Employing an intralesional laser to treat inflammatory complications caused by permanent facial fillers showed a 92% overall improvement rate, according to an Italian study that appeared in the August issue of Plastic and Reconstructive Surgery.
A total of 218 consecutive patients (204 of whom were women) with a mean age of 49 years were treated with an 808 nm diode laser (LASEmaR 800; Eufoton, Treiste, Italy) between 2006 and 2013.
Patients with infiltrating distribution in the tissues, as in crisscross retrograde injection, were managed by intralesional laser treatment alone. However, patients with cystic distribution in the tissues, as in bolus injections, were treated with both laser-assisted evacuation and drainage through stab wound incisions.
Researchers chose the 810 nm wavelength because of less associated pain than other infrared diodes.
Typically, no anesthesia is required for the laser treatment, according to the study authors, which consists of percutaneously inserting a 200-micron fiberoptic laser directly into the lesions and drilling several small holes. The result is removal of the foreign substance and the inflammatory reaction.
“A period of up to 6 months is usually necessary to fully appreciate the resolution of the lump together with the healing of the surrounding inflammation often extended far beyond the original implant,” writes lead author Daniel Cassuto, M.D., and his associates from Modena and Milan, Italy.
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NEXT: Study Results
The study, which had a minimum follow-up of 6 months, achieved partial improvement in 30% of patients and lesions disappeared completely in 61% of cases.
Transient swelling occurred in all cases, hematoma in 2%, secondary sterile abscess in 9.5% and minimal scarring in 10%.
"The article illustrates the complex issues that can occur with the use of permanent/nonresorbable fillers for facial aesthetic enhancement,” says Cosmetic Surgery Times editorial advisor Steven Fagien, M.D., FACS, a plastic surgeon in private practice in Boca Raton, Fla. “Unlike nonpermanent fillers such as hyaluronic acid gels, where the agent can be chemically reduced should complications arise that require their removal, permanent fillers may present greater challenges, as the substances more often cannot be removed chemically or even mechanically/surgically for technical reasons.”
Dr. Fagien says that Dr. Cassuto and his collaborators “have a wealth of experience” with facial fillers, noting that many of these injected agents are not approved for use in the U.S. The researchers “have treated these issues with varied success, suggesting that the causation may likely be multifactorial and many times evasive,” Dr. Fagien says.
Nonetheless, the authors “demonstrate enhanced successes with a novel approach and sensible algorithm, using energy-based devices in combination with standard therapies, in attempting to eradicate both the foreign substance and the biological processes that ensue when more traditional treatments have failed,” Dr. Fagien says. “I congratulate the authors on this very interesting paper that will hopefully lead to better outcomes when these complications arise.”
NEXT: Treatment Algorithm
The normal laser power is 7 watts (W). However, if at the start of treatment, the patient exhibits excessive discomfort, reduce power to 6 W and change the emission from continuous wave to pulsed: 500 msec on and 500 msec off.
Squeeze out heat-liquefied materials by finger compression through the skin entrance points of the probe.
Postoperatively, instruct patients apply frequent lukewarm saline compresses. Also advise repeated gentle squeezing of the treated area to ensure continuous drainage of the liquefied foreign material and necrotic inflammatory tissue.
For patients at risk of post infection, oral macrolide antibiotic therapy is recommended.