NEEDLELESS LIP FILLER PLUS

NEEDLELESS LIP FILLER PLUS

Eleven months after receiving Elevess, the patient is symptom free.Ī 41-year-old Caucasian female with a past history of using Juvederm Ultra Plus on multiple occasions in the nasolabial folds, lips, and infraorbital area (tear trough) without prior adverse events, presented for treatment of her tear trough area. Juvederm Ultra was injected into her upper nasolabial folds bilaterally without incident. She understood the risk of reactivating the reaction. Signs and symptoms subsided 101 days post-Elevess injection.ĭespite the adverse reaction to Elevess, the patient requested to be treated with Juvederm (Allergan, Inc., Irvine, California) several weeks following resolution of her symptoms. With each aspiration/hyaluronidase injection, the patient experienced immediate relief and improvement. Hyaluronidase (100units/cc) was injected into the treatment sites on Days 51, 64, and 78 following aspirations in an effort to break down any filler that might be stimulating the patient's chronically recurring fluctuant nodules. She reported that her swelling and tenderness had diminished except for the right upper nasolabial area. The patient was started on ibuprofen 600mg every eight hours. Intralesional triamcinolone (0.5cc of 5mg/cc) was injected on Day 45. On Day 38, the patient was put on prednisone (20mg twice daily for 7 days), which was rapidly tapered due to intolerance of the medication. Photo taken 32 days after initial Elevess treatment. Patient from Case Report 1 treated with Elevess. The aspirant from Days 37 and 51 post-Elevess were cultured for aerobic and anaerobic bacteria and mycobacterium and was found to be sterile. Each aspiration yielded yellowish, cloudy, odorless, thick, slightly hemorrhagic fluid.

Aspirations were performed four more times on Days 39, 51, 64, and 78 post-Elevess injection to relieve pressure and pain. A second aspiration was performed after the areas refilled within 48 hours. The patient experienced immediate pain relief and flattening of the areas. Two fluctuant nodules were aspirated, yielding over 1cc of yellow, opaque, slightly hemorrhagic fluid from each site. After three days of methylprednisolone, the areas had improved and become notably fluctuant. A methylprednisolone dose pack was also prescribed two days later when the patient complained of increasing swelling ( Figure 2). Because infection was initially suspected as the cause of the inflammation, minocycline was prescribed (50mg twice daily for 10 days). The patient immediately experienced minor swelling appropriate to the procedure, but presented 30 days after the injections with continued swelling, increased firmness over the treatment sites, and a 6mm nodule above the left lip. Graphic timeline of Case Report 1 showing medications, treatments, and procedures provided relative to the initial Elevess treatment. In the authors' experience, anecdotal evidence is surfacing that details adverse events with injectable Elevess including edema, pain, nodules, redness, purpura, and formation of granulomas and purulent exudate. It is indicated for injection for the correction of moderate-to-severe facial wrinkles. It is a cross-linked hyaluronan gel suspended in a buffer solution with 0.3% lidocaine hydrochloride. 5 As new products enter the market, however, adverse reactions may become more common.Įlevess (Anika Therapeutics, Inc., Bedford, Massachusetts), an HA-based injectable filler, was approved by the United States Food and Drug Administration (FDA) in 2006 for cosmetic use. 4 Although rare, hypersensitivity and inflammatory reactions likely due to contamination of byproducts with bacterial fermentation are the most common adverse reactions associated with HA-based fillers. 3 The reports of adverse reactions in the use of PLA-based injectables has declined in recent years due to an increase in physician education and standardized practice. 2 The most serious reactions can be reduced through a greater understanding of the anatomy of the area being treated as well as proper technique employed to avoid blood vessels. 1 Hyaluronic acid (HA)-based injectables as well as polylactic acid (PLA)-based fillers, when injected into the glabella, are reported to have a lower incidence of complications compared to permanent fillers.

Adverse events with these materials are rare. Injectable fillers are commonly used for soft tissue augmentation in areas of collagen loss.

Needleless lip filler