Facial Plast Surg 2024; 40(01): 019-030
DOI: 10.1055/a-2019-5131
Original Research

Aesthetic Surgical Pathway in Permanent Facial Filler Removal

Michele Pascali
1   Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Roma, Lazio, Italy
,
Fabrizio Chirico
2   Department of Maxillo Facial Surgery, University of Rome La Sapienza, Rome, Lazio, Italy
,
Luigi Rugge
3   Private Practice - Maxillo Facial Unit, Naples, Italy
,
Raffaele Rauso
4   Department of Cranio-maxillo Facial Surgery, Private Hospital ‘L. Cobellis’, Vallo Della Lucania (SA), Italy
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Although permanent fillers have been introduced in order to get long-lasting results, many studies have shown numerous severe and disfiguring complications. Nonsurgical procedures may mitigate those adverse events but the only way to remove the filler previously injected is represented by surgical excision. We present a pathway of facial surgical accesses to be performed achieving two goals: permanent filler removal and restore facial aesthetic balance. The proposed surgical accesses are already standardized in aesthetic surgical practice in order to avoid direct excision and unpleasant facial scar. A total of 231 patients underwent surgery for permanent filler removal and aesthetic restoration of the involved facial area, represented by forehead, glabella, nose, cheeks, eyelids, chin, jawline, and lips. Magnetic resonance evaluation was performed with the exception of lip patients who were evaluated with ultrasound. Postoperative follow-up was 12 months to 6 years. Subjective and objective methods were used for outcome evaluation according to the FACE-Q questionnaire. Functional and aesthetic correction was scored using the patient-graded Global Aesthetic Improvement Scale (GAIS), overall patient satisfaction was assessed by a five-point scale questionnaire. Functional and aesthetic restoration was globally recognized as improved according to the GAIS. Patients reported high levels of satisfaction assessed by a five-point scale questionnaire. A very good satisfaction level was registered in both subjective and objective judgment scores. To the best of our knowledge, we present the largest case series regarding surgical removal of permanent facial fillers. A proper preoperative evaluation, filler removal followed by restorative facial aesthetic surgery technique is paramount to approach challenging cases.

Keywords

permanent filler - filler removal - filler complications - facial reconstruction - aesthetic surgery


Publication History

Accepted Manuscript online:
25 January 2023

Article published online:
16 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Goldberg DJ, Bass LM, Fitzgerald R, Graivier MH, Lorenc ZP. Expanding treatment options for injectable agents. Aesthet Surg J 2018; 38 (Suppl. 01) S1-S7
    CrossrefPubMedGoogle Scholar
  • 2 Fitzgerald R, Bass LM, Goldberg DJ, Graivier MH, Lorenc ZP. Physiochemical characteristics of poly-L-lactic acid (PLLA). Aesthet Surg J 2018; 38 (Suppl. 01) S13-S17
    CrossrefPubMedGoogle Scholar
  • 3 Rauso R, Califano L, Rugge L, Chirico F, Tartaro G. Surgical lip remodeling after injection of permanent filler. Aesthet Surg J 2019; 39 (05) 565-571
    CrossrefPubMedGoogle Scholar
  • 4 Rauso R, Zerbinati N, Franco R. et al. Cross-linked hyaluronic acid filler hydrolysis with hyaluronidase: different settings to reproduce different clinical scenarios. Dermatol Ther 2020; 33 (02) e13269
    CrossrefPubMedGoogle Scholar
  • 5 Rauso R, Califano L, Rugge L, Chirico F, Tartaro G. Late onset complications secondary to polyacrylamide hydrogel-based filler for rehabilitation of HIV-related facial lipoatropy. Aesthet Surg J 2018; 38 (11) NP170-NP174
    CrossrefPubMedGoogle Scholar
  • 6 Fitzgerald R, Graivier MH, Kane M. et al. Update on facial aging. Aesthet Surg J 2010; 30 (Suppl): 11S-24S
    CrossrefPubMedGoogle Scholar
  • 7 Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E. Adverse reactions to injectable soft tissue permanent fillers. Aesthetic Plast Surg 2005; 29 (01) 34-48
    CrossrefPubMedGoogle Scholar
  • 8 De Santis G, Pinelli M, Benanti E, Baccarani A, Starnoni M. Lipofilling after Laser-Assisted Treatment for Facial Filler Complication: Volumetric and Regenerative Effect. Plast Reconstr Surg 2021; 147 (03) 585-591
    CrossrefPubMedGoogle Scholar
  • 9 Zaccaria G, Cassuto D, Baccarani A, Lusetti IL, Santis G. Filler-induced complications of the lips: 10 years experience with intralesional laser treatment and refinements. J Plast Reconstr Aesthet Surg 2022; 75 (03) 1215-1223
    CrossrefPubMedGoogle Scholar
  • 10 Oranges CM, Brucato D, Schaefer DJ, Kalbermatten DF, Harder Y. Complications of nonpermanent facial fillers: a systematic review. Plast Reconstr Surg Glob Open 2021; 9 (10) e3851
    CrossrefPubMedGoogle Scholar
  • 11 Cassuto D, Pignatti M, Pacchioni L, Boscaini G, Spaggiari A, De Santis G. Management of complications caused by permanent fillers in the face: a treatment algorithm. Plast Reconstr Surg 2016; 138 (02) 215e-227e
    CrossrefPubMedGoogle Scholar
  • 12 van Dam D, van der Lei B, Cromheecke M. Statements on the safety of permanent soft tissue fillers in Europe. Aesthetic Plast Surg 2009; 33 (04) 479-481
    CrossrefPubMedGoogle Scholar
  • 13 Kadouch JA, Tutein Nolthenius CJ, Kadouch DJ, van der Woude HJ, Karim RB, Hoekzema R. Complications after facial injections with permanent fillers: important limitations and considerations of MRI evaluation. Aesthet Surg J 2014; 34 (06) 913-923
    CrossrefPubMedGoogle Scholar
  • 14 Ginat DT, Schatz CJ. Imaging features of midface injectable fillers and associated complications. AJNR Am J Neuroradiol 2013; 34 (08) 1488-1495
    CrossrefPubMedGoogle Scholar
  • 15 Goldman A, Wollina U. Intralesional neodymium YAG laser to treat complications of polymethylmethacrylate. Open Access Maced J Med Sci 2018; 6 (09) 1636-1641
    CrossrefPubMedGoogle Scholar
  • 16 Wilson YL, Ellis DA. Large needle suction aspiration of permanent fillers. Laryngoscope 2011; 121 (10) 2146-2149
    CrossrefPubMedGoogle Scholar
  • 17 Carella S, Ruggeri G, La Russa R, Volonnino G, Frati P, Onesti MG. Clinical management of complications following filler injection. Aesthetic Plast Surg 2022; 46 (02) 886-894
    CrossrefPubMedGoogle Scholar
  • 18 Kästner S, Gonser P, Paprottka F, Kaye KO. Removal of polyacrylamide gel (Aquamid®) from the lip as a solution for late-onset complications: our 8-year experience. Aesthetic Plast Surg 2018; 42 (03) 791-797
    CrossrefPubMedGoogle Scholar
  • 19 Rauso R, Albani G, Salini C, Rugge L, Chirico F, Tartaro G. Continuum: late onset complications secondary to polyacrylamide hydrogel-based filler for rehabilitation of HIV-related facial lipoatropy. Aesthet Surg J 2019; 39 (05) NP152-NP155
    CrossrefPubMedGoogle Scholar
  • 20 Botti C, Botti G, Pascali M. Facial aging surgery: healing time, duration over the years, and the right time to perform a facelift. Aesthet Surg J 2021; 41 (11) NP1408-NP1420
    CrossrefPubMedGoogle Scholar
  • 21 Pascali M, Gentile P, Di Pasquali C, Bocchini I, Cervelli V. The auricular cartilage in 197 secondary and tertiary rhinoplasties. J Craniofac Surg 2016; 27 (02) 339-344
    CrossrefPubMedGoogle Scholar
  • 22 Pascali M, Botti C, Cervelli V, Botti G. Midface rejuvenation: a critical evaluation of a 7-year experience. Plast Reconstr Surg 2015; 135 (05) 1305-1316
    CrossrefPubMedGoogle Scholar
  • 23 Jacono AA, Stong BC. Anatomic comparison of the deep-plane face-lift and the transtemporal midface-lift. Arch Facial Plast Surg 2010; 12 (05) 339-341
    CrossrefPubMedGoogle Scholar
  • 24 Romo III T, Jacono AA, Sclafani AP. Endoscopic forehead lifting and contouring. Facial Plast Surg 2001; 17 (01) 3-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Bertossi D, Albanese M, Nocini R, Mortellaro C, Kumar N, Nocini PF. Osteotomy in genioplasty by piezosurgery. J Craniofac Surg 2021; 32 (03) e317-e321
    CrossrefPubMedGoogle Scholar
  • 26 Steffen N, Goldenberg DC. Re: Brazilian Consensus Recommendation on the Use of Polymethylmethacrylate Filler in Facial and Corporal Aesthetics by Túlio Armanini Blanco Souza, Letícia Marques Colomé, Eduardo André Bender, Gottfriede Lemperle Aesthethic Plastic Surgery 2018; 42(5): 1244-51. Aesthetic Plast Surg 2019; 43 (04) 1126-1127
    CrossrefPubMedGoogle Scholar
  • 27 Zeltzer AA, Craggs B, Van Thielen J, Hendrickx B, Seidenstuecker K, Hamdi M. Massive hemi-facial edema after permanent filler removal in an HIV-positive patient. Precautions and patient information. Aesthetic Plast Surg 2015; 39 (03) 425-427
    CrossrefPubMedGoogle Scholar
  • 28 Wolter TP, Pallua N. Removal of the permanent filler polyacrylamide hydrogel (aquamid) is possible and easy even after several years. Plast Reconstr Surg 2010; 126 (03) 138e-139e
    CrossrefPubMedGoogle Scholar
  • 29 Schelke LW, Velthuis PJ, van Dijk MR. Polyalkylimide: a nonstable filler over time. Dermatol Surg 2018; 44 (04) 563-567
    CrossrefPubMedGoogle Scholar
  • 30 Mandy S, Del Campo R. Commentary on polyalkylimide. Dermatol Surg 2018; 44 (04) 568
    CrossrefPubMedGoogle Scholar