An advantage of breast augmentation with injectable fillers is that the desired size can be determined and achieved under local anesthesia with a short recovery time. However, a high complication rate is a critical disadvantage. Some fillers are challenging to remove, resulting in breast deformity and scarring. Five patients who underwent surgery to manage a foreign body in the breasts in 2021 were enrolled in this study. Two had copolyamide filler injections, while the other three had polyacrylamide hydrogel filler injections. A physical examination was performed, and preoperative and intraoperative photographs were obtained. Two patients underwent subcutaneous mastectomy because most of the filler had infiltrated into the normal breast tissue. In contrast, the other patients underwent filler removal and debridement because most of the filler had remained separate from the normal breast tissue. All patients who had a subcutaneous mastectomy and one who underwent only filler removal underwent immediate breast reconstruction with cohesive gel implants. The other patients rejected immediate reconstruction, and only filler removal was performed. All patients recovered without complications. We propose an algorithm for diagnosis and treatment based on our cases, which we hope can help clinicians manage the complications of filler injections for breast augmentation.

Wohlfahrtiimonas chitiniclastica are aerobic, non-motile, gram-negative rods, first described by Toth et al. in 2008. A small number of cases of W. chitiniclastica infections have been reported worldwide. These bacteria are transmitted through fly larvae in open wounds of skin and/or mucosal surfaces on the host. W. chitiniclastica is pathogenic to humans and can cause severe diseases like septicemia and osteomyelitis. Herein, we report the identification of W. chitiniclastica in tissue culture from a severely ill, infected patient without myiasis. Diagnoses of W. chitiniclastica without myiasis are often missed; therefore, careful attention is needed. It is reported that W. chitiniclastica infection responds well to antibiotics and general treatment of open wounds in diabetic feet. Hence, early intravenous antibiotic treatment and adequate surgical management are required for efficient management and also to prevent progression to severe disease.

There is growing interest in minimizing postoperative scarring after a thyroidectomy. Among the many treatment types, laser therapy, especially picosecond-domain laser therapy, is accepted as a standard method. In the present case, a patient with a pigmented, contracted scar was treated using the combination of a picosecond laser and ablative fractional (AF) CO2 laser. After 15 sessions of 1,064-nm picosecond with micro lens array (MLA) and AF CO2 laser application, the patient showed significant improvement in their pigmented lesions and scar contracture with no noticeable side effects for 16 months. These results suggest that a combination of picosecond laser with MLA and AF CO2 laser can treat pigmented, contracted scars safely and effectively.

We report a case of transient unilateral exotropia, a rare complication that occurred after an infraorbital local anesthetic injection, and present the possible mechanism underlying this adverse effect. A 64-year-old man underwent an excisional biopsy under local anesthesia for bilateral lower eyelid masses. He received a subcutaneous injection of a local anesthetic (a combination of 1:100,000 epinephrine and 2% lidocaine). Intraoperatively, we observed a homogeneous, fat-attenuated mass with thin fibrous septae inside the orbital septum of each eye. Following excision of the masses, the patient developed severe diplopia accompanied by exotropia, impaired adduction, and mydriasis of the right eye. The pupillary light reflex, visual acuity, and visual field test results were within normal ranges. Notably, his symptoms completely resolved 4 hours postoperatively without intervention. To our knowledge, transient unilateral exotropia following infraorbital local anesthetic injection is rare. The exotropia was attributed to diffusion of the epinephrine/lidocaine solution, which may have affected the ciliary ganglion and the medial rectus muscle. Caution is warranted during local anesthetic injections in patients who undergo periorbital surgery.