Background Soft tissue filler is commonly used for facial contouring. However, incorrect use can lead to severe ocular complications. Even though filler injections are quite different from fat grafts, they are considered similar procedures. However, to date, there are no proven preventive measures or treatments for blindness secondary to soft tissue filler injections. Objectives This literature review aimed to investigate visual compromise secondary to soft tissue filler injection and discuss the related vascular anatomy, pathophysiology, and prevention of ocular complications of soft tissue filler injections. Methods A literature search until July 2018 was performed for reports on visual compromise after filler injections. We evaluated the previous literature and eliminated cases using fat grafts and unknown fillers. Results A total of 50 reports of filler‐induced visual compromise were identified. Analysis of these cases showed that the procedure with greatest risk was nasal augmentation, followed by glabellar wrinkle treatment. Within the last 3 years searched, 35% of reported cases involved treatment of the nose. There were no reports of blindness from injections into the temple or chin and relatively few case reports involving forehead injections. Conclusion The most common injection site associated with blindness in a previous report was the glabella; however, the most common site currently associated with blindness due to filler injections was the nose. Extreme caution is necessary when performing nasal augmentation or glabellar wrinkle correction using soft tissue fillers to avoid the branches of the internal carotid artery.

BACKGROUND Hyaluronic acid (HA) fillers are the most commonly used fillers for soft-tissue augmentation. The face is a dynamic structure. Facial rejuvenation by filler products depends on mechanical forces on the region of the face. The successful use of injectable HA fillers requires an understanding of the options available. OBJECTIVE The purpose of this study is to measure the rheological properties of HA fillers and to clarify how to select these fillers considering their rheological properties. MATERIALS AND METHODS Rheological characterization was performed on 41 fillers. Physical parameters directly linked to product performance were measured. RESULTS The properties of the HA fillers varied. These findings provide a basis for selection guideline regarding rheological properties in facial rejuvenation. CONCLUSION The authors' report is the largest study to determine the rheological properties of HA fillers to date. Understanding the fillers' properties can help physicians select the appropriate fillers for more predictable and sustainable results.

Double-stranded RNA mediates interferon regulatory factor 3 activation and interleukin-6 production by engaging Toll-like receptor 3 in human brain astrocytes Introduction Toll-like receptors (TLR) play a key role in the innate immune response by recognizing pathogens. They regulate the production of inflammatory mediators and cytokines. 1 SummaryToll-like receptor 3 (TLR3) participates in the innate immune response by recognizing viral pathogens. In this study, human brain astrocytes were found to constitutively express TLR3, and this expression was increased by interferon-c (IFN-c) or double-stranded RNA (dsRNA). Treatment employing dsRNA in astrocytes induced IFN regulatory factor 3 (IRF3) phosphorylation, dimer formation and nuclear translocation followed by STAT1 activation. This treatment also activated nuclear factor-jB, p38 and c-Jun N-terminal kinase significantly, while activating extracellular signal-regulated kinase to a lesser extent. Treatment with anti-TLR3 antibody inhibited dsRNA-mediated interleukin-6 (IL-6) production. In the presence of mitogen-activated protein kinase inhibitors, astrocytes failed to secrete IL-6 in response to dsRNA treatment. Therefore, dsRNAinduced IL-6 production is dependent on mitogen-activated protein kinases and type I IFN production is dependent on IRF3 in brain astrocytes. These results suggest that brain inflammation, which produces inflammatory cytokines and type I IFNs, may enhance TLR3 expression in astrocytes. Additionally, upregulated TLR3 might modulate inflammatory processes by producing proinflammatory cytokines.Keywords: astrocytes; cytokine; interferon-regulatory factor 3; mitogenactivated protein kinase; Toll-like receptor 3Abbreviations: CNS, central nervous system; dsRNA, double-stranded RNA; DMEM, Dulbecco's modified Eagle's minimum essential medium; EDTA, ethylenediaminetetraacetic acid; ELISA, enzyme-linked immunosorbent assay; EMSA, electrophoretic mobility shift assay; ERK, extracellular signal-regulated kinase; FCS, fetal calf serum; IFN, interferon; IgG, immunoglobulin G; IL-6, interleukin-6; IRF3, interferon regulatory factor 3; JNK, c-Jun N-terminal kinase; LPS, lipopolysaccharide; MAL, MyD88-adaptor-like; MAPK, mitogen-activated protein kinase; NF-jB, nuclear factor-jB; PBS, phosphate-buffered saline; PBST, PBS-Tween-20; RT-PCR, reverse transcription-polymerase chain reaction; SDS-PAGE, sodium dodecyl sulphate-polyacrylamide gel electrophoresis; STAT1, signal transducer and activator of transcription 1; TICAM-1, Toll/interleukin-1 receptor-containing adaptor molecule-1; TIRAP, Toll/interleukin-1 receptor domain-containing adaptor protein; TLR, Toll-like receptor; TRIF, Toll/interleukin-1 receptor domain-containing adaptor-inducing interferon-b.

Background Injection of hyaluronic acid filler is a common procedure for nasolabial fold correction. However, it poses a risk of vascular compromise, which can result in skin necrosis and blindness. Objective We aimed to examine the facial arterial pathway in real-time using Doppler ultrasound, to avoid arterial complications during filler injections. Methods Forty patients (80 cases with nasolabial folds; 2 men and 38 women; mean age, 46.5 years (range, 28–72 years)] underwent examination of the facial artery pathway with Doppler ultrasound before hyaluronic acid filler injection. On the basis of the Doppler evaluation results, the filler injection targeted the subdermal, subcutaneous, and deep to submuscular layers by bypassing the facial artery. The efficacy of the filler injection was evaluated for each patient. Results The facial artery was detected lateral to the nasolabial fold in 31% patients, while it was detected at the nasolabial fold in the other cases as follows: subdermal layer in 13% patients, subcutaneous layer in 29% patients, muscular layer in 24% patients, and submuscular layer in 4% patients. The mean Wrinkle Severity Rating Scale score was 3.68 ± 0.76 before injection and 2.28 ± 0.78 3 months after injection. Two patients experienced unilateral bruising of the nasolabial fold, which resolved after 2 weeks without treatment. Conclusions Doppler ultrasound can be considered as pretreatment tool for the prevention of vascular complications during filler injections to correct nasolabial folds.

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