Komplikationen nach Faltenunterspritzung und ihre Behandlung[1]

 

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Zusammenfassung

Alle injizierbaren Faltenmittel können frühe und späte Komplikationen verursachen. Zu den frühen gehören Schwellung, Rötung und Blutergüsse nach intradermalen oder subkutanen Injektionen, die vom Patienten akzeptiert werden müssen. Komplikationen, die länger als zwei Wochen anhalten, sind oft auf technische Mängel, d. h. auf eine zu oberflächliche Injektion des Füllmaterials, zurückzuführen. Die meisten dieser Nebenwirkungen können wirkungsvoll mit intraläsionalen Injektionen von Kortikosteroiden und 5-Fluorouracil, Laser oder „intense pulse light“ behandelt werden und, wenn dies nicht hilft, mit der Dermabrasion nivelliert oder tangential abgetragen werden. Spätkomplikationen sind vorwiegend immunologische Reaktionen wie chronische Rötungen oder Allergien vom Typ IV sowie Fremdkörper-Granulome. Beide Überreaktionen reagieren sehr effektiv auf intraläsional injizierte Steroidkristalle, die meist wiederholt appliziert werden müssen, bis die richtige Dosis gefunden ist. Chirurgische Exzisionen sollten unbedingt vermieden und nur bei sichtbaren harten Knötchen, besonders in den Lippen oder im subkutanen Fett, in Betracht gezogen werden.

Abstract

All dermal fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of these risks and be prepared to accept them. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., the implantation of a long-lasting filler substance was too superficial). Such adverse events can be treated with intradermal 5-fluorouracil and steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunological phenomena such as late-onset allergy and non-allergic foreign body granulomas. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions should remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granulomas in the subcutaneous fat.

1 Nach einem Vortrag anlässlich der gemeinsamen Jahrestagung der VDPC, VDÄPC und ÖGPÄRCH in München, 27. September bis 1. Oktober 2005

Literatur

• 1 André P, Wechsler J, Revuz J. Facial lipoatrophy: Report of five cases after injection of synthetic filler into nasolabial folds.  J Cosmet Dermatol. 2002;  1 120-123
  PubMedGoogle Scholar
• 2 André P, Lowe N J, Clerici T H, Zimmermann U. Adverse reactions to dermal fillers: A review of European experience.  J Cosmet Laser Ther. 2005;  7 171-176
  CrossrefPubMedGoogle Scholar
• 3 Asilan A, Darougheh A, Shariati F. New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars.  Dermatol Surg. 2006;  31 907-915
  PubMedGoogle Scholar
• 4 Bellman D. Immediate and delayed hypersensitivity reactions to Restylane - Case reports.  Aesthet Surg J. 2005;  25 489-491
  CrossrefPubMedGoogle Scholar
• 5 Bülow von S, Heimburg von D, Pallua N. Efficacy and safety of polyacrylamide hydrogel for facial soft-tissue augmentation.  Plast Reconstr Surg. 2005;  116 1137-1146
  CrossrefPubMedGoogle Scholar
• 6 Carruthers A, Carruthers J DA. Polymethylmethacrylate microspheres/collagen as a tissue augmenting agent: Personal experience over 5 years.  Dermatol Surg. 2005;  31 1561-1565
  PubMedGoogle Scholar
• 7 Cheng N-X, Xu S-L, Deng H. et al . Migration of implants: A problem with injectable polyacrylamide gel in aesthetic plastic surgery.  Aesth Plast Surg. 2006;  30 215-225
  CrossrefPubMedGoogle Scholar
• 8 Coleman S R. Structural fat grafting: much more than permanent fillers.  Plast Reconstr Surg. 2006;  118 (Suppl) 108S-120S
  CrossrefPubMedGoogle Scholar
• 9 Duffy D M. Liquid silicone for soft tissue augmentation: Histological, clinical, and molecular perspectives. Klein AW Tissue Augmentation in Clinical Practice. 2nd ed. New York; Taylor & Francis Grou 2006: 141-238
  Google Scholar
• 10 Edwards P C, Fantasia J E, Iovino R. Foreign body reaction to hyaluronic acid (Restylane): An adverse outcome of lip augmentation.  Oral Maxillofac Surg. 2006;  64 1296-1299
  PubMedGoogle Scholar
• 11 Ghislanzoni M, Bianchi F, Barbareschi M, Alessi E. Cutaneous granulomatous reaction to injectable hyaluronic acid gel.  Brit J Dermatol. 2006;  154 755-758
  PubMedGoogle Scholar
• 12 Glaich A S, Cohen J L, Goldberg L H. Injection necrosis of the glabella: Protocol for prevention and treatment after use of dermal fillers.  Dermatol Surg. 2006;  32 276-281
  PubMedGoogle Scholar
• 13 Gniadecka M, Jemec G BE. Quantitative evaluation of chronological ageing and photoageing in vivo: Studies on skin echogenicity and thickness.  Brit J Dermatol. 1998;  139 815-821
  PubMedGoogle Scholar
• 14 von Heimburg D, Hemmrich K, Zachariah S, Staiger H, Pallua N. Oxygen consumption in undifferentiated versus differentiated adipogenic mesenchymal precursor cells.  Respir Physiol Neurobiol. 2005;  146 107-116
  CrossrefPubMedGoogle Scholar
• 15 Hoenig J F, Brink U, Korabiowska M. Severe granulomatous allergic tissue reaction after hyaluronic acid injection in the treatment of facial lines and its surgical correction.  J Craniofac Surg. 2003;  14 197-200
  CrossrefPubMedGoogle Scholar
• 16 Jansen D, Graivier M H. Evaluation of a calcium-hydoxylapatite-based implant for facial soft tissue augmentation.  Plast Reconstr Surg. 2006;  118 (Suppl) 225-305
  PubMedGoogle Scholar
• 17 Jones D H, Carruthers A, Orentreich D. et al . Highly purified 1000-cSt silicone oil for treatment of human immunodeficiency virus associated facial lipoatrophy: An open pilot trial.  Dermatol Surg. 2004;  30 1279-1286
  CrossrefPubMedGoogle Scholar
• 18 Knapp T R, Kaplan E N, Daniels J R. Injectable collagen for soft-tissue augmentation.  Plast Reconstr Surg. 1977;  60 398-408
  PubMedGoogle Scholar
• 19 Lambros V. The use of hyaluronidase to reverse the effects of hyaluronic acid filler.  Plast Reconstr Surg. 2004;  114 277
  PubMedGoogle Scholar
• 20 Lemperle G, Morhenn V B, Charrier U. Human histology and persistence of various injectable filler substances for soft tissue augmentation.  Aesth Plast Surg. 2003;  27 354-366
  CrossrefPubMedGoogle Scholar
• 21 Lemperle G. What happens to free fat grafts after 20 years in patients who gain weight?.  Plast Reconstr Surg. 2005;  116 2035-2036
  PubMedGoogle Scholar
• 22 Lemperle G, Gauthier-Hazan N, Wolters M, Eisemann-Klein M, Zimmermann U S, Duffy D M. Foreign body granuloma after all injectable dermal fillers: Possible causes and treatment options.  Plast Reconstr Surg. 2007;  119
  PubMedGoogle Scholar
• 23 Lemperle G, Rullan P, Gauthier-Hazan N. Avoiding and treating dermal filler complications.  Plast Reconstr Surg. 2006;  118 (Suppl) 925-1075
  PubMedGoogle Scholar
• 24 Lemperle G, Romano J J, Busso M. Soft tissue augmentation with Artecoll: 10-year history, indications, techniques, and complications.  Dermatol Surg. 2003;  29 573-587
  CrossrefPubMedGoogle Scholar
• 25 Moy R L, Fincher E F. Poly-L-lactic acid for the aesthetic correction of facial volume loss.  Aesth Surg J. 2005;  25 646-648
  CrossrefPubMedGoogle Scholar
• 26 Nicolau P J. Long lasting and permanent fillers: Biomaterial influence over host tissue response.  Plast Reconstr Surg. 2007;  119
  PubMedGoogle Scholar
• 27 Patel V J, Bruck M C, Katz B E. Hypersensitivity reaction to hyaluronic acid with negative skin testing.  Plast Reconstr Surg. 2006;  117 1828
  PubMedGoogle Scholar
• 28 Pellacani G, Seidenari S. Variations in facial skin thickness and echography with site and age.  Acta Derm Venereol. 1999;  79 366-369
  CrossrefPubMedGoogle Scholar
• 29 Saylan Z. Facial fillers and their complications.  Aesthet Surg J. 2003;  23 221-224
  CrossrefPubMedGoogle Scholar
• 30 Schoepe S, Schaecke H, May E, Asdullah K. Glucocorticoid therapy-induced skin atrophy.  Exper Dermatol. 2006;  15 406-420
  PubMedGoogle Scholar
• 31 Schmidt-Westhausen A M, Frage J, Reichart P A. Abscess formation after lip augmentation with silicone: Case report.  Int J Oral Maxillofac Surg. 2004;  33 198-200
  CrossrefPubMedGoogle Scholar
• 32 Shumaker R P, England L J, Dover J S. et al . Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model: Part 2.  Lasers Surg Med. 2006;  38 211-217
  CrossrefPubMedGoogle Scholar
• 33 Vleggaar D. Facial volumetric correction with injectable poly-l-lactic acid.  Dermatol Surg. 2006;  31 1511-1518
  PubMedGoogle Scholar
• 34 Voy E D, Mohasseb J. Lipoatrophie als seltene Komplikation nach Auffüllung der Nasolabialfalten mit injizierbaren Implantaten.  Magazin Aesth Chir. 2002;  3 36-39
  PubMedGoogle Scholar
• 35 Wolters M, Lampe H. Nicht-operative Faltenbehandlung im Gesicht.  Plastische Chirurgie. 2003;  2 69-82
  PubMedGoogle Scholar
• 36 Zide B M. Radiance: Short-term experience.  Aesthet Surg J. 2004;  23 495-499
  PubMedGoogle Scholar

1 Nach einem Vortrag anlässlich der gemeinsamen Jahrestagung der VDPC, VDÄPC und ÖGPÄRCH in München, 27. September bis 1. Oktober 2005

Prof. Dr. med. Gottfried Lemperle

Division of Plastic Surgery
University of California, San Diego

200 West Arbor Drive #8220

San Diego, CA 92103-8220

USA

Email: glemperle@aol.com