Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Roma, Lazio, Italy.
Department of Maxillo Facial Surgery, University of Rome La Sapienza, Rome, Lazio, Italy.
Facial Plast Surg. 2024 Feb;40(1):19-30. doi: 10.1055/a-2019-5131. Epub 2023 Jan 25.
Although permanent fillers have been introduced in order to get long-lasting results, many studies have shown numerous severe and disfiguring complications. Nonsurgical procedures may mitigate those adverse events but the only way to remove the filler previously injected is represented by surgical excision. We present a pathway of facial surgical accesses to be performed achieving two goals: permanent filler removal and restore facial aesthetic balance. The proposed surgical accesses are already standardized in aesthetic surgical practice in order to avoid direct excision and unpleasant facial scar. A total of 231 patients underwent surgery for permanent filler removal and aesthetic restoration of the involved facial area, represented by forehead, glabella, nose, cheeks, eyelids, chin, jawline, and lips. Magnetic resonance evaluation was performed with the exception of lip patients who were evaluated with ultrasound. Postoperative follow-up was 12 months to 6 years. Subjective and objective methods were used for outcome evaluation according to the FACE-Q questionnaire. Functional and aesthetic correction was scored using the patient-graded Global Aesthetic Improvement Scale (GAIS), overall patient satisfaction was assessed by a five-point scale questionnaire. Functional and aesthetic restoration was globally recognized as improved according to the GAIS. Patients reported high levels of satisfaction assessed by a five-point scale questionnaire. A very good satisfaction level was registered in both subjective and objective judgment scores. To the best of our knowledge, we present the largest case series regarding surgical removal of permanent facial fillers. A proper preoperative evaluation, filler removal followed by restorative facial aesthetic surgery technique is paramount to approach challenging cases.
尽管已经引入了永久性填充物以获得持久的效果，但许多研究表明存在许多严重和毁容的并发症。非手术程序可能会减轻这些不良事件，但去除先前注射的填充物的唯一方法是手术切除。我们提出了一种面部手术入路的途径，以实现两个目标：永久性填充物去除和恢复面部美学平衡。所提出的手术入路已经在美容外科实践中标准化，以避免直接切除和不美观的面部疤痕。共有 231 名患者接受了手术，以去除永久性填充物并修复受影响的面部区域的美学，包括额头、眉间、鼻子、脸颊、眼睑、下巴、下颌线和嘴唇。除了唇部患者，他们接受了超声评估外，所有患者均进行了磁共振评估。术后随访时间为 12 个月至 6 年。根据 FACE-Q 问卷，采用主观和客观方法进行结果评估。采用患者分级整体美学改善量表（GAIS）对功能和美学矫正进行评分，采用 5 分制问卷评估整体患者满意度。根据 GAIS，功能和美学恢复被普遍认为得到了改善。患者通过 5 分制问卷报告了高水平的满意度。主观和客观判断评分均记录了非常满意的水平。据我们所知，这是关于手术去除永久性面部填充物的最大病例系列。适当的术前评估、填充物去除后再进行修复性面部美学手术技术对于处理具有挑战性的病例至关重要。
