Invited Discussion on: Clinical Experience with Treatment of Aquafilling Filler-Associated Complications: A Retrospectiv
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Clinical Experience with Treatment of Aquafilling Filler-Associated Complications: A Retrospective Study of 146 Cases Graeme Southwick OAM1
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Alenka Paddle1
Received: 26 August 2020 / Accepted: 29 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. The demand for non-operative aesthetic procedures is high and has been increasing yearly as reported by ISAPS (1.27 million in Global Survey Results 2018) and ASAPS (3.12 million in the 2019 Aesthetic Plastic Surgery Databank, an increase of 13.3% from 2015). In fact, non-operative aesthetic procedures are much more commonly performed than surgical. For this reason, there is an increasing demand by patients seeking aesthetic services and therefore greater pressure for providers to deliver nonoperative alternatives to surgery. This has resulted in a number of injectables becoming available globally to fulfill these requirements. Unfortunately, development and release of new injectables may not stand the test of time due to an unacceptable side effect profile. The current paper [1] reports a retrospective study of 146 patients describing the clinical features of the complications seen after Aquafilling filler use for large volume augmentation in the breasts and buttocks and their subsequent management. Ninety-three percent of the 146 cases involved the breast alone and 4% the buttock, and on average, complications were seen after a mean of 38.5 months (with a range of 5–144 months) after injection. Aquafilling is one available injectable that has been released in an attempt to mitigate complications seen in its & Graeme Southwick OAM [email protected] 1
Melbourne Institute of Plastic Surgery, 253 Wattletree Rd, Malvern, VIC 3144, Australia
problematic predecessor PAAG fillers (‘‘Interfall,’’ ‘‘Aquamid’’ and ‘‘Amazingel’’), and yet, its composition is very similar leading to comparable safety concerns. This paper provides a strong reminder of the issues at stake when large amounts of injectables are used for aesthetic body contouring. The complications described in the paper add weight to the concern of other international experts including the Korean Academic Society of Aesthetic and Reconstructive Breast Surgeons who urged against the hasty uptake of Aquafilling filler and opposed its use for breast augmentation until sufficient evidence of long-term safety was accumulated and verified [2]. Meanwhile, in 2015 the US Food and Drug Administration disallowed the use of any dermal filler to increase breast size [3]. A key lesson from this paper relates to the fact that the products do not respect anatomic boundaries, permeating into adjacent soft tissues. This is illust
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