Elie M. Ferneini

An Overview of Vascular Adverse Events Associated With Facial Soft Tissue Fillers: Recognition, Prevention, and Treatment

Minimally invasive facial cosmetic surgery procedures have seen an exponential increase in numbers over the past decade. The most commonly performed procedures are neuromodulator and soft tissue filler procedures. Although soft tissue fillers have a high safety and predictability profile, these procedures recently have been associated with serious and dire adverse events. This article will discuss some of the vascular complications associated with facial soft tissue fillers. Management and prevention of these adverse events also will be discussed.

Complications Associated with Facial Soft-Tissue Fillers

Minimally invasive facial cosmetic surgery procedures have seen an increase in numbers over the past decade. The two most common procedures are Botulinum toxin type A injection and soft-tissue fillers. Although soft-tissue fillers have a high safety profile, these materials have been recently associated with serious and irreversible complications. This article reviews complications associated with facial soft-tissue fillers and their management. In addition, ways to prevent these unwanted complications are discussed.

Review of Facial Fillers and Injectable Neurotoxins

Introduction: Noninvasive cosmetic techniques continue to increase in popularity. In particular, dermal fillers and botulinum toxin injectables have consistently shown a rise in demand. Pharmaceutical companies have spent millions of dollars to develop these products to produce more achievable, predictable, and long-lasting results. As a result, multiple products were developed that differ in their physical and chemical properties. By understanding these characteristics, the cosmetic surgeon will achieve more safe and reliable results. Materials and Methods: A literature search on dermal fillers and botulinum toxin injectable treatments was completed from 2005 to 2013. Results: Injectables are a great resource for clinicians to improve a patients appearance in a short time with relatively little discomfort to the patient. With a rise in the number of patients requesting these treatments, it is crucial that the surgeon and patient are aware of all of the risks and benefits of treatment. As the quest for the youthful image continues in our society, anti-aging therapies will continue to improve. Conclusions: Patients and cosmetic surgeons will continue to work with these and more advanced products as they are approved. With proper training and experience, the surgeon should be able to provide treatments that consistently benefit their patients. It is the purpose of the paper to provide the cosmetic surgeon with a description of the current products available as well as the complications that can arise when using these materials.

Platelet-Rich Plasma in Androgenic Alopecia: Indications, Technique, and Potential Benefits

PURPOSE The purpose of this study was to provide an overview of platelet-rich plasma (PRP) injected into the scalp for the management of androgenic alopecia. MATERIALS AND METHODS A literature review was performed to evaluate the benefits of PRP in androgenic alopecia. RESULTS Hair restoration has been increasing. PRPs main components of platelet-derived growth factor, transforming growth factor, and vascular endothelial growth factor have the potential to stimulate hard and soft tissue wound healing. In general, PRP showed a benefit on patients with androgenic alopecia, including increased hair density and quality. Currently, different PRP preparations are being used with no standard technique. CONCLUSION This review found beneficial effects of PRP on androgenic alopecia. However, more rigorous study designs, including larger samples, quantitative measurements of effect, and longer follow-up periods, are needed to solidify the utility of PRP for treating patients with androgenic alopecia.

Hypersensitivity Reaction to Facial Augmentation with a Hyaluronic Acid Filler

For cosmetic surgeons, facial augmentation with hyaluronic acid (HA) fillers is a standard and safe technique. We report the case of an unusual allergic reaction to a nasolabial fold augmentation with Restylane-L (a popular HA filler) and review the literature.

An Overview of Infections Associated With Soft Tissue Facial Fillers: Identification, Prevention, and Treatment

PURPOSE The purpose of this study was to provide an overview of infections associated with facial soft tissue fillers. MATERIALS AND METHODS A literature review was performed which evaluated infections associated with facial soft tissue fillers. RESULTS Infection rates with soft tissue fillers are low and are estimated at 0.04 to 0.2%. Most of these infections arise when skin contaminants infiltrate the injection site at the time of injection. These infections can occur early, up to several days after treatment, or delayed, occurring weeks to years after treatment. Reactions vary based on the filler absorbability and duration. Early recognition and treatment are important factors in managing our cosmetic surgery patients. CONCLUSION Although facial fillers are safe and predictable, infections can still occur. Oral and maxillofacial surgeons need to be able to prevent, recognize, and properly manage infections related to these popular injections.

A Review of New Facial Filler Techniques for Facial Rejuvenation

Introduction: Over the recent years, the use of facial fillers for rejuvenation of the aging face has continued to increase in popularity. As the demand for noninvasive cosmetic enhancements increases, so does the need for new cosmetic techniques that will increase patient satisfaction while decreasing complications. In the past, facial fillers were mostly used for lip augmentation, nasolabial folds, and marionette lines. However, because of advances in cosmetic techniques and types of dermal fillers, cosmetic surgeons today are able to correct lines, wrinkles, and volume loss seen in crows feet, around the eyes, chin, and cheeks. Materials and Methods: A literature search was performed from 2006 to 2013 to determine new cosmetic techniques used for facial rejuvenation of the aging face. Results: Advances in facial rejuvenation are helping to give cosmetic surgeons better results with little discomfort when using dermal fillers around the eyes, cheeks, and chin to improve the overall look of wrinkles and volume loss. Conclusions: The development of new techniques and injectable dermal fillers will continue to advance with the increasing demand for a youthful appearance. Up until recently, facial fillers were used mainly to improve the effects of aging seen around the lips, nasolabial folds, and marionette lines. Today, because of advances in the type of facial filler and used techniques, facial fillers can be used to improve volume loss, lines, and wrinkles around the eyes, cheeks, and chin.

Squamous cell carcinoma arising within a maxillary odontogenic keratocyst: A rare occurrence

Squamous cell carcinoma (SCC) arising within the lining of an odontogenic keratocyst (OKC) is a rare occurrence. Although potentially locally destructive, OKC is a benign odontogenic process that typically presents with clinical and radiographic features characteristic of a benign intraosseous neoplasm. We present the clinical and radiographic features of a maxillary mass that demonstrated SCC arising from the lining of an OKC. Although the initial clinical and radiographic presentation suggested an infection or malignant neoplasm, biopsies revealed an infiltrative well-differentiated SCC contiguous with and arising from the focus of a pre-existing OKC. The patient subsequently underwent a type II hemi-maxillectomy with neoadjuvant chemoradiation. This report discusses the clinical and radiographic features associated with intraosseous malignancies, especially those arising from an otherwise benign odontogenic lesion. While the majority of OKCs are benign, the current report illustrates the potential for carcinomatous transformation within the lining of an OKC.

Prevention of Venous Thromboembolism in Abdominoplasty

Introduction: Venous thromboembolism is an important and life-threatening complication associated with abdominoplasty, a common cosmetic procedure. Materials and Methods: A retrospective study of 100 consecutive patients who underwent abdominoplasty in an outpatient setting. Results: The complication rate was 35%. The most common complication was wound separation. No patient developed deep vein thrombosis, although 2 patients developed postoperative abdominal hematoma due to Lovenox prophylaxis. Conclusions: Abdominoplasty was found to be a safe and predictable outpatient procedure in our patient population.

Anesthesia Complications: Management and Prevention

The volume of cosmetic surgery continues to grow rapidly, so does the demand for skilled anesthesia care. Although anesthesia for facial cosmetic surgical procedures remains remarkably safe, no anesthesia should be considered minor. Complications can occur at any time. Proper preoperative evaluation, patient selection, incorporation of a safety checklist, and close collaboration with the surgeon will decrease adverse events leading to increased patient safety and improved outcomes.