Search

Accidental arterial embolization of hyaluronic acid (HA) fillers can lead to severe complications, including skin ischemia, blindness, and stroke. Currently, the intra-arterial dispersal and fragmentation behavior of HA gels is unknown but critical to our understanding of the pathomechanism of these injuries. This work introduces the Pulsatile Unit for the Laboratory Simulation of Arterio-embolic Restrictions (PULSAR) and evaluates the intravascular behavior of different HA gels. The fragmentation and dispersal behaviors of four HA gels with distinct rheological properties were evaluated via high-resolution videography and ImageJ particle size and morphology analysis. The gels' elastic modulus (G′), loss modulus (G″), tan(δ), and HA concentration were subsequently correlated with their intra-arterial behaviors. This study effectively confirms the extensive fragmentation of HA gels upon arterial inoculation, with particle sizes ranging from <50 µm to >1 mm. Gel particle size and morphology correlated most significantly with tan(δ). Conversely, arterial flow rates did not significantly influence gel fragmentation behavior, though the probability of proximal, macrovascular obstruction was affected. Overall, this study validates the PULSAR model for simulation of arterial dynamics and the testing of intravascular filler kinematics. The findings demonstrate the ability of gels to microfragment and disseminate distally, as well as induce partial proximal occlusion depending on gel rheology and arterial flow parameters. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: The field of aesthetic medicine has expanded substantially in the past decade, with significant practitioner diversification and departure from core-specialty supervision. The increased autonomy of nonphysician practitioners in a rapidly evolving field has raised accentuated the importance of scientific literacy and practice-based learning standards in the delivery of aesthetic medical care. OBJECTIVE: To assess the degree of scientific literacy among aesthetic medicine practitioners of different educational and training backgrounds in the United States and abroad. MATERIALS AND METHODS: A cross-sectional survey of 52 national and international aesthetic medicine practitioners employing a validated, 28-item, scientific literacy tool. RESULTS: The average score for all participants was 76% (SD = 18%, range = 43%–100%). Physician practitioners scored higher in all competencies compared non-physicians (86% vs 68%, p < 0.001), with a greater discrepancy among US practitioners (95% vs 71%, p < 0.001). Competencies relating to identification of bias/confounding variables, graphical data representation, and statistical inference/correlation showed the lowest proficiency. Practitioners with a doctorate or equivalent degree were significantly more likely to report frequent engagement with medical literature than non-physicians (p = 0.02). CONCLUSION: There exists a significant disparity in scientific literacy between physician and nonphysician aesthetic medicine practitioners. This gap underscores the need for enhanced educational programs and continuous professional development to ensure safe and effective patient care in the evolving field of aesthetic medicine. [ABSTRACT FROM AUTHOR]

The article titled "Commentary on 'Histopathologic analysis of hyaluronic acid composite solution following intravascular injection: Variability and safety'" by Zhang et al. provides valuable insights into the behavior of hyaluronic acid fillers when injected intravascularly and the impact of product rheology on the resulting injury. The authors conducted a clinical and histopathological study using a rat model and found that non-crosslinked hyaluronic acid filler dispersed over time without causing ischemic flap injury. This is in contrast to their previous study in 2019, which showed that crosslinked hyaluronic acid gel resulted in prolonged occlusion and ischemic necrosis. The study also analyzed histological photographs to quantify the fragmentation and clearance of the fillers over time. The findings contribute to our understanding of the behavior of hyaluronic acid fillers in arterial networks and the potential risks associated with their use. [Extracted from the article]

The article is a letter to the editor in response to a study on the use of hyaluronidase injection to relieve vascular adverse events (VAEs) caused by non-hyaluronic acid (HA) fillers. The authors of the letter express concerns about the interpretation of the findings in the original study, pointing out assumptions made about the etiology and clinical progression of the diagnosis. They argue that the evidence presented does not sufficiently support the claim of a primary, nonembolic, spastic etiology for VAEs. The authors suggest that further research is needed to clarify the potential role of vasospasm in filler-associated vascular injuries and the effects of hyaluronidase on such etiology. [Extracted from the article]

The commentary discusses a study conducted by Germani et al. on the effects of supramandibular platysmal botulinum injections on the infraorbital region. The authors argue that the study fails to account for measurement error, observer bias, and proper use of parametric testing, which undermines the validity of their findings. They also criticize the authors' methodology, particularly their use of stereophotogrammetry for volume measurements and their analysis of clinical severity. The commentary concludes that while the study is commendable, it does not convincingly support the claim that botulinum injections improve infraorbital hollowing. [Extracted from the article]