Expertise Crucial in Filler Correction

NAPLES, Fla. - Dermatologists know best how to prevent and to correct facial filler complications, compared with medi-spa aestheticians and other employees, Dr. Oscar Hevia said.

“Our ability to identify, treat, and correct our complications [is what will set us apart]. It’s all about experience,” Dr. Hevia said at the meeting.

Some complications are more specific to particular filler types or products, whereas others can occur regardless of which agent is chosen to enhance the forehead, infraorbital area, or the naso­labial folds, for example. Appropriate expertise goes beyond recognition of early complications in the first 2 weeks, to include late complications (that arise within 1 year), and delayed complications thereafter.

“Forehead contouring is not an area we normally think about with fillers. [However,] you can get a nice correction in someone who might have brow ptosis if you used a toxin,” said Dr. Hevia, who is in private practice in Miami and on the faculty in the department of dermatology and cutaneous surgery at the University of Miami Leonard M. Miller School of Medicine.

“Looking at the eyes, the superior temporal rim is important too. Take away any bony landmarks around the eyes,” he said.

More commonly, patients will ask dermatologists to improve their infraorbital hollows. Injection of fillers to replace lost volume below the eyes is part of his restorative approach to the face, Dr. Hevia said. “Much of the early aging in patients is really around the eyes. You are taking someone from worn or tired ... to looking their best.” Calcium hydroxyapatite (Radiesse, BioForm Medical Inc.) and polydimethylsiloxane (Silikon 1000, Alcon Laboratories) are options for filling the infraorbital area.

Along with these techniques comes the potential for complications. For example, it is easy to overcorrect with calcium hydroxyapatite injections under the eyes, Dr. Hevia said. “You really should use a half-inch 30-G needle, small volumes, a little at a time, and you will do fine.” A yellowish discoloration after this product is injected into thin skin, such as under the eyes, is another specific potential complication, he added.

Bruising, tenderness, erythema, and vascular compromise are nonspecific complications, or events not associated with a specific filler product or type.

“Bruising is part of life. You are going to see it, especially when you inject around the eye,” Dr. Hevia said. If postprocedure bruising is superficial, you can treat it with lasers, he added.

Caution with infraorbital injections also is warranted when a patient has visible malar mounds. Injection of any filler into the compartmentalized fat pads under the eyes might exacerbate them, Dr. Hevia said. Infraorbital edema is another nonspecific complication in this ana­tomic area.

Hematoma and vascular compromises are other adverse events not necessarily associated with any particular facial filler product.

There also are more specific sequelae. For example, incorrect injection of polydimethylsiloxane can cause delayed overcorrection of nasolabial folds, rhytids, or acne scars. Dr. Hevia cited one patient, for example, with facial acne scars who developed protruding bumps on her skin. Placement of this filler too superficially is usually to blame.

Granuloma is another complication associated with some filler products more than others, Dr. Hevia said. “What we see in Miami is a ‘biopolymer’ granulomatous response.” Some patients get biopolymer injections at a medi-spa and then present to Dr. Hevia with delayed overcorrections, such as around their upper lip.

Late- or delayed-onset granuloma also can occur with poly-l-lactic acid injections, Dr. Hevia said. “In some patients, this can arise more than a year later.”

Disclosures: Dr. Hevia said he had no relevant financial disclosures.

NAPLES, Fla. - Dermatologists know best how to prevent and to correct facial filler complications, compared with medi-spa aestheticians and other employees, Dr. Oscar Hevia said.

“Our ability to identify, treat, and correct our complications [is what will set us apart]. It’s all about experience,” Dr. Hevia said at the meeting.

Some complications are more specific to particular filler types or products, whereas others can occur regardless of which agent is chosen to enhance the forehead, infraorbital area, or the naso­labial folds, for example. Appropriate expertise goes beyond recognition of early complications in the first 2 weeks, to include late complications (that arise within 1 year), and delayed complications thereafter.

“Forehead contouring is not an area we normally think about with fillers. [However,] you can get a nice correction in someone who might have brow ptosis if you used a toxin,” said Dr. Hevia, who is in private practice in Miami and on the faculty in the department of dermatology and cutaneous surgery at the University of Miami Leonard M. Miller School of Medicine.

“Looking at the eyes, the superior temporal rim is important too. Take away any bony landmarks around the eyes,” he said.

More commonly, patients will ask dermatologists to improve their infraorbital hollows. Injection of fillers to replace lost volume below the eyes is part of his restorative approach to the face, Dr. Hevia said. “Much of the early aging in patients is really around the eyes. You are taking someone from worn or tired ... to looking their best.” Calcium hydroxyapatite (Radiesse, BioForm Medical Inc.) and polydimethylsiloxane (Silikon 1000, Alcon Laboratories) are options for filling the infraorbital area.

Along with these techniques comes the potential for complications. For example, it is easy to overcorrect with calcium hydroxyapatite injections under the eyes, Dr. Hevia said. “You really should use a half-inch 30-G needle, small volumes, a little at a time, and you will do fine.” A yellowish discoloration after this product is injected into thin skin, such as under the eyes, is another specific potential complication, he added.

Bruising, tenderness, erythema, and vascular compromise are nonspecific complications, or events not associated with a specific filler product or type.

“Bruising is part of life. You are going to see it, especially when you inject around the eye,” Dr. Hevia said. If postprocedure bruising is superficial, you can treat it with lasers, he added.

Caution with infraorbital injections also is warranted when a patient has visible malar mounds. Injection of any filler into the compartmentalized fat pads under the eyes might exacerbate them, Dr. Hevia said. Infraorbital edema is another nonspecific complication in this ana­tomic area.

Hematoma and vascular compromises are other adverse events not necessarily associated with any particular facial filler product.

There also are more specific sequelae. For example, incorrect injection of polydimethylsiloxane can cause delayed overcorrection of nasolabial folds, rhytids, or acne scars. Dr. Hevia cited one patient, for example, with facial acne scars who developed protruding bumps on her skin. Placement of this filler too superficially is usually to blame.

Granuloma is another complication associated with some filler products more than others, Dr. Hevia said. “What we see in Miami is a ‘biopolymer’ granulomatous response.” Some patients get biopolymer injections at a medi-spa and then present to Dr. Hevia with delayed overcorrections, such as around their upper lip.

Late- or delayed-onset granuloma also can occur with poly-l-lactic acid injections, Dr. Hevia said. “In some patients, this can arise more than a year later.”

Disclosures: Dr. Hevia said he had no relevant financial disclosures.

NAPLES, Fla. - Dermatologists know best how to prevent and to correct facial filler complications, compared with medi-spa aestheticians and other employees, Dr. Oscar Hevia said.

“Our ability to identify, treat, and correct our complications [is what will set us apart]. It’s all about experience,” Dr. Hevia said at the meeting.

Some complications are more specific to particular filler types or products, whereas others can occur regardless of which agent is chosen to enhance the forehead, infraorbital area, or the naso­labial folds, for example. Appropriate expertise goes beyond recognition of early complications in the first 2 weeks, to include late complications (that arise within 1 year), and delayed complications thereafter.

“Forehead contouring is not an area we normally think about with fillers. [However,] you can get a nice correction in someone who might have brow ptosis if you used a toxin,” said Dr. Hevia, who is in private practice in Miami and on the faculty in the department of dermatology and cutaneous surgery at the University of Miami Leonard M. Miller School of Medicine.

“Looking at the eyes, the superior temporal rim is important too. Take away any bony landmarks around the eyes,” he said.

More commonly, patients will ask dermatologists to improve their infraorbital hollows. Injection of fillers to replace lost volume below the eyes is part of his restorative approach to the face, Dr. Hevia said. “Much of the early aging in patients is really around the eyes. You are taking someone from worn or tired ... to looking their best.” Calcium hydroxyapatite (Radiesse, BioForm Medical Inc.) and polydimethylsiloxane (Silikon 1000, Alcon Laboratories) are options for filling the infraorbital area.

Along with these techniques comes the potential for complications. For example, it is easy to overcorrect with calcium hydroxyapatite injections under the eyes, Dr. Hevia said. “You really should use a half-inch 30-G needle, small volumes, a little at a time, and you will do fine.” A yellowish discoloration after this product is injected into thin skin, such as under the eyes, is another specific potential complication, he added.

Bruising, tenderness, erythema, and vascular compromise are nonspecific complications, or events not associated with a specific filler product or type.

“Bruising is part of life. You are going to see it, especially when you inject around the eye,” Dr. Hevia said. If postprocedure bruising is superficial, you can treat it with lasers, he added.

Caution with infraorbital injections also is warranted when a patient has visible malar mounds. Injection of any filler into the compartmentalized fat pads under the eyes might exacerbate them, Dr. Hevia said. Infraorbital edema is another nonspecific complication in this ana­tomic area.

Hematoma and vascular compromises are other adverse events not necessarily associated with any particular facial filler product.

There also are more specific sequelae. For example, incorrect injection of polydimethylsiloxane can cause delayed overcorrection of nasolabial folds, rhytids, or acne scars. Dr. Hevia cited one patient, for example, with facial acne scars who developed protruding bumps on her skin. Placement of this filler too superficially is usually to blame.

Granuloma is another complication associated with some filler products more than others, Dr. Hevia said. “What we see in Miami is a ‘biopolymer’ granulomatous response.” Some patients get biopolymer injections at a medi-spa and then present to Dr. Hevia with delayed overcorrections, such as around their upper lip.

Late- or delayed-onset granuloma also can occur with poly-l-lactic acid injections, Dr. Hevia said. “In some patients, this can arise more than a year later.”

Disclosures: Dr. Hevia said he had no relevant financial disclosures.