UNASSIGNED: Blindness and stroke resulting from hyaluronic acid (HA) fillers are not frequently reported complications. Reports on stroke recovery after HA injection are limited. In the current study, the recovery process, task-based functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and neurophysiological changes of a patient with monocular blindness and ipsilateral motor cortical stroke after forehead injection of HA are explored.
UNASSIGNED: The study comprised a 34-year-old female patient who presented with left eye blindness and a stroke after receiving an HA injection a month before admission. The lesion was mainly limited to the left precentral gyrus, and the patient had pure arm monoparesis. For 3 weeks, the patient received conventional rehabilitation treatments and ten sessions of repetitive transcranial magnetic stimulation (rTMS) intervention. Clinical assessments, neurophysiological evaluation, task-based fMRI, and DTI examinations were conducted to assess her motor improvement and the possible neuro mechanism.
UNASSIGNED: The patient\'s right upper limb motor function was almost completely restored after receiving rehabilitation therapy. However, the vision in her left eye did not show significant improvement. The neurophysiological evaluation showed partial recovery of the ipsilesional motor evoked potentials (MEPs). DTI results showed that the ipsilesional corticospinal tract (CST) was intact. Task-based fMRI results indicated that the activation pattern of the affected hand movement was gradually restored to normal.
UNASSIGNED: A case of good motor recovery after stroke due to HA injection with a lesion mainly restricted to the precentral gyrus but without CST damage is presented in the current study. Further studies should be conducted to explore the efficacy and the mechanisms of rehabilitation and neuromodulation approaches to motor cortical stroke.

Delayed inflammatory reactions (DIRs) associated with hyaluronic acid injections are not rare and can be seen in up to 4.25% of patients. Although the exact mechanism is not clear, several triggering factors, including infections, trauma, and dental procedures, were reported in the literature. A 43-year-old female patient treated with HA fillers developed an inflammatory reaction following vaccination in all areas of injection, including temples, lips, and lower eyelids. Systemic steroid and ciprofloxacin were used as a first-line treatment without response. Colchicine 1 mg/day along with hyaluronidase in lower eyelids improved all lesions successfully.

BACKGROUND: Dermatochalasis of the upper eyelids (blepharochalasis) is a typical age-related change in the upper third of the face and a major concern for facial aesthetics. Nowadays both surgical and nonsurgical interventions are available for patients complaining of upper eyelid dermatochalasis. Although nonsurgical treatments are often easier to perform, if they are not performed correctly, complications may ensue and worsen the condition.
METHODS: We describe the case of a Caucasian patient presenting with bilateral upper eyelid dermatochalasis, previously treated with multiple injections of hyaluronic acid filler. Following these procedures, the patient reported nonspecific eye symptoms (such as a sense of heaviness and asthenopia) and cosmetic concerns. We decided to perform an upper eyelid blepharoplasty. During the procedure we found a ribbon of hard, fibrous material, which was carefully removed. The patient reported resolution of functional eye symptoms owing to the reduction of upper lid heaviness, which also resulted in subjective improvement of the visual field. Patient satisfaction was assessed preoperatively and 3 months postoperatively using the Blepharoplasty Outcomes Evaluation (BOE), which showed an overall satisfaction rate of 95.8 %.
CONCLUSIONS: Blepharoplasty not only treated the patient\'s blepharochalasis but also allowed us to correct the previous nonsurgical intervention by removing the excessive amount of injected hyaluronic acid. Both aesthetic and functional results were successfully achieved.

BACKGROUND: Hyaluronic acid filler reactions have been increasingly observed in recent years. Our study investigates whether the increased number of filler reactions observed since 2014 is associated with a specific histopathologic inflammatory pattern and type of filler.
METHODS: The institution\'s dermatopathology electronic database was retrospectively searched for histopathologic reactions to hyaluronic acid from January 2014 to December 2019. The age, sex, type of filler, procedure, location, and histopathologic patterns were recorded.
RESULTS: From 2014 to 2019, there were 15 cases of granulomatous reactions to hyaluronic acid filler. In 10 of these cases, there was a characteristic inflammatory pattern characterized by tightly cuffed palisades of histiocytes with varying numbers of eosinophils. Of the 11 cases in which the type of filler was known, all used Vycross technology, a novel manufacturing process in the production of hyaluronic acid filler.
CONCLUSIONS: A characteristic histopathologic pattern of discrete foci of tightly cuffed palisaded granulomas with eosinophils is associated with fillers manufactured using Vycross technology.

BACKGROUND: Hyaluronic fillers have been used for filling in folds and contour the face according to global aesthetic standards to achieve a smooth ogee curve on the face. But sometimes these result in a bulkier look to the face thus preventing more people from opting for these procedures. Although M.D codes have now been given to guide the injecting physicians for various points of injections on the face, they need to be used judiciously and tailored to individuals, using the lateral points of the face first.
OBJECTIVE: Patients still come to physicians to get the midface and nasolabial folds corrected but a proper aesthetic evaluation is essential and it was observed that targeting the peripheral points of the face leads to better tightening of the face and a slimmer look for the patient. A case was injected on peripheral points including some newer points not mentioned in the M.D codes. These points are on the forehead along the hairline and the mastoid process. Safety and efficacy of injecting on these particular points were evaluated.
METHODS: 2-ml hyaluronic acid syringes (20 mg conc) were used to give bolus injections on the peripheral points of the face, including a new point on mastoid process and peripheral points on forehead.
RESULTS: A good aesthetic outcome was achieved resulting in slimming of face with patient satisfaction and without any complications.
CONCLUSIONS: A good nonsurgical contouring of a young face can be achieved with 2 ml hyaluronic acid injection when the correct points are injected.

Under eyelid bags and tear troughs are the two most common concerns for the patients coming to an aesthetic center, and specially their correction without undergoing a surgery. Efficacy of hyaluronic acid fillers has been proven successfully in correction of periorbital volume loss but no reports have been published for their role in concealing infraorbital fat pads. Hence, the effectiveness and safety of hyaluronic acid filler in treatment and correction of tear troughs thereby concealing under eyelid bags are being reported in this article. A 43-year-old woman who presented with grade 3 tear troughs and bulged out infraorbital fat pads underwent a single treatment session with 1ml 15mg/mL cross-linked hyaluronic acid filler (Juvederm Volbella®). Assessment of the periorbital area was done immediately after the procedure and after 3 days. Hyaluronic acid filler injection not only showed significant improvement in periorbital hollowness but also concealed the bulge of infraorbital fat pads remarkably. Correction of tear troughs is known to be done with the help of hyaluronic acid but it can also become an excellent alternative to surgery for concealing under eye orbital fat pads without any formation of lumps and irregularity.

Parry-Romberg syndrome is a rare acquired neurocutaneous disorder typically characterized by hemifacial atrophy. Few cases of bilateral facial involvement have been reported. We report a case of a 60-year-old female with a 20-year history of progressive bilateral facial atrophy. Although an initial diagnosis of acquired partial lipodystrophy was considered, a diagnosis of bilateral Parry-Romberg was favored for three main reasons: (a) lipoatrophy was confined to the face (b) imaging findings of enophthalmos and underlying white matter changes (c) laboratories showing absence of C3 nephritic factor and normal complement levels. The patient was treated with hyaluronic acid fillers with dramatic improvement in cosmetic appearance.