Search

Background Dermal fillers are widely used for facial rejuvenation and esthetic enhancement, offering temporary solutions for aging and volume loss. Despite their general safety, a rare but severe complication associated with these fillers is visual impairment, including blindness. This underscores the need for a thorough understanding of risks associated with various filler materials. Historical cases of blindness following filler injections date back to 1963, with increasing reports linked to the expansion of the cosmetic filler industry. While hyaluronic acid (HA) and autologous fat have been extensively studied, other fillers such as calcium hydroxylapatite and poly-l-lactic acid (PLLA) are less understood.Objective This systematic review aims to address gaps in the literature by providing a comprehensive overview of visual impairment caused by fillers other than HA and autologous fat. We systematically examine the prevalence, causes, clinical features, and treatment outcomes associated with these less common fillers.Materials and methods A comprehensive literature search was conducted across databases including PubMed, Scopus, and Google Scholar using terms related to visual impairment and dermal fillers. Studies published between 2014 and 2021, including observational studies and case reports, were included. Studies were selected based on predefined inclusion and exclusion criteria, and a PRISMA flow diagram was used to illustrate the study selection process.Results The review identifies and summarizes cases of visual impairment associated with calcium hydroxylapatite, poly-d,l-lactic acid (PDLLA), and PLLA fillers. Key findings reveal that visual impairment following these fillers is rare but can occur suddenly or within a few days of the procedure. Cases of delayed onset up to two weeks are also noted, emphasizing the need for extended post-procedure monitoring.Discussion The review highlights unique insights into the risks associated with non-HA fillers, such as the heightened risk in the periorbital region and other facial areas. It explores mechanisms of complications, including retrograde flow of emboli leading to retinal ischemia. The discussion also covers emergency protocols and preventative measures, providing valuable guidance for managing and mitigating risks.Conclusions Visual impairment caused by fillers other than HA and autologous fat, while rare, represents a serious complication that requires careful attention. This review contributes new perspectives on the differential risks of various fillers, symptom onset variability, and anatomical risk factors. Emphasizing the importance of proper patient selection, technique, and monitoring, it calls for further research to better understand and prevent these complications, ultimately aiming for safer and more effective use of soft-tissue fillers.

This article aims to share our experience of using intense pulsed light (IPL) technology safely and effectively in our clinic. We aimed to provide valuable insights for other cosmetic practitioners interested in incorporating IPL technology into their practices. In this article, we elaborate on the various challenges faced while using IPL technology, such as ensuring the safety of clients and educating them on proper aftercare. We will explain the precautions taken, such as conducting a thorough consultation and patch testing, to mitigate the risk of adverse side effects. We also describe several interesting cases where IPL was used to treat post-inflammatory hyperpigmentation of different origins. We also explain how we tailor our treatments to suit individual clients’ needs and provide them with detailed instructions on how to care for their skin after treatment. In conclusion, IPL technology is a safe and effective way to treat various cosmetic concerns and improve the overall appearance of the skin. With proper safety measures and tailored treatments, we hope that our experience and insights will be valuable to other cosmetic practitioners.

Laser and light therapies have revolutionized the field of cosmetic medicine because of their ability to treat a range of dermatological conditions safely and effectively. However, the theoretical principles underlying these modalities have often been overlooked. To explore the key principles of quantum mechanics and physics involved in laser and light therapy. We, a team of doctors who are quantum mechanics enthusiasts, discuss the concept of wave particle duality, wherein a photon can exist in two states simultaneously, allowing for its emission and absorption during laser and light therapy. Moreover, we examined the concepts of the Pauli exclusion principle, superposition, emission mechanism, and different reactions from the absorption of light energy by skin tissue. Although these concepts are not taught in medical schools, it would be interesting to understand them. Understanding the principles of quantum mechanics and physics is vital for optimizing the clinical outcomes of laser and light therapy. Combining these fundamental principles with empirical observations and clinical experience can enhance the efficacy and safety of laser- and light-based cosmetic interventions and pave the way for further advancements in this field.

Background: The increasing popularity of laser- and light-based esthetic treatments for facial rejuvenation has raised concerns regarding ocular safety. Although these procedures are generally considered safe and effective, there is a growing body of evidence highlighting the potential for ocular complications. This review aims to systematically analyze the types and mechanisms of ocular injuries associated with such treatments, as well as to evaluate preventive measures and management strategies. Methods: A comprehensive literature search was conducted using databases including MEDLINE, PubMed and Ovid for relevant studies published on clinical trials, diagnosis and treatment. Some papers were further reviewed using a double-blinding approach, varying sample sizes, control usage, randomization usage and objective endpoint measurements. All studies were classified according to the Oxford Centre for evidence-based medicine evidence hierarchy. Result: Our review identified several types of ocular complications associated with facial laser or light treatments, including but not limited to conjunctival burns, corneal damage, retinal phototoxicity, and transient vision disturbances. The incidence of these complications varies significantly depending on the type of laser or light source employed, treatment parameters, and the anatomical proximity of the eyes to the treatment area. Factors such as inadequate protective measures, patient movement during the procedure, and the operator’s experience were found to contribute to the risk of ocular injury. Strategies such as the use of appropriate eye protection, careful patient positioning, and thorough pre-treatment assessments were highlighted as essential preventive measures. Conclusion: Ocular complications, though rare, represent a significant risk in facial esthetic laser and light treatments. This review underscores the importance of awareness among practitioners regarding the potential ocular hazards and the implementation of robust safety protocols. Future research is needed to establish standardized guidelines to minimize risks and enhance patient safety in esthetic dermatological practices. Continued education and improved protective strategies will be essential in safeguarding ocular health as the field of esthetic treatments continues to evolve. This comprehensive review serves as an essential resource for practitioners, informing them of ocular risks, management options, and the need for vigilance to mitigate complications in clinical practice.

Background: Ocular and periocular tattoos, involving ink application to the eyeball or surrounding skin, have gained popularity as forms of self-expression. However, this trend raises significant concerns about potential complications that can adversely affect ocular health and esthetics. Awareness of these risks is crucial for both patients and practitioners. Methods: A comprehensive literature review was conducted, focusing on studies discussing complications related to ocular and periocular tattooing. Relevant studies were identified through the MEDLINE, PubMed, and Ovid databases. The reviewed papers were evaluated based on study design, including blinding, sample size, control use, randomization, and objective endpoints, and classified according to the Oxford Center for Evidence-Based Medicine evidence hierarchy. Results: The review identified a wide range of complications, including immediate issues like bleeding, infections (conjunctivitis, endophthalmitis), and allergic reactions. Delayed reactions included granuloma formation, often requiring further treatment. The most serious risk identified was potential visual impairment due to improper technique or ink placement. Conclusions: With the growing trend in ocular and periocular tattooing, there is an urgent need for increased awareness of associated risks. It is crucial to ensure that only qualified professionals perform these procedures, emphasizing the importance of understanding ocular anatomy. Developing strict regulatory guidelines and prioritizing research on the long-term effects of these tattoos are essential for patient safety. A collaborative approach among healthcare providers, regulatory bodies, and educational institutions is needed to mitigate risks and promote best practices in cosmetic tattooing.

(1) Background: The demand for body-contouring procedures has surged, with lipolysis emerging as a common technique for excess fat removal. Laser-assisted lipolysis (LAL) has gained attention as a potential alternative to surgical fat removal (SFR), offering perceived advantages in safety and efficacy. However, the comparative benefits of LAL and SFR remain uncertain. (2) Objective: To conduct a review of the existing literature comparing the efficacy, safety, and patient satisfaction of LAL and SFR. (3) Methods: A comprehensive search of major electronic databases was conducted to identify studies comparing LAL and SFR for body-contouring procedures. Studies were included if they were published in English, involved human subjects, and reported outcomes for LAL and SFR. All studies were classified according to the Oxford Center for Evidence-Based Medicine evidence hierarchy (4) Results: LAL may not be a safer and more effective option than SFR. However, the evidence for these differences was limited by the quality of the studies and the heterogeneity of the results. (5) Conclusions: This review suggests that LAL may not be a safer and more effective option than SFR for body-contouring procedures because LAL is associated with higher risks of complications such as burns and scarring, whereas SFR offers a more established safety profile and consistent efficacy.

Background: Botulinum toxin type A is widely utilized for both therapeutic and aesthetic purposes, yet concerns regarding its immunogenicity have raised issues related to treatment failure and adverse reactions. Objective: This review aims to evaluate the immunogenicity of commercially available botulinum toxin type A products across various clinical indications and identify the risk factors associated with antibody formation. Methods: A comprehensive search of electronic databases was conducted to find studies that investigated the immunogenicity of botulinum toxin type A in patients treated for different conditions. The studies were classified based on the Oxford Center for Evidence-Based Medicine’s evidence hierarchy. Results: The overall incidence of neutralizing antibody formation with botulinum toxin type A treatment is relatively low. However, it varies depending on the indication and is influenced by factors such as the frequency of injections and the cumulative dose. The total cumulative dose and the number of treatment cycles are critical factors in determining the risk of developing antibodies against botulinum toxin type A. Conclusion: This literature review highlights that the immunogenicity of botulinum toxin type A products differs across indications, with repeated injections posing a significant risk for the formation of neutralizing antibodies. The findings underscore the need for further research to better understand antibody formation mechanisms and to develop strategies that minimize their impact on treatment efficacy.

Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.

The increase in the use of filler treatments within minimally invasive cosmetic surgery has correspondingly escalated the variety and frequency of associated side effects. Initially, unregulated procedures led to primary side effects such as infections, foreign body reactions, and granuloma formation. However, severe vascular complications like skin and tissue necrosis and blindness have emerged as recognized risks. Side effects from filler treatments can range from mild to life-threatening, including edema, pain, tenderness, numbness, bleeding, bruising, hematoma, redness, erythema, pigmentation, allergic reactions, itching, pruritus, the Tyndall effect, asymmetry, irregularity, migration, skin and soft tissue infections, nodules, granulomas, and vascular compromise. These side effects are categorized into early and delayed types. Many complications, particularly those related to vascular abnormalities, are frequently linked to procedural issues, emphasizing the importance of understanding filler properties, injection techniques, and facial anatomy. Preventing side effects is ideal, but early detection and treatment are crucial. Recognizing potential side effects based on their timing and understanding appropriate preemptive treatment methods is essential. This discussion addresses non-vascular side effects, highlighting their onset, symptoms, and management strategies. The comprehensive understanding and careful management of these side effects are vital for minimizing complications and ensuring patient safety in filler treatments.

Background: After significant weight loss, the abdominal skin can become permanently stretched, resulting in stretch marks, laxity, and thinning of the dermis. For many patients, surgical methods such as abdominoplasty are too risky due to the potential for complications, the lengthy recovery period, and the high cost. Objective: The purpose of this pilot study was to use microfocused ultrasound, calcium hydroxyapatite, and Incobotulinum toxin A to improve the appearance of patients who were suffering from abdominal skin laxity after heavy weight loss. The combination of these treatments can provide comprehensive results with minimal downtime and lower risk compared to traditional surgical procedures. Methods: Our team treated four female Chinese patients with microfocused ultrasound, diluted calcium hydroxylapatite, and Incobotulinum toxin A with different combinations, respectively. The first and second cases were only treated with 810 shots of microfocused ultrasound. The third case received 850 shots of microfocused ultrasound plus 5 mL of diluted calcium hydroxylapatite and 50 units of Incobotulinum toxin A on the left abdominal skin, and the fourth case was treated with 900 shots of microfocused ultrasound plus 5 mL of diluted calcium hydroxylapatite and 10 units of Incobotulinum toxin A on the left abdominal skin. All four patients received a single treatment session. Clinical photographs were taken before each treatment, and two individual blinded investigators were asked to assess photographs taken after 4 weeks and compare them with the pretreatment photos. Results: All four cases showed an overall clinical improvement, with the third and fourth cases demonstrating more significant skin tightening based on photographic analysis. The data indicate that the inclusion of calcium hydroxylapatite and Incobotulinum toxin A in microfocused ultrasound treatment yields superior results for abdominal rejuvenation. Conclusions: Abdominal skin laxity can be treated with a triple therapy combining microfocused ultrasound, diluted calcium hydroxylapatite, and Incobotulinum toxin A.