Zusammenfassung
Alle injizierbaren Faltenmittel können frühe und späte Komplikationen verursachen. Zu den frühen gehören Schwellung, Rötung und Blutergüsse nach intradermalen oder subkutanen Injektionen, die vom Patienten akzeptiert werden müssen. Komplikationen, die länger als zwei Wochen anhalten, sind oft auf technische Mängel, d. h. auf eine zu oberflächliche Injektion des Füllmaterials, zurückzuführen. Die meisten dieser Nebenwirkungen können wirkungsvoll mit intraläsionalen Injektionen von Kortikosteroiden und 5-Fluorouracil, Laser oder „intense pulse light“ behandelt werden und, wenn dies nicht hilft, mit der Dermabrasion nivelliert oder tangential abgetragen werden. Spätkomplikationen sind vorwiegend immunologische Reaktionen wie chronische Rötungen oder Allergien vom Typ IV sowie Fremdkörper-Granulome. Beide Überreaktionen reagieren sehr effektiv auf intraläsional injizierte Steroidkristalle, die meist wiederholt appliziert werden müssen, bis die richtige Dosis gefunden ist. Chirurgische Exzisionen sollten unbedingt vermieden und nur bei sichtbaren harten Knötchen, besonders in den Lippen oder im subkutanen Fett, in Betracht gezogen werden.
Abstract
All dermal fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of these risks and be prepared to accept them. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., the implantation of a long-lasting filler substance was too superficial). Such adverse events can be treated with intradermal 5-fluorouracil and steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunological phenomena such as late-onset allergy and non-allergic foreign body granulomas. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions should remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granulomas in the subcutaneous fat.
Schlüsselwörter
Faltenmittel - Komplikationen - Nebenwirkungen - Granuloma - Fremdkörper-Granulome - Kortikosteroid-Injektionen
Key words
Dermal fillers - complications - adverse events - foreign body granulomas - corticosteroid injections
Literatur
-
1
André P, Wechsler J, Revuz J.
Facial lipoatrophy: Report of five cases after injection of synthetic filler into nasolabial folds.
J Cosmet Dermatol.
2002;
1
120-123
-
2
André P, Lowe N J, Clerici T H, Zimmermann U.
Adverse reactions to dermal fillers: A review of European experience.
J Cosmet Laser Ther.
2005;
7
171-176
-
3
Asilan A, Darougheh A, Shariati F.
New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars.
Dermatol Surg.
2006;
31
907-915
-
4
Bellman D.
Immediate and delayed hypersensitivity reactions to Restylane - Case reports.
Aesthet Surg J.
2005;
25
489-491
-
5
Bülow von S, Heimburg von D, Pallua N.
Efficacy and safety of polyacrylamide hydrogel for facial soft-tissue augmentation.
Plast Reconstr Surg.
2005;
116
1137-1146
-
6
Carruthers A, Carruthers J DA.
Polymethylmethacrylate microspheres/collagen as a tissue augmenting agent: Personal experience over 5 years.
Dermatol Surg.
2005;
31
1561-1565
-
7
Cheng N-X, Xu S-L, Deng H. et al .
Migration of implants: A problem with injectable polyacrylamide gel in aesthetic plastic surgery.
Aesth Plast Surg.
2006;
30
215-225
-
8
Coleman S R.
Structural fat grafting: much more than permanent fillers.
Plast Reconstr Surg.
2006;
118 (Suppl)
108S-120S
-
9 Duffy D M. Liquid silicone for soft tissue augmentation: Histological, clinical, and molecular perspectives. Klein AW Tissue Augmentation in Clinical Practice. 2nd ed. New York; Taylor & Francis Grou 2006: 141-238
-
10
Edwards P C, Fantasia J E, Iovino R.
Foreign body reaction to hyaluronic acid (Restylane): An adverse outcome of lip augmentation.
Oral Maxillofac Surg.
2006;
64
1296-1299
-
11
Ghislanzoni M, Bianchi F, Barbareschi M, Alessi E.
Cutaneous granulomatous reaction to injectable hyaluronic acid gel.
Brit J Dermatol.
2006;
154
755-758
-
12
Glaich A S, Cohen J L, Goldberg L H.
Injection necrosis of the glabella: Protocol for prevention and treatment after use of dermal fillers.
Dermatol Surg.
2006;
32
276-281
-
13
Gniadecka M, Jemec G BE.
Quantitative evaluation of chronological ageing and photoageing in vivo: Studies on skin echogenicity and thickness.
Brit J Dermatol.
1998;
139
815-821
-
14
von Heimburg D, Hemmrich K, Zachariah S, Staiger H, Pallua N.
Oxygen consumption in undifferentiated versus differentiated adipogenic mesenchymal precursor cells.
Respir Physiol Neurobiol.
2005;
146
107-116
-
15
Hoenig J F, Brink U, Korabiowska M.
Severe granulomatous allergic tissue reaction after hyaluronic acid injection in the treatment of facial lines and its surgical correction.
J Craniofac Surg.
2003;
14
197-200
-
16
Jansen D, Graivier M H.
Evaluation of a calcium-hydoxylapatite-based implant for facial soft tissue augmentation.
Plast Reconstr Surg.
2006;
118 (Suppl)
225-305
-
17
Jones D H, Carruthers A, Orentreich D. et al .
Highly purified 1000-cSt silicone oil for treatment of human immunodeficiency virus associated facial lipoatrophy: An open pilot trial.
Dermatol Surg.
2004;
30
1279-1286
-
18
Knapp T R, Kaplan E N, Daniels J R.
Injectable collagen for soft-tissue augmentation.
Plast Reconstr Surg.
1977;
60
398-408
-
19
Lambros V.
The use of hyaluronidase to reverse the effects of hyaluronic acid filler.
Plast Reconstr Surg.
2004;
114
277
-
20
Lemperle G, Morhenn V B, Charrier U.
Human histology and persistence of various injectable filler substances for soft tissue augmentation.
Aesth Plast Surg.
2003;
27
354-366
-
21
Lemperle G.
What happens to free fat grafts after 20 years in patients who gain weight?.
Plast Reconstr Surg.
2005;
116
2035-2036
-
22
Lemperle G, Gauthier-Hazan N, Wolters M, Eisemann-Klein M, Zimmermann U S, Duffy D M.
Foreign body granuloma after all injectable dermal fillers: Possible causes and treatment options.
Plast Reconstr Surg.
2007;
119
-
23
Lemperle G, Rullan P, Gauthier-Hazan N.
Avoiding and treating dermal filler complications.
Plast Reconstr Surg.
2006;
118 (Suppl)
925-1075
-
24
Lemperle G, Romano J J, Busso M.
Soft tissue augmentation with Artecoll: 10-year history, indications, techniques, and complications.
Dermatol Surg.
2003;
29
573-587
-
25
Moy R L, Fincher E F.
Poly-L-lactic acid for the aesthetic correction of facial volume loss.
Aesth Surg J.
2005;
25
646-648
-
26
Nicolau P J.
Long lasting and permanent fillers: Biomaterial influence over host tissue response.
Plast Reconstr Surg.
2007;
119
-
27
Patel V J, Bruck M C, Katz B E.
Hypersensitivity reaction to hyaluronic acid with negative skin testing.
Plast Reconstr Surg.
2006;
117
1828
-
28
Pellacani G, Seidenari S.
Variations in facial skin thickness and echography with site and age.
Acta Derm Venereol.
1999;
79
366-369
-
29
Saylan Z.
Facial fillers and their complications.
Aesthet Surg J.
2003;
23
221-224
-
30
Schoepe S, Schaecke H, May E, Asdullah K.
Glucocorticoid therapy-induced skin atrophy.
Exper Dermatol.
2006;
15
406-420
-
31
Schmidt-Westhausen A M, Frage J, Reichart P A.
Abscess formation after lip augmentation with silicone: Case report.
Int J Oral Maxillofac Surg.
2004;
33
198-200
-
32
Shumaker R P, England L J, Dover J S. et al .
Effect of monopolar radiofrequency treatment over soft-tissue fillers in an animal model: Part 2.
Lasers Surg Med.
2006;
38
211-217
-
33
Vleggaar D.
Facial volumetric correction with injectable poly-l-lactic acid.
Dermatol Surg.
2006;
31
1511-1518
-
34
Voy E D, Mohasseb J.
Lipoatrophie als seltene Komplikation nach Auffüllung der Nasolabialfalten mit injizierbaren Implantaten.
Magazin Aesth Chir.
2002;
3
36-39
-
35
Wolters M, Lampe H.
Nicht-operative Faltenbehandlung im Gesicht.
Plastische Chirurgie.
2003;
2
69-82
-
36
Zide B M.
Radiance: Short-term experience.
Aesthet Surg J.
2004;
23
495-499
1 Nach einem Vortrag anlässlich der gemeinsamen Jahrestagung der VDPC, VDÄPC und ÖGPÄRCH in München, 27. September bis 1. Oktober 2005
Prof. Dr. med. Gottfried Lemperle
Division of Plastic Surgery
University of California, San Diego
200 West Arbor Drive #8220
San Diego, CA 92103-8220
USA
Email: glemperle@aol.com
