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David Funt,1 Tatjana Pavicic21Mount Sinai Hospital, Department of Plastic Surgery, New York, NY, USA; 2Department of Dermatology and Allergy, Ludwig-Maximilian University of Munich, Munich, GermanyBackground: The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase.Objective: To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance.Methods: Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors' extensive experience, recommendations for avoiding and managing complications are provided.Results: Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique.Conclusion: For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications.Keywords: aesthetic medicine, complications

Background: Radiesse, a widely utilized calcium hydroxylapatite (CaHA) dermal filler, has shown effectiveness in soft tissue augmentation and regeneration. As with all dermal fillers, the potential for nodules may arise. Understanding the pathogenesis of these nodules and exploring effective treatment methodologies are crucial for optimizing patient outcomes., Objectives: A literature search was carried out to identify published literature documenting reversal of CaHA nodules. After identification, a consensus panel developed a structured approach, denoted by levels, for applying such reversal methods., Methods: This concise review presents an algorithmic approach to addressing CaHA focal accumulations (noninflammatory nodules) based on invasiveness, cost, and potential risks based on published literature., Results: Level 0 involves no intervention, relying on natural degradation for asymptomatic nodules. Level 1 interventions utilize mechanical dispersion techniques, including massage and in situ dispersion, which have demonstrated high success rates, cost effectiveness, and minimal invasiveness. Level 2 introduces alternative modalities such as pharmacological treatments with 5-fluorouracil and corticosteroids, lasers, and experimental approaches. Level 3 represents last-resort options, including calcium-chelating agents, manual removal, and surgical excision., Conclusions: The article offers a structured approach to managing CaHA focal accumulations., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society.)

Background: Inadvertent intra-arterial injection of dermal fillers including calcium hydroxylapatite (CaHA) can result in serious adverse events including soft tissue necrosis, permanent scarring, visual impairment, and blindness. When intra-arterial injection occurs, immediate action is required for optimal outcomes, but the infrequency of this event means that many physicians may never have experienced this scenario. The aim of this document is to provide evidence-based and expert opinion recommendations for the recognition and management of vascular compromise following inadvertent injection of CaHA., Methods: An international group of experts with experience in injection of CaHA and management of vascular complications was convened to develop a consensus on the optimal management of vascular compromise following intra-arterial CaHA injection. The consensus members were asked to provide preventative advice for the avoidance of intravascular injection and to produce a treatment protocol for acute and delayed presentation. To ensure all relevant treatment options were included, the recommendations were supplemented with a PubMed search of the literature., Results: For prevention of intra-arterial CaHA injection, consensus members outlined the importance of a thorough knowledge of facial vascular anatomy and patient history, as well as highlighting potential risk zones and optimal injection techniques. Individual sections document how to recognize the symptoms of vascular occlusion leading to vision loss and tissue necrosis as well as detailed treatment protocols for the management of these events. For impending tissue necrosis, recommendations are provided for early and delayed presentations with treatment protocols for acute and follow-up treatment. A separate section details the treatment options for open and closed wounds., Conclusions: All physicians should be prepared for the eventuality of intra-arterial injection of a dermal filler, despite its rarity. These consensus recommendations combine advice from aesthetic experts with the latest reports from the published literature to provide an up-to-date office-based protocol for the prevention and treatment of complications arising from intra-arterial CaHA injection., (© 2020 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals, Inc.)

Background: The ever-expanding range of dermal filler products for aesthetic soft tissue augmentation is of benefit for patients and physicians, but as indications and the number of procedures performed increase, the number of complications will likely also increase., Objective: To describe potential adverse events associated with dermal fillers and to provide structured and clear guidance on their treatment and avoidance., Methods: Reports of dermal filler complications in the medical literature were reviewed and, based on the publications retrieved and the authors' extensive experience, recommendations for avoiding and managing complications are provided., Results: Different dermal fillers have widely varying properties, associated risks, and injection requirements. All dermal fillers have the potential to cause complications. Most are related to volume and technique, though some are associated with the material itself. The majority of adverse reactions are mild and transient, such as bruising and trauma-related edema. Serious adverse events are rare, and most are avoidable with proper planning and technique., Conclusion: For optimum outcomes, aesthetic physicians should have a detailed understanding of facial anatomy; the individual characteristics of available fillers; their indications, contraindications, benefits, and drawbacks; and ways to prevent and avoid potential complications.

Unlabelled: Coronary heart disease is now the leading cause of death in the world and in Poland. Every year, the acute coronary syndromes (ACS) falls over a hundred thousand people, of whom the vast majority are treated invasively. Percutaneous coronary intervention (PCI) carries a possible complication. The possibility of their occurrence is one of the reasons to feel fear and discomfort prior to the study., The Aim of Study: Was to assess of the level of discomfort and anxiety experienced by those undergoing percutaneous coronary intervention., Material and Methods: The study included 100 consecutive patients undergoing percutaneous coronary intervention for ACS or stable angina. The research method used in the survey was a questionnaire form, includes a total of 23 questions. The survey was carried out 24 hours after the execution diagnostic procedure or therapy., Results: PCI was performed significantly more often with radial access--65%, than femoral--35%. People undergo PCI in 77% had knowledge of it. The main source of information was the hospital staff (48%), GPs (20%) and to a lesser extent, the Internet (16%) and friends (12%). To assess the discomfort uses a linear scale of points. Depending on the vascular access was obtained an average of 5.7 points for radial access and 8.8 points for femoral access, corresponding to moderate and very large intensity of discomfort. The degree of discomfort was lower (42%) or compatible (27%) of the representations before the treatments. The intensity of the perceived fear determined the 53% of the very large, and 21% as large. On average, a 10-point scale, respondents have identified him at 7.9 points. Significantly negatively correlated on the level of education (r = -0.421, P < 0.05) and with the degree of knowledge of the declared procedure (r = -0.519, P < 0.01) and positively correlated with the intensity of reported discomfort (r = 0.497 p < 0.05)., Conclusions: Reducing discomfort and anxiety in patients undergoing PCI is very important. This affects the success of the procedure and for appropriate treatment and rehabilitation. Active detection of factors affecting these phenomena and their reduction should be one of the tasks of the personnel involved in the treatment. It is necessary to proper education, including get familiar with the methods of endovascular interventions.