Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery

Abstract

The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.

Asplit‐face, blind, randomized placebo‐controlled clinical trial investigating the efficacy and safety of hyaluronic acid filler for the correction of atrophic facial scars

“…Hyaluronic acid is currently the leading dermal filler type for cosmetic use due to both its efficacy and improved safety (low allergenicity, longevity, and ability to be reversed). Hyaluronic acid filler in previous atrophic scar studies showed high treatment satisfaction with only mild transitory erythema, bruising, and mild to moderate pain during injection 1‐7 . Goodman and Broek published the use of a modified tower technique, creating vertical posts through a retrograde injection bringing the HA up into the superficial dermis with resolution of over 70% of the scars 2 .…”

“…Hyaluronic acid filler in previous atrophic scar studies showed high treatment satisfaction with only mild transitory erythema, bruising, and mild to moderate pain during injection. 1 , 2 , 3 , 4 , 5 , 6 , 7 Goodman and Broek published the use of a modified tower technique, creating vertical posts through a retrograde injection bringing the HA up into the superficial dermis with resolution of over 70% of the scars. 2 This paper also noted the importance of injection of the superficial dermis to create blebs that could then be massaged out, 2 something that should not be done with PMMA.…”

“…Current treatment options for atrophic scarring, include hyaluronic acid (HA) 1 , 2 , 3 , 4 , 5 , 6 , 7 or polymethylmethacrylate (PMMA) fillers, 8 , 9 , 10 chemical peels, 11 ablative or non‐ablative laser treatments, 12 , 13 , 14 , 15 , 16 dermabrasion, 14 punch techniques, 17 microneedling 18 , 19 , 20 , 21 with or without radiofrequency, 22 fractional micro‐plasma radiofrequency, 23 botox, 24 and subcision. 25 , 26 , 27 Most of these treatments have limited efficacy, possible side effects, and prolonged downtime.…”

Is the Treatment of the Tear Trough Deformity with Hyaluronic Acid Injections a Safe Procedure? A Systematic Review

“…The demand for non-surgical procedures to correct blemishes has grown considerably in recent years, and the injection of hyaluronic acid (HA) represents the second most common procedure after the injection of botulinum toxin, with an increase in demand of 60% from 2014 to 2018 [29]. Hyaluronic acid-based treatments offer a valid alternative to some surgical interventions, with immediate results, little or no recovery times, and the possibility to repeat the procedure if needed [30][31][32]. Treatment options for the tear-trough deformity can be surgical [33], alloplastic implant [34], or autologous fat grafting [35].…”

Toxicity Assessment of a Single Dose of Poly(ethylene glycol) Diglycidyl Ether (PEGDE) Administered Subcutaneously in Mice

“…In addition, PEGDE was used as a cross-linker for HA-itaconic acid film which is a bioadhesive matrix used for topical drug delivery in ophthalmology [9]. Further, PEGDE crosslinked HA fillers were utilized for facial rejuvenation and aesthetic enhancement following facial reconstructive surgery [10]. In such cases, PEGDE is used as a cross-linking agent to allow the formation of C-O-C bonds, thus increasing the stability of a hydrogel.…”