs at a lower rate during the summer; this means that the skin is more hydrated and that more beneficial lipids are present in the stratum corneum than during to the winter months. So, what causes such huge changes in our skin’s behaviour and how do we minimize potential damage?

Also Read: Mesotherapy for Facial Skin Hydration

Warm weather

Although being in the sun can be dangerous due to exposure to UV radiation, there is the benefit of vitamin D being produced via sun exposure. In many countries, winters are dark, and there is not enough UVB radiation to synthesize vitamin D.  This process can only occur during the warmer months. The NHS recommends safely getting vitamin D by exposing uncovered skin to the sun for short periods of time. Between the hours of 11:00 a.m. and 3:00 p.m., most people can expose their limbs to the sun for up to 30 minutes, but sunscreen should be worn on the face to protect it from premature aging. Vitamin D offers many benefits to the skin as well, as it aids in cell differentiation, proliferation, cutaneous immune function, and much more. In fact, being deficient in vitamin D has been linked to acne and skin cancers.

Pigment change can also occur due to sun exposure, and patients undergoing laser or plasma treatments and effective chemical peels are more likely to develop post-inflammatory hyperpigmentation. Those with melasma often find that it worsens during the summer. These concerns or complications can be avoided by using SPF sunscreen, avoiding direct sunlight, and keeping out of extreme heat.

High temperatures lead to an increase in sebum production. When it mixes with sweat, the skin looks very shiny. As such, acne might get worse, but, conversely, it may get better because there is less dead and dry skin to clog pores. Eczema and psoriasis have also been found to improve during the summer months. On the other hand, heat and humidity might lead to fungal infections, such as athlete’s foot. Rosacea is worsened by UV radiation. Some medications may also increase photosensitivity, and patients may develop rashes as a result.

Treatment

In the summer, it is best to avoid aggressive treatments such as retinol, unless the patient adheres to using SPF daily and stays out of the sun. Otherwise, patients are advised to use an oil-controlling cleanser and a light antioxidant serum to take care of any free radicals created by UV exposure.  In patients with oily and acne-prone skin, chemical and physical exfoliation is recommended along with a salicylic acid product to break up the sebum. Mandelic acid is an appropriate chemical peel for the summertime, as it is a less aggressive alpha hydroxy acid and less likely to cause complications. Otherwise, any treatments that might cause PIH, such as lasers, peels, or plasma, should be limited or avoided.

Cooler months

The winter can be harsh on the skin due to the rapidly changing temperatures. When we go from inside to outside, capillaries expand and contract, causing redness and telangiectasia. When we are exposed to wet, snowy weather, our barrier function can be stripped. The cold, dry air only increases trans-epidermal water loss. Combined with central heating, skin often ends up dry and irritated. Patients with already dry skin will often experience some difficulties managing the excessive dryness.

Treatment

During the winter months, the goal should be to increase hydration and promote the natural moisture of the skin in order to support the health of the epidermis. Repairing the barrier function can be accomplished with ingredients like ceramides and hyaluronic acid, whereas colloidal oatmeal soothes dry and itchy skin.  Since temperatures and UV radiation are much lower during these months, the risk of complications from more aggressive procedures is minimized, but the skin should be appropriately prepared prior to being subjected to these sorts of procedures so as to avoid complications. This means that during the fall months, the skin can be treated with retinols to prepare it for peels and lasers. Finally, just because it is cold does not mean patients should forgo SPF protection!

Summary

Temperature, humidity, and UV radiation all change with the seasons. It is no surprise our skin is affected by these changes! Understanding the physiology of our skin can help patients prepare for all the variations caused by the changing of the seasons, which in turn can help them minimize the chances of developing skin diseases. Importantly, patients should not wait for signs of disease before seeking or beginning treatment. Preparing the skin in the spring and fall will ensure that skin is ready for the more extreme conditions of summer and winter.

A woman gets a filler injection into temple to show Possible Filler Complications

Possible Filler Complications?

Professionals / By  meddepo2

24 Sep

Filler Complications

Introduction

The increased popularity of dermal fillers in enhancing facial aesthetics is due to their minimally invasive nature, short recovery time, and excellent outcomes. While collagen fillers dominated the market for over 20 years since their approval by the Food and Drug Administration (FDA) in 1981, it was the emergence of hyaluronic acid (HA) fillers that paved the way for new filler brands and technologies.

As with any medical procedure, a multitude of complications can occur after filler injection. The supposed reversibility of HA-based fillers adds their popularity; however, increased use of these fillers also puts less common but significant side effects in the spotlight. Injecting physicians must be aware of the adverse effects associated with dermal fillers because some of these complications can be devastating and irreversible. Additionally, some complications occur more frequently with specific filler materials or products; thus, the injector must know the properties of each filler at their disposal.

Patient Evaluation

As many complications are due to problems with injection technique, it is important to train extensively and gain experience, preferably with a reversible filler, in order to minimize potential problems. However, side effects are also related to the inherent properties of the filler or unappreciated patient factors.1 Patients presenting with complications after a filler injection should be questioned about previous medical procedures, filler-related issues, number of injections and treated areas.2 Immunosuppressed patients must be counseled for higher risk of infection. In patients with immunologic diseases, it is recommended to consult the rheumatologist or dermatologist before performing additional procedures.

If a patient is not satisfied with previous filler outcomes, the physician should not re-administer the same product. It is best to suggest an alternative filler material or treatment modality, or not treat at all.  In attempting to remedy a complication, the patient should be informed that the elective treatment might require multiple sessions. It is also important to inform the patient that such interventions may result to permanent scarring.

Pre-Procedure Considerations

The best way to treat complications is to prevent them from occurring. Providing excellent predictable outcomes and avoiding unsatisfactory results begins before the actual injection process. While there is no filler product available without concomitant side effects, the physician can minimize complications by choosing the appropriate filler type and injection technique. Not all hyaluronic acid fillers have the same properties and indications. Each filler differs in cohesiveness, molecular size, and cross-linking technologies. In patients who have been treated multiple times, a detailed facial surgery and filler history should be obtained to guide the decision to inject, the placement of the product, and the type of filler to use.

The patients’ expectations should be managed. Completing a proper initial evaluation prior to injection is essential. The priority of the treatment is to satisfy the patient, thus before and after photographs should be taken. During the initial assessment, identify asymmetries and discuss each skin concern to facilitate a clear and honest discussion towards achieving the patient’s desired outcome. It is also essential to discuss the financial commitment involved in pursuing the treatment plan, including the number of syringes needed and if subsequent sessions will be necessary to reach the patient’s intended goal.

Skin Testing

The reactivity profile of the chosen filler should be reviewed prior to injection. Any filling material from foreign sources can theoretically trigger immune reactions to a variable degree, from redness to anaphylaxis. Products that are highly reactive, such as those containing bovine collagen, require skin testing prior to injection.Anaphylaxis is extremely rare but the Food and Drug Administration (FDA) still requires allergy testing for these products. The most popular filler material, hyaluronic acid, has a low rate of hypersensitivity, ranging from 0.6% to 0.8% regardless if the formula is bacterial or viral in origin.4 Hypersensitivity reactions to bovine collagen may be local or systemic while reported reactions to hyaluronic acid were often immediate, localized, and typically resolved within three weeks.5

The use of collagen fillers has declined due to the development of new fillers with better safety profiles. New products containing hyaluronic acid and calcium hydroxyapatite have been found to be superior to collagen with a very small chance of local reactions. Popular bovine collagen and human collagen products are no longer being manufactured; the only product available with 80% purified bovine collagen, which requires skin testing, has polymethylmethacrylate as the main ingredient (Artefill).

Filler Selection

Product-related complications are influenced by the physiochemical properties of the filler and the patient’s response to the product.Currently, available fillers may be classified as temporary or permanent. Temporary fillers are biodegradable and are absorbed or metabolized by the body. The duration of effects of these fillers vary and is dependent on the type and amount of filler injected, treatment location, and injection technique utilized.7 Temporary fillers cleared by the FDA include hyaluronic acid, collagen, calcium hydroxylapatite (CaHA), and poly-l-lactic acid (PLLA). The only FDA-approved permanent filler contains biocompatible, non-biodegradable polymethylmethacrylate (PMMA) beads intended to reduce wrinkles around the mouth, and recently, for the treatment of acne scars.

Inappropriate Placement and Its Manifestations

It is imperative to understand the underlying body, soft tissue structures and vascular anatomy when injecting facial fillers. Accurate and safe placement of filler products depends not only on these factors but also on thorough understanding of the patient’s history and the product’s properties. Inappropriate placement of fillers, such as superficial injection, can lead to a range of complications. Injecting too superficially is a common error and may result in inflammatory nodule formation, visible product, a bluish hue under the skin, and hypertrophic scarring.8,9 While these reactions can be somewhat prevented by the use of correct injection technique, they can, however, cause anxiety and dissatisfaction for patients.

Simple lumps and bumps associated with superficial placement can be alleviated by massaging the area, as well as through aspiration or incision and drainage.10 If the reaction is due to an hyaluronic acid product, hyaluronidase can help treat this problem. Polymethylmethacrylate plus collagen is a permanent filler that, less forgiving, can be associated with another set of complications such as long-lasting itching and redness. If the product in question contains calcium hydroxyapatite (Radiesse), superficial injection is associated with white nodule formation. This is often managed by puncturing and expressing the nodules using a No 11 blade or needle.11 The same technique is used if the injecting physician overfills a particular area. Massaging the area to disperse the product is an adequate solution in some cases; however, one can puncture the skin and express excess filler if the overfill persists.

Injection Site Reactions

Despite best practices, including allergic testing and proper product selection, reactions can still occur. Local injection site reactions are the most common side effect associated with filler injection since it requires skin piercing and introduction of a foreign substance. Other foreign materials other than the filler, such as residual makeup incompletely removed from the patient’s skin, could cause a reaction; therefore, makeup in the injection area must be removed prior to application. The most commonly observed reactions are redness, swelling, bruising, tenderness or pain, and itchiness. These reactions are often mild to moderate and could last for a few days to a week.

Edema and ecchymosis are often due to injection technique, speed of injection, and filler choice. Regardless of the product injected, swelling and bruising are usually localized, mild, and self-limiting. Comparing the package inserts of some popular fillers: Juvederm Ultra (HA) has an 86% reported incidence of swelling and 59% incidence of bruising; Sculptra injectables (PLLA) have 4-7% incidence of swelling and 6-38% incidence of bruising; and the use of Radiesse (CaHA) has a reported 69.2% incidence of swelling and 63.2% incidence of bruising.12,13,14 Dr. John Quinn suggests using the smallest needle possible and microcannula for danger areas to reduce the risk of swelling and bruising. This is particularly important when augmenting the lip as the labial artery runs deep in the body of the lips, thus the border between wet and dry area is more likely to bruise.

Early Onset Complications

One of the most devastating complications of soft tissue augmentation with injectables is intravascular injection, which can lead to potential tissue necrosis, scarring, and even blindness. The best treatment for vascular compromise begins with sufficient prevention. Thorough knowledge of facial anatomy and awareness of danger zones reduces the risk, but actual vascular structures possess considerable variation. Early recognition of the warning signs is highly important as the injecting physician must be ready to administer appropriate treatment immediately. Hyaluronidase and other supplemental treatments, such as a warm compress, nitro paste, and sildenafil, must be immediately available.

The glabella, nasolabial fold, and nose are the most common danger zones, as these areas have rich anastomoses with the internal carotid artery.15 Nose reshaping with facial fillers has become a common procedure in the past few years. Because of the increasing incidence of nasal tip necrosis due to the compression of facial blood vessels in the area, this procedure should be performed by specialists rather than newly trained practitioners. Post-injection blindness is not a commonly reported side effect with dermal filler, but knowing proper management and prevention is paramount. Pain and pallor are common signs of arterial compromise. Embolization and compression of the glabellar arteries can occur due to the small amount of space between the skin and periosteum in this area.8 In the event of a vascular compromise, treatment includes massage, hyaluronidase, heat, and topical GTN.

Delayed Onset Complications

Delayed onset nodule formation and granulomatous reactions have been reported with several filler products. Biofilms may play a role in the presentation of delayed onset erythematous nodules (“angry red bumps”). These bumps are different from ordinary nodules (collections of injected fillers) and are regarded as possible foreign body reactions, hypersensitivity reactions, infections, or sterile abscesses. To help minimize the risk of infection, clean preparation of the skin using chlorhexidine is recommended prior to filler injection. A granuloma is an immune response to an implanted foreign material and develops via an accumulation of immune-related cells, such as lymphocytes, in an attempt to eliminate the foreign body.16

In contrast to granuloma, the key signs of infection are erythema, warmth, and tenderness. The usual cause of late onset infection is less common bacteria like mycobacteria.17 Successful treatment requires appropriate antibiotic therapy as well as aggressive debridement of all infected skin and subcutaneous tissue. Dr. Quinn prescribes clarithromycin 500 mg twice a day for four weeks, while other physicians advise the use of ciprofloxacin 750 mg bd for a month.

Implanted fillers can migrate up to several years after injection. Semi-permanent and permanent fillers are most likely to migrate, but infection or delayed granuloma can also trigger migration. If the injected product is HA-based, hyaluronidase is the preferred treatment, but surgical removal may be necessary for other filler materials.

Conclusion

An efficient way to enhance facial aesthetics with minimal downtime, dermal fillers are the gold standard for soft-tissue augmentation. While adverse events are rare, cautious injection and public education regarding the potentially catastrophic consequences of unregulated filler injection are essential. It is the responsibility of the physician to consider the individual characteristics of each patients and the properties of available fillers when selecting a treatment. The physician’s readiness to handle various adverse events, and careful following of treatment consensus in the occurrence of a nodule, granuloma, or vascular compromise, ensures optimal management.

References

1) Leonhardt, J.M., Lawrence, N., & Narins, R.S. Angioedema acute hypersensitivity reaction to injectable hyaluronic acid, Dermatol Surg, 31, 5.

2) Jin Moon, H., & Sook Yi J. (2016). Management of Facial Filler InjectionComplications in Aesthetic Plastic Surgery of the East Asian Face, Thieme, p. 406

3) Bailey, S., Cohen, J., & Kenkel, J. (2011). Etiology, Prevention, and Treatment of Dermal Filler Complications, Aesthetic Surgery Journal, 31, 1.

4) Andre, P. (2004). Evaluation of the safety of a non-animal stabilized hyaluronic acid (NASHA—Q-Medical, Sweden) in European countries: a retrospective study from 1997 to 2001, J Eur Acad Dermatol Venereol, 18, 4.

5) Friedman, P.M., Mafong, E.A., Kauvar, A.N., & Geronemus, R.G. (2002). Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation. Dermatol Surg, 28, 6.

6) Gravier, M., Bass, L., Lorence, P., et al. (2018). Differentiating non-permanent injectable fillers: Prevention and treatment of filler complications, Aesthetic Surgery Journal, 38, 1.

7) Luebberding, S., & Alexiades-Armenakas, M. (2013). Critical appraisal of the safety of dermal fillers: a primer for clinicians, Curr Derm Rep

8) Narins, R.S.M., Jewell, M.M., Rubin, M.M., Cohen, J.M., & Strobos, J.M. (2006). Clinical conference: management of rare events following dermal fillers-focal necrosis and angry red bumps, Dermatol Surg, 32.

9) Zielke, H., Wölber, L., Wiest, L., Rzany, B. (2008). Risk profiles of different injectable fillers: results from the injectable filler safety study (IFS Study), Dermatol Surg, 35, 1.

10) Brody, H.J. (2005). Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement, Dermatol Surg, 34, 1.

11) Berlin, A., Cohen, J.L., & Goldberg, D.J. (2006). Calcium hydroxylapatite for facial rejuvenation, Semin Cutan Med Surg, 25.

12) Juvederm package insert. [Available from: http://www3.juvederm.com/professionals/pdf/juvederm_dfu.pdf ]. Accessed April 1, 2019.

13) Sculptra package insert. [Available from: http://products.sanofi -aventis.us/sculptra/sculptra.html ]. Accessed April 1, 2019.

14) Radiesse Injectable Implant Instructions For Use. [Available from: http://www.accessdata.fda.gov/cdrh_docs/pdf5/P050037c.pdf ]. Accessed April 1, 2019.

15) Brennan, C. (2014). Avoiding the “danger zones” when injecting dermal fillers and volume enhancers, Plast Surg Nurs, 34, 3.

16) Sidwell, R.U., Dhillon, A.P., Butler, P.E., & Rustin, M.H. (2004). Localized granulomatous reaction to a semi-permanent hyaluronic acid and acrylic hydrogel cosmetic filler, Clin Exp Dermatol, 29.

17) Hirsch, R.J., Narurkar, V., & Carruthers, J. (2006). Management of injected hyaluronic acid induced Tyndall effects, Lasers SurgMed, 33, 3.

18) Plaus, W.J., & Hermann, G. (1991). The surgical management of superficial infections caused by atypical mycobacteria, Surgery, 110.

Personal Protective Equipment on the table

PPE Function, Equipment, and Usage

Professionals / By  Medical Community

05 Aug

The role of PPE or Personal Protective Equipment has taken a drastic change in recent times.What was once used solely in workplaces with a certain degree of safety hazards is now an undeniable necessity in ensuring our health and protection.

Personal Protective Equipment acts as a barrier between the skin and harmful contaminants or impact hazards from the environment. In this current age, it is what stands between the unprecedented transmission of the highly infectious COVID-19 and our safety.

With the virus being transmitted through direct and indirect contact, mere physical proximity amongst each other can pose as a serious threat.  While we slowly work to resume necessary social activities, we must take necessary precautions to mitigate the harms.  Everyone in the workplace should wear PPE and understand what it is for.

What is PPE?

Personal Protective Equipment is an apparatus or accessory worn over the body to protect against injury, contamination, impact, and exposure to microbes, biological secretions, splatters, chemicals, and other safety hazards.

There are different types of PPE, and each one is specifically made to protect against a particular type of safety hazard. With COVID-19, the mode of transmission is through physical contact—so the protective equipment recommended by WHO is one that acts as a barrier against the skin, face, and respiratory system.

Types of PPE for COVID-19

Face and Eye Protection

These PPE equipment protect the eyes and face from any possible infection, exposure or immediate impact from biological spatters, viral contaminants, and harmful microbes.

Face Shields cover the entire facial area including the eyes, nose, and mouth with a clear polycarbonate lens that offers unrestricted visibility. Face Shields may be repeatedly used as long as the proper disinfection process is undertaken after every use.

Medical Goggles fully enclose the entire area around the eyes to protect against becoming contaminated or infiltrated with biological spatters, infectious microbes, and impact hazards. Medical Goggles may be repeatedly used as long as the proper disinfection process is undertaken after every use.

Respiratory Protection

This apparel prevents pathogenic microorganisms, infectious contaminants, toxic gases, or any other particulate matter that may cause irritation and infection from entering the lungs through the nose and mouth.

N95 Masks have four layers of protection to effectively filter 95% of all air particulates from entering the respiratory system. N95 Masks have passed the US Regulatory standards for respiratory protection against viruses, microbes, and all toxic inhalants. N95 Masks should be worn for a maximum of eight hours only and should be replaced as often as necessary.

KN95 Masks are tight-fitting respirator masks that cover the mouth and nose against all air contaminants including pollution, pollen, dust, smoke, germs, bacteria, ash, and other nasal allergic triggers. KN95 masks pass health regulatory standards around the world. KN95 Masks should be worn for a maximum of eight hours only and should be replaced as often as necessary.

Surgical Masks prevent biological spatters, pathogenic microorganisms, and viral contaminants from getting expelled by the wearer towards the environment. Masks should be discarded and replaced as soon as they become contaminated.

Skin and Body Protection

This PPE covers the skin so that no liquid spatters, toxic chemicals, viral microbes, and biological secretions can come into contact with the body.

Medical Coveralls enclose the entire body including the head, arms, torso, and legs with a non-woven fabric that effectively repels moisture, fluids, and liquid matter. Disposable Emergency Medical Coveralls should be used for a maximum of eight hours only.

Medical Gloves provide secure, enclosed protection for the hands against contamination and exposure to liquid spatters, biological secretions, viral microbes, and other hazardous particles. Gloves should be used for a maximum of 8 hours only and discarded after every use that involves some degree of exposure to contaminants.

All PPE clothing must be sterile, CE-marked/FDA-Approved and recommended by the World Health Organization.

How To Wear PPE?

The proper donning and disposal of PPE is key to ensure that the PPE performs for optimum protection.

An important reminder in wearing PPE is that one garment must not interfere with another. The entire set of apparel worn by an individual must be comfortable enough for movement but also for utmost functionality with no leakages.

Here are the following steps to wear full PPE properly:

1.  Identify and gather the proper PPE set. Always ensure it is the correct size for the person who will be wearing it.

2. Wash hands thoroughly for thirty seconds.

3. Put on the Medical Coveralls.

4. Wear the mask (KN95 or N95 or Surgical Mask) while ensuring that the nosepiece is fitted to the nose. Place the loops around the ears. Both nose and mouth should be covered. Secure the top tie on the crown of the head and the bottom tie on the base of the neck

5. Put on either the Face Shields or Goggles. Use the most appropriate face protection that does not interfere with the seal of the mask.

6. Put on the gloves.

How To Remove PPE Gear?      

PPE gear must be removed properly or else contamination and exposure to infectious contaminants are very likely, invalidating the usage of PPE in the first place.

Here are the following steps in removing the PPE in proper order:

1.  Remove gloves properly, making sure the hands do not come into contact with the external side of the glove that has been exposed to the environment.

2. Remove the coveralls carefully in the utmost avoidance of contact to the side exposed to the environment. Assistance from another person may be required.

3. Wash hands thoroughly for 20 seconds and more, or use hand sanitizer.

4. Remove the Face Shield or Goggles by grabbing the strap or snapping the lock. Pull it upwards and away from the head.

5. Remove the mask by tugging at the loops over the ears and throw it in the proper trash bin immediately. Do not touch the front of the mask.

6. Wash hands thoroughly for 20 seconds.

Conclusion

With the number of Covid-19 cases rising, it is a necessary precaution to maintain social distancing, adhere to quarantine, and to wear PPE when in contact with another individual. PPE is very integral to our safety and survival as well as others around us.

Understanding what Personal Protective Equipment is, what it does, and how to wear and dispose of it properly is how we can ensure not only our health and safety but everyone around us.

A woman gets a dermal filler injection into her left cheek

Filler Complications | Medica Depot

Professionals / By  Medical Community

08 Oct

Filler Complications

Introduction

The increased popularity of dermal fillers in enhancing facial aesthetics is due to their minimally invasive nature, short recovery time, and excellent outcomes. While collagen fillers dominated the market for over 20 years since their approval by the Food and Drug Administration (FDA) in 1981, it was the emergence of hyaluronic acid (HA) fillers that paved the way for new filler brands and technologies.

As with any medical procedure, a multitude of complications can occur after filler injection. The supposed reversibility of HA-based fillers adds their popularity; however, increased use of these fillers also puts less common but significant side effects in the spotlight. Injecting physicians must be aware of the adverse effects associated with dermal fillers because some of these complications can be devastating and irreversible. Additionally, some complications occur more frequently with specific filler materials or products; thus, the injector must know the properties of each filler at their disposal.

Patient Evaluation

As many complications are due to problems with injection technique, it is important to train extensively and gain experience, preferably with a reversible filler, in order to minimize potential problems. However, side effects are also related to the inherent properties of the filler or unappreciated patient factors.1 Patients presenting with complications after a filler injection should be questioned about previous medical procedures, filler-related issues, number of injections and treated areas.2 Immunosuppressed patients must be counseled for higher risk of infection. In patients with immunologic diseases, it is recommended to consult the rheumatologist or dermatologist before performing additional procedures.

If a patient is not satisfied with previous filler outcomes, the physician should not re-administer the same product. It is best to suggest an alternative filler material or treatment modality, or not treat at all.  In attempting to remedy a complication, the patient should be informed that the elective treatment might require multiple sessions. It is also important to inform the patient that such interventions may result to permanent scarring.

Pre-Procedure Considerations

The best way to treat complications is to prevent them from occurring. Providing excellent predictable outcomes and avoiding unsatisfactory results begins before the actual injection process. While there is no filler product available without concomitant side effects, the physician can minimize complications by choosing the appropriate filler type and injection technique. Not all hyaluronic acid fillers have the same properties and indications. Each filler differs in cohesiveness, molecular size, and cross-linking technologies. In patients who have been treated multiple times, a detailed facial surgery and filler history should be obtained to guide the decision to inject, the placement of the product, and the type of filler to use.

The patients’ expectations should be managed. Completing a proper initial evaluation prior to injection is essential. The priority of the treatment is to satisfy the patient, thus before and after photographs should be taken. During the initial assessment, identify asymmetries and discuss each skin concern to facilitate a clear and honest discussion towards achieving the patient’s desired outcome. It is also essential to discuss the financial commitment involved in pursuing the treatment plan, including the number of syringes needed and if subsequent sessions will be necessary to reach the patient’s intended goal.

Skin Testing

The reactivity profile of the chosen filler should be reviewed prior to injection. Any filling material from foreign sources can theoretically trigger immune reactions to a variable degree, from redness to anaphylaxis. Products that are highly reactive, such as those containing bovine collagen, require skin testing prior to injection.3 Anaphylaxis is extremely rare but the Food and Drug Administration (FDA) still requires allergy testing for these products. The most popular filler material, hyaluronic acid, has a low rate of hypersensitivity, ranging from 0.6% to 0.8% regardless if the formula is bacterial or viral in origin.4 Hypersensitivity reactions to bovine collagen may be local or systemic while reported reactions to hyaluronic acid were often immediate, localized, and typically resolved within three weeks.5

The use of collagen fillers has declined due to the development of new fillers with better safety profiles. New products containing hyaluronic acid and calcium hydroxyapatite have been found to be superior to collagen with a very small chance of local reactions. Popular bovine collagen and human collagen products are no longer being manufactured; the only product available with 80% purified bovine collagen, which requires skin testing, has polymethylmethacrylate as the main ingredient (Artefill).

Filler Selection

Product-related complications are influenced by the physiochemical properties of the filler and the patient’s response to the product.6 Currently, available fillers may be classified as temporary or permanent. Temporary fillers are biodegradable and are absorbed or metabolized by the body. The duration of effects of these fillers vary and is dependent on the type and amount of filler injected, treatment location, and injection technique utilized.7 Temporary fillers cleared by the FDA include hyaluronic acid, collagen, calcium hydroxylapatite (CaHA), and poly-l-lactic acid (PLLA). The only FDA-approved permanent filler contains biocompatible, non-biodegradable polymethylmethacrylate (PMMA) beads intended to reduce wrinkles around the mouth, and recently, for the treatment of acne scars.

Inappropriate Placement and Its Manifestations

It is imperative to understand the underlying body, soft tissue structures and vascular anatomy when injecting facial fillers. Accurate and safe placement of filler products depends not only on these factors but also on thorough understanding of the patient’s history and the product’s properties. Inappropriate placement of fillers, such as superficial injection, can lead to a range of complications. Injecting too superficially is a common error and may result in inflammatory nodule formation, visible product, a bluish hue under the skin, and hypertrophic scarring.8,9 While these reactions can be somewhat prevented by the use of correct injection technique, they can, however, cause anxiety and dissatisfaction for patients.

Simple lumps and bumps associated with superficial placement can be alleviated by massaging the area, as well as through aspiration or incision and drainage.10 If the reaction is due to an hyaluronic acid product, hyaluronidase can help treat this problem. Polymethylmethacrylate plus collagen is a permanent filler that, less forgiving, can be associated with another set of complications such as long-lasting itching and redness. If the product in question contains calcium hydroxyapatite (Radiesse), superficial injection is associated with white nodule formation. This is often managed by puncturing and expressing the nodules using a No 11 blade or needle.11 The same technique is used if the injecting physician overfills a particular area. Massaging the area to disperse the product is an adequate solution in some cases; however, one can puncture the skin and express excess filler if the overfill persists.

Injection Site Reactions

Despite best practices, including allergic testing and proper product selection, reactions can still occur. Local injection site reactions are the most common side effect associated with filler injection since it requires skin piercing and introduction of a foreign substance. Other foreign materials other than the filler, such as residual makeup incompletely removed from the patient’s skin, could cause a reaction; therefore, makeup in the injection area must be removed prior to application. The most commonly observed reactions are redness, swelling, bruising, tenderness or pain, and itchiness. These reactions are often mild to moderate and could last for a few days to a week.

Edema and ecchymosis are often due to injection technique, speed of injection, and filler choice. Regardless of the product injected, swelling and bruising are usually localized, mild, and self-limiting. Comparing the package inserts of some popular fillers: Juvederm Ultra (HA) has an 86% reported incidence of swelling and 59% incidence of bruising; Injections from Sculptra (PLLA) has 4-7% incidence of swelling and 6-38% incidence of bruising; and the use of Radiesse (CaHA) has a reported 69.2% incidence of swelling and 63.2% incidence of bruising.12,13,14 Dr. John Quinn suggests using the smallest needle possible and microcannula for danger areas to reduce the risk of swelling and bruising. This is particularly important when augmenting the lip as the labial artery runs deep in the body of the lips, thus the border between wet and dry area is more likely to bruise.

Early Onset Complications

One of the most devastating complications of soft tissue augmentation with injectables is intravascular injection, which can lead to potential tissue necrosis, scarring, and even blindness. The best treatment for vascular compromise begins with sufficient prevention. Thorough knowledge of facial anatomy and awareness of danger zones reduces the risk, but actual vascular structures possess considerable variation. Early recognition of the warning signs is highly important as the injecting physician must be ready to administer appropriate treatment immediately. Hyaluronidase and other supplemental treatments, such as a warm compress, nitro paste, and sildenafil, must be immediately available.

The glabella, nasolabial fold, and nose are the most common danger zones, as these areas have rich anastomoses with the internal carotid artery.15 Nose reshaping with facial fillers has become a common procedure in the past few years. Because of the increasing incidence of nasal tip necrosis due to the compression of facial blood vessels in the area, this procedure should be performed by specialists rather than newly trained practitioners. Post-injection blindness is not a commonly reported side effect with dermal filler, but knowing proper management and prevention is paramount. Pain and pallor are common signs of arterial compromise. Embolization and compression of the glabellar arteries can occur due to the small amount of space between the skin and periosteum in this area.8 In the event of a vascular compromise, treatment includes massage, hyaluronidase, heat, and topical GTN.

Delayed Onset Complications

Delayed onset nodule formation and granulomatous reactions have been reported with several filler products. Biofilms may play a role in the presentation of delayed onset erythematous nodules (“angry red bumps”). These bumps are different from ordinary nodules (collections of injected fillers) and are regarded as possible foreign body reactions, hypersensitivity reactions, infections, or sterile abscesses. To help minimize the risk of infection, clean preparation of the skin using chlorhexidine is recommended prior to filler injection. A granuloma is an immune response to an implanted foreign material and develops via an accumulation of immune-related cells, such as lymphocytes, in an attempt to eliminate the foreign body.16

In contrast to granuloma, the key signs of infection are erythema, warmth, and tenderness. The usual cause of late onset infection is less common bacteria like mycobacteria.17 Successful treatment requires appropriate antibiotic therapy as well as aggressive debridement of all infected skin and subcutaneous tissue. Dr. Quinn prescribes clarithromycin 500 mg twice a day for four weeks, while other physicians advise the use of ciprofloxacin 750 mg bd for a month.

Implanted fillers can migrate up to several years after injection. Semi-permanent and permanent fillers are most likely to migrate, but infection or delayed granuloma can also trigger migration. If the injected product is HA-based, hyaluronidase is the preferred treatment, but surgical removal may be necessary for other filler materials.

Conclusion

An efficient way to enhance facial aesthetics with minimal downtime, dermal fillers are the gold standard for soft-tissue augmentation. While adverse events are rare, cautious injection and public education regarding the potentially catastrophic consequences of unregulated filler injection are essential. It is the responsibility of the physician to consider the individual characteristics of each patients and the properties of available fillers when selecting a treatment. The physician’s readiness to handle various adverse events, and careful following of treatment consensus in the occurrence of a nodule, granuloma, or vascular compromise, ensures optimal management.

References

1.  Leonhardt, J.M., Lawrence, N., & Narins, R.S. Angioedema acute hypersensitivity reaction to injectable hyaluronic acid, Dermatol Surg, 31, 5.

2.Jin Moon, H., & Sook Yi J. (2016). Management of Facial Filler InjectionComplications in Aesthetic Plastic Surgery of the East Asian Face, Thieme, p. 406

3. Bailey, S., Cohen, J., & Kenkel, J. (2011). Etiology, Prevention, and Treatment of Dermal Filler Complications, Aesthetic Surgery Journal, 31, 1.

4. Andre, P. (2004). Evaluation of the safety of a non-animal stabilized hyaluronic acid (NASHA—Q-Medical, Sweden) in European countries: a retrospective study from 1997 to 2001, J Eur Acad Dermatol Venereol, 18, 4.

5. Friedman, P.M., Mafong, E.A., Kauvar, A.N., & Geronemus, R.G. (2002). Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation. Dermatol Surg, 28, 6.

6. Gravier, M., Bass, L., Lorence, P., et al. (2018). Differentiating non-permanent injectable fillers: Prevention and treatment of filler complications, Aesthetic Surgery Journal, 38, 1.

7. Luebberding, S., & Alexiades-Armenakas, M. (2013). Critical appraisal of the safety of dermal fillers: a primer for clinicians, Curr Derm Rep

8. Narins, R.S.M., Jewell, M.M., Rubin, M.M., Cohen, J.M., & Strobos, J.M. (2006). Clinical conference: management of rare events following dermal fillers-focal necrosis and angry red bumps, Dermatol Surg, 32.

9. Zielke, H., Wölber, L., Wiest, L., Rzany, B. (2008). Risk profiles of different injectable fillers: results from the injectable filler safety study (IFS Study), Dermatol Surg, 35, 1.

10. Brody, H.J. (2005). Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement, Dermatol Surg, 34, 1.

11. Berlin, A., Cohen, J.L., & Goldberg, D.J. (2006). Calcium hydroxylapatite for facial rejuvenation, Semin Cutan Med Surg, 25.

12. Juvederm package insert. [Available from: http://www3.juvederm.com/professionals/pdf/juvederm_dfu.pdf ]. Accessed April 1, 2019.

13. Sculptra package insert. [Available from: http://products.sanofi -aventis.us/sculptra/sculptra.html ]. Accessed April 1, 2019.

14. Radiesse Injectable Implant Instructions For Use. [Available from: http://www.accessdata.fda.gov/cdrh_docs/pdf5/P050037c.pdf ]. Accessed April 1, 2019.

15. Brennan, C. (2014). Avoiding the “danger zones” when injecting dermal fillers and volume enhancers, Plast Surg Nurs, 34, 3.

16. Sidwell, R.U., Dhillon, A.P., Butler, P.E., & Rustin, M.H. (2004). Localized granulomatous reaction to a semi-permanent hyaluronic acid and acrylic hydrogel cosmetic filler, Clin Exp Dermatol, 29.

17. Hirsch, R.J., Narurkar, V., & Carruthers, J. (2006). Management of injected hyaluronic acid induced Tyndall effects, Lasers SurgMed, 33, 3.

18. Plaus, W.J., & Hermann, G. (1991). The surgical management of superficial infections caused by atypical mycobacteria, Surgery, 110.

A smiling woman in the sun demonstrates how Your Skin Change with the Seasons

Does Your Skin Change with the Seasons?

Professionals / By  Medical Community

18 Apr

The skin covers the entire body, making it our largest organ. Due to its exposure to the elements, it comes as no surprise that the skin is largely affected by the environment and its changes. Temperature and humidity changes necessitate adjusting skincare routines to maintain skin health, as many skin-related diseases and issues—such as  acne, psoriasis, eczema, and rosacea—show seasonal variability. Fortunately, there are plenty of effective skincare products that differ in terms of moisture content, thickness, and strength, which means there are plenty of products to meet the skin’s needs. It is important to consider seasonal changes when planning clinical treatments as well.

Understanding the structure and function of skin

The skin can be divided into two main layers: the epidermis and dermis. The uppermost layer is the epidermis, which is composed of tightly packed epithelial cells. It is essentially the barrier that keeps out harmful substances such as bacteria, toxins, and UV light, among a number of others. The epidermis is primarily composed of keratinocytes, which form the stratum corneum on the outermost layer of the epidermis. Melanocytes, the cells responsible for producing melanin in response to UV radiation and hormonal stimulation, are mixed in.

The dermis is composed of connective tissue and is comprised of a mixture of nerve endings, blood vessels, hair follicles, sebaceous glands, and sweat glands. It is also a thicker layer due to collagen and elastin; these substances give the skin its strength and flexibility. Finally, below the dermis is the subcutaneous layer called the hypodermis. It is a layer of loose connective tissue made up of a number of fat cells.

Skin changes with seasons

Recently, the British Journal of Dermatology published a study suggesting that the barrier function of the skin changes between the summer and winter. Looking specifically at the skin on cheeks and hands in summer and winter, the researchers assessed the changes that occur in skin at the cellular level in 80 subjects. They analysed natural moisturizing factors (NMF) and skin texture. There are seasonal effects on NMFs in hands and cheeks, and there is also an increase in the breakdown of filaggrin, which is a protein that maintains the barrier’s function. Additionally, they found changes in the texture of corneocytes.

The heat of the summer often increases sebum production in the skin, and pigmentation increases due to UV exposure. On the contrary, trans-epidermal water loss occurs at a lower rate during the summer; this means that the skin is more hydrated and that more beneficial lipids are present in the stratum corneum than during to the winter months. So, what causes such huge changes in our skin’s behaviour and how do we minimize potential damage?

Also Read: Mesotherapy for Facial Skin Hydration

Warm weather

Although being in the sun can be dangerous due to exposure to UV radiation, there is the benefit of vitamin D being produced via sun exposure. In many countries, winters are dark, and there is not enough UVB radiation to synthesize vitamin D.  This process can only occur during the warmer months. The NHS recommends safely getting vitamin D by exposing uncovered skin to the sun for short periods of time. Between the hours of 11:00 a.m. and 3:00 p.m., most people can expose their limbs to the sun for up to 30 minutes, but sunscreen should be worn on the face to protect it from premature aging. Vitamin D offers many benefits to the skin as well, as it aids in cell differentiation, proliferation, cutaneous immune function, and much more. In fact, being deficient in vitamin D has been linked to acne and skin cancers.

Pigment change can also occur due to sun exposure, and patients undergoing laser or plasma treatments and the popular chemical peels are more likely to develop post-inflammatory hyperpigmentation. Those with melasma often find that it worsens during the summer. These concerns or complications can be avoided by using SPF sunscreen, avoiding direct sunlight, and keeping out of extreme heat.

High temperatures lead to an increase in sebum production. When it mixes with sweat, the skin looks very shiny. As such, acne might get worse, but, conversely, it may get better because there is less dead and dry skin to clog pores. Eczema and psoriasis have also been found to improve during the summer months. On the other hand, heat and humidity might lead to fungal infections, such as athlete’s foot. Rosacea is worsened by UV radiation. Some medications may also increase photosensitivity, and patients may develop rashes as a result.

Treatment

In the summer, it is best to avoid aggressive treatments such as retinol, unless the patient adheres to using SPF daily and stays out of the sun. Otherwise, patients are advised to use an oil-controlling cleanser and a light antioxidant serum to take care of any free radicals created by UV exposure.  In patients with oily and acne-prone skin, chemical and physical exfoliation is recommended along with a salicylic acid product to break up the sebum. Mandelic acid is an appropriate chemical peel for the summertime, as it is a less aggressive alpha hydroxy acid and less likely to cause complications. Otherwise, any treatments that might cause PIH, such as lasers, peels, or plasma, should be limited or avoided.

Cooler months

The winter can be harsh on the skin due to the rapidly changing temperatures. When we go from inside to outside, capillaries expand and contract, causing redness and telangiectasia. When we are exposed to wet, snowy weather, our barrier function can be stripped. The cold, dry air only increases trans-epidermal water loss. Combined with central heating, skin often ends up dry and irritated. Patients with already dry skin will often experience some difficulties managing the excessive dryness.

Treatment

During the winter months, the goal should be to increase hydration and promote the natural moisture of the skin in order to support the health of the epidermis. Repairing the barrier function can be accomplished with ingredients like ceramides and hyaluronic acid, whereas colloidal oatmeal soothes dry and itchy skin.  Since temperatures and UV radiation are much lower during these months, the risk of complications from more aggressive procedures is minimized, but the skin should be appropriately prepared prior to being subjected to these sorts of procedures so as to avoid complications. This means that during the fall months, the skin can be treated with retinols to prepare it for peels and lasers. Finally, just because it is cold does not mean patients should forgo SPF protection!

Summary

Temperature, humidity, and UV radiation all change with the seasons. It is no surprise our skin is affected by these changes! Understanding the physiology of our skin can help patients prepare for all the variations caused by the changing of the seasons, which in turn can help them minimize the chances of developing skin diseases. Importantly, patients should not wait for signs of disease before seeking or beginning treatment. Preparing the skin in the spring and fall will ensure that skin is ready for the more extreme conditions of summer and winter.