背景:已经广泛研究了临时和永久性填料的并发症。然而,缺乏关于聚-L-乳酸(PLLA)的比较数据,钙羟基磷灰石(CaHA),和聚己内酯(PCL)被称为胶原生物刺激剂。
目的:本研究讨论了胶原生物刺激剂的诊断并发症,产品类型,治疗,和监测。
方法:向巴西皮肤超声专家发送电子问卷,以确定与生物刺激器相关的并发症。生物刺激器的类型,申请地点,注射的小瓶数量,申请计划,注射治疗和并发症之间的时间,喷油器轮廓,治疗,并评估预后。
结果:确定了55例,其中49.1%由PLLA-Elleva®引起,23.6%的CaHA(单独或与透明质酸组合),20.0%由PLLA-Sculptra®,PCL为7.3%。受影响最大的部位是面部(72.7%),结节是最常见的临床形式(89.1%),一般发生晚(60.0%)(>1个月)。只有一例在不正确的深度(肌膜神经系统-SMAS)注射。尽管有几次治疗,包括生理盐水(45.5%),透明质酸酶(25.5%),稀释的皮质类固醇(23.6%),和基于能源的设备(10.9%),只有五个案例显示完全解决。当羟基磷灰石钙与透明质酸存在关联时,透明质酸酶在与填充剂相关的并发症中是有益的(p<0.01)。
结论:胶原生物刺激剂引起的并发症在面部更为常见,通常表现在治疗后约1个月。这些问题似乎更多地与产品的性能有关,而不是技术不足。此外,透明质酸酶仅在与HA相关的情况下显示出功效。
BACKGROUND: Complications of temporary and permanent fillers have been extensively studied. However, there is a lack of comparative data regarding poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and polycaprolactone (PCL) known as collagen biostimulators.
OBJECTIVE: This study addressed the complications of collagen biostimulators concerning their diagnosis, type of product, treatment, and monitoring.
METHODS: An electronic questionnaire was sent to Brazilian dermatologic ultrasound experts to identify complications related to biostimulators. The type of biostimulator, location of application, number of vials injected, application plan, time between injection treatment and complication, injector profile, treatment, and prognosis were assessed.
RESULTS: Fifty-five cases were identified, of which 49.1% were caused by PLLA-Elleva®, 23.6% by CaHA (alone or combined with hyaluronic acid), 20.0% by PLLA-Sculptra®, and 7.3% by PCL. The most affected area was the face (72.7%), with
nodules being the most common clinical form (89.1%), generally occurring late (60.0%) (>1 month). Only one case was injected at an incorrect depth (musculoaponeurotic system-SMAS). Despite several treatments, including saline (45.5%), hyaluronidase (25.5%), diluted corticosteroids (23.6%), and energy-based devices (10.9%), only five cases showed complete resolution. Hyaluronidase was beneficial in complications related to fillers when there was an association of calcium hydroxyapatite with hyaluronic acid (p < 0.01).
CONCLUSIONS: Complications from collagen biostimulators were more common on the face, typically manifesting about 1 month after treatment. These issues seemed to be related more to the properties of the products rather than inadequate technique. Furthermore, hyaluronidase demonstrated efficacy only in cases where there was an association with HA.