The authors of this paper present their experience in dealing with fillers complications. With an astonishing group of 219 patients over a seven-year period this may be one of the largest series of treated fillers complications in the literature.
The authors divide the lesions into cystic and infiltrative, depending on an ultrasound soft tissue examination performed before the treatment. Whereas infiltrating lesions are treated by intralesional laser treatment, cystic lesions are treated by the same laser plus stab incision and drainage of the material. The key point of this treatment philosophy is the avoidance of intralesional or systemic steroids, which has been the main tool for addressing this problem in former decades, and the use of the 808nm diode laser to soften and fluidify the polymers and make them drainable through small skin incisions. The success rate, defined by both patient satisfaction and the disappearance of lumps and skin deformities reached 62% and partial improvement was reported by an additional 30% of the patients. No severe complications occurred in this series. Permanent fillers have been used for decades in cosmetic medicine; over the years none of them has proven to be safe. Fillers injection complications usually appear more than five years after treatment so their use has been severely reduced lately, with an unpopularity that makes them difficult to be sold to patients and authorised by the different regulatory organisations of health products. Regardless of this, patients who were injected with these permanent fillers years ago are still searching for treatments to restore their faces to their previous state. This paper offers a new tool and an interesting algorithm to treat all those difficult cases.

Management of complications caused by permanent fillers in the face: a treatment algorithm.
Cassuto D, Pignatti M, Pacchioni L, et al.
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Eduardo Morera Serna

Hospital Universitario Son Espases, Palma de Mallorca, Spain.

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