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• W2321168713 abstract "Sir: We read the report on polyacrylamide hydrogel injection by Dr. Ono et al. with respect and interest.1 In Asia, injectable fillers have been used extensively by plastic surgeons for facial correction and breast augmentation.2–5 Along with the advantages, we have also noticed emerging negative results. We agree with the authors on their major points, yet still have something to say about countermeasures against the filler-associated complications. First, the number of patients is not more than four in either group,1 which is too small for sampling and is statistically unreasonable, because a larger sample may yield different results. Our results with fillers revealed much lower complication rates. We also find that eyelid, nasolabial groove, and nose corrections have a higher risk than chin and chest augmentation. Additional data need to be collected with a larger sample to support this view. Second, we rely mainly on physical examination. Accessory tools include molybdenum target radiography, B-mode ultrasound, computed tomographic scanning, and magnetic resonance imaging. With high acuity and accuracy, magnetic resonance imaging enables targeting and provides knowledge regarding injection range, surrounding tissue, and even the capsule. Positron emission computed tomography is also of help, because it reveals not only the local focus but also filler migration. However, its high price constrains its clinical use. In sum, magnetic resonance imaging is currently the criterion standard for probing after injection of polyacrylamide hydrogel.3–5 Third, removal of injection fillers is very difficult in the superficial layers (e.g., eyelid, nasolabial crease, and cheek), where surgery is sometimes contraindicated to avoid scarring of the face. Moreover, multilayer and multifoci injection filler, when complicated by infectious diseases, may result in severe scar, various infection foci, and other unsatisfactory results. In the case of breast augmentation, removal of fillers can have good results, because the injection site is superficial and the skin lesion is mild. Drainage or surgical procedures may yield good results. Fourth, in China, injection fillers are frequently used in breast, nose, and chin augmentation, among which chin augmentation has a higher complication rate. Removal of the filler will be easy when the interval between injection and operation is short and the design of the operative procedure is simple. The filler is often injected through an alar incision. A short incision line is preferred, to avoid scarring, because wide isolation with scissors, multidirectional curettage, and repeated drainage help remove most of the fillers. A suborbital incision is recommended to take out fillers in the nose. Secondary rhinoplasty should be performed no less than 3 months later. Fifth, for those receiving heavy doses of fillers, our principles are as follows: Preoperative magnetic resonance imaging is indispensable, because the results help categorize the patients. In one category, the filler is located in a single, intact capsule below the breast. In the other, it is found in many scattered sacs of different sizes: in the breast, below the breast, between the muscle fibers of the pectoralis major, and even on the abdominal wall. Timing of its removal is controversial. Some patients may not show any adverse reaction yet still request immediate removal because of increasing anxiety. Generally, we do not operate on those with a single capsule and after labor, but perform frequent follow-up examinations. However, we recommend early removal in the case of contour change or other complications. Although it remains unclear whether injection of fillers affects breast feeding, we recommend that the patient feed their children with alternatives, to avoid possible complications, including acute mastitis and undesirable effects on growth and development. The operation can be performed through a semilunar incision below the inferior border of the breast areola or along the inframammary fold. We choose an areolar approach, because Chinese patients are prone to developing a scar. With the help of magnetic resonance imaging findings, it is not difficult to remove the injectable fillers and the capsule. The surgeon should be alert to contour change if the patient shows a wide range of filler migration. Also, repetitive washing and postoperative drainage are of great importance. Also of note, it is unnecessary to clear away all of the filler between muscle fibers. Secondary breast augmentation should be performed at least 3 months after removal. Injection fillers are located mostly above the pectoralis major and below the breast. Placement under the pectoralis major will prevent possible complications from contact of prosthesis and remnant fillers. Bi Bo Yang Ping Zhou Yiqun Liu Tianyi Plastic and Reconstructive Surgery Hua Dong Hospital Fu Dan University Shanghai, China" @default.
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• W2321168713 date "2011-06-01" @default.
• W2321168713 modified "2023-09-30" @default.
• W2321168713 title "Finding a Favorable Treatment of Polyacrylamide Hydrogel Injection Complication" @default.
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• W2321168713 doi "https://doi.org/10.1097/prs.0b013e3182131b0b" @default.
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