Alain Tenenbaum

Swiss Academy of Cosmetic Dermatology and Aesthetic Medicine, Switzerland

Title: Complications of dermal fillers and endoprosthesis

Biography

Abstract

Most of Plastic Surgeons, Dermatologists believe permanent fillers are dangerous and resorbable fillers are not dangerous. In fact, all kind of fillers give the same complications like granulomas, nodules, necrosis, migrations, infections, persistent oedema and so on. The most frequent complication encountered after lipofilling is Granulomas. Every patient who undergoes endoprosthesis should ultrasonography of 20 mHz and not 7.5 mHz, for the following reasons:

Which seems to be a capsula post filler or endoprosthesis on 7.5 mHz is in fact a convergence of refringerent structures which may be fibroblasts and not a real capsula. That explains migrations.

On 20 mHz the diagnosis is re-established

Also on 20 mHz before granulomas manifest themselves clinically, they can be detected and through the aspect of the granuloma in ultrasonography, it is now possible to know which filler or endoprosthesis is involved.

To demonstrate granulomas resulting from silicon injection are stable and less dangerous than granulomas resulting from polylactic acid. This proves silicon (permanent filler) is less dangerous in case of granuloma complication than polylactic acid (resorbable filler)

Also the most dangerous granulomas which are unstable and destroy the whole dermis are those resulting from mixed biphasic fillers, combining a metacrylat (permanent) with collagen (resorbable) or hyaluronic acid (resorbable). Such granulomas can never be stopped even if treated by corticotherapy or 5 fluoro uracil.

Further studies to treat such granulomas, combining IPL, in-situ didnâ€™t yield good results. While mixed biphasic fillers are presented commercially as Long lasting fillers. Acrylates are considered less dangerous if they are:

Not hydrogel

Having no Monomers

metallic ions are absent

Gamma sterilized.

But all acrylates (fillers as endoprosthesis) should be taken off of the market, as most patients have already get a filler (hyaluronic acid, which is the most performed one) and the association acrylat â€“ presence of hyaluronic acid lead almost systematically to complications (even if on the mouse, acrylats like described above never led to complications because laboratory animals never changed of doctors and never get any hyaluronic acid or else during the acrylat experimentation)

The factors which lead mostly to granulomas are parodontosis, facelift, mesotherapy, acupuncture, Botulinum toxin. It usually occurs 6 Months before and after the filler or endoprosthesis procedure. Mixing fillers in same areas lead to the highest percentage of granulomas.

Also the best and easiest differences between true and real endoprosthesis and fillers are the MRI with T1 and T2. For example in case of rhinoplasty, the MRI shows the fillers like spots and the true endoprosthesis like blocks. On T1 and T2 the capsula looks same for an endoprosthesis as prosthesis like silicon but the difference between the silicon prosthesis and endoprosthesis is the color inside the block. For silicone, it is black as the prosthesis does not contain any water and for the endoprosthesis the color is white proving that it contains water. Hydrophile does not mean hydrogel. Also hyaluronic acid fillers lead to 7.5% allergies in the population which lead to Granulomas anyway. Nodules have to be distinguished from granulomas, as their treatment is only surgical with mostly satisfactory results. Their causes are mostly due to wrong techniques.