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What can be done for filler complications?

Paris — It's preferable to use biodegradable fillers, such as hyaluronic acids, to minimize the possibility of complications that can occur, says Pierre Andre, M.D., formerly an assistant professor in the department of skin surgery at the University of Paris at Crèteil.

Speaking at the International Academy of Cosmetic Dermatology here, Dr. Andre said new fillers, such as forms of hyaluronic acid, offer an alternative to traditional fillers such as bovine collagen. About 3 percent of the population is allergic to collagen and can experience complications such as a rash, nodules or granulomatous reactions. Hyaluronic acid occurs naturally in the skin, so an advantage of using it as a filler is that it doesn't require a skin test.

"The complications that occur with hyaluronic acid are always temporary, and they occur in less than 0.5 percent of cases," Dr. Andre tells Dermatology Times. "Most of the complications that occur are not severe and will disappear when the product is biodegraded."

Volume

Hyaluronic acid can also be administered to increase volume.

Fillers that are designed to be temporary are preferred over fillers that are permanent, according to Dr. Andre.

"We need to think in terms of good clinical correction," Dr. Andre says. "If the product has an effect for about six months, then it will provide that kind of correction. We can use it for wrinkles or lip augmentation. We have to consider if patients will lose or gain weight, and this is why it's important to see patients annually. We need to consider whether injection of the fillers to increase volume is necessary over the long term."

A survey that Dr. Andre published in 2004 in the Journal of the European Academy of Dermatology and Venereology examined safety and the incidence of adverse reactions between 1997 and 2001 after injections of hyaluronic acid, specifically Restylane (Q-Med Laboratories) products from Sweden, for cosmetic purposes. The retrospective investigation of more than 4,300 cases across Europe found 34 reported cases of hypersensitivity, 16 of which were immediate and 18 of which were delayed. The researchers concluded the global risk of sensitivity was 0.8 percent.

Dr. Andre notes that, since 2000, the amount of raw product in the filler has decreased and, consequently, so has the incidence of hypersensitivity. The rate is now about 0.6 percent, half of which results from immediate reactions that are resolved in less than a month. The risk of strong, transient delayed reactions is about 0.3 percent. Four cases of abscess were reported, and all were sterile. No bacterial infection occurred.

"If you see an abscess develop, then you have to take action as a clinician," Dr. Andre says. "If you see more mild reactions, they will resolve on their own."

When performing a lip augmentation, there is a risk of herpetic recurrence, depending upon the injection technique.

"When performing a lip augmentation, it is very important to use a very fine needle," Dr. Andre says.

Newer fillers are made of polylactic acid and purport to last two to three years. Polylactic acid is also used to treat HIV-associated facial lipoatrophy. Dr. Andre discourages the use of fillers made of polylactic acid for the purposes of wrinkle correction because of the possible development of subcutaneous nodules.

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