Fibrosis: for what reason does it form. Do fillers and threads affect it?

What is fibrosis

Fibrosis is the process of proliferation of connective tissue as a result of an inflammatory process. There are two types of fibrosis:

• controlled, when wound healing occurs after tissue damage and tissue growth helps the skin create the necessary supporting framework;
• uncontrolled when bumps and scars form as a result of infection in the wound. The causes of infection can be either a simple scratch or an incision during surgery.

Photos before and after thread lifting. Photo from the website of D.R. Grishkyan. There are contraindications, specialist consultation is required

Literature

1. Injection methods in cosmetology / ed. B. Asher; lane from English; Ed. N.P. Mikhailova - M: MEDpress-inform, 2016. - 584 p.
2. Ilsheva T.V. Complications of injection methods of correction in aesthetic medicine // Metamorphoses. – 2013. – No. 2. – P. 48–52.
3. Ozerskaya O.S. Skin scars and their dermatocosmetological correction. – St. Petersburg: OJSC “Art of Russia”, 2007. – 224 p.
4. Butov S.N., Akhtyamov Yu.S. Practical dermatocosmetology. - M.: Medicine, 2003. - 397 p.
5. Privalova E.G., Gubanova E.I., Vasiliev A.Yu., Davydov D.V. The role of high-resolution ultrasound in the diagnosis of complications of facial contouring // Metamorphoses. - 2022. - No. 17.
6. Karpyuk V.B. The state of nitrooxydergic vasorelaxation in subarachnoid hemorrhage (clinical and pathogenetic aspects of cerebral vasospasm): abstract. dis. ...cand. honey. Sci. – M., 2001. – 29 p.
7. Bondarenko I.N. Clinical, pathogenetic and prognostic significance of nitric oxide in leptospirosis: dis. ...cand. honey. Sci. – Krasnodar, 2008. – 129 p.
8. Karpova E.I. Compression-ischemic syndrome in the practice of a cosmetologist // Metamorphoses. -2014. - No. 5 - P. 54-58.
9. Mingazova L.R., Karpova E.I., Orlova O.R., Kotenko K.V., Kruglova L.S. Complications in the form of neuropathic disorders in the facial area after contour injection plastic surgery // Russian Journal of Skin and Venereal Diseases. – 2014. – No. 3 – P. 52-55.
10. Korenevskaya I.Ya., Shirshakova M.A. Where do the Fillers go? Visual diagnostics of tissue fillers // Metamorphoses. - 2017. - No. 17.

Formation of fibrosis after threads

After thread lifting, scar tissue forms in the tissues - this is a normal process, as a result of which collagen is released and a supporting frame is formed. But sometimes, instead of the planned result, collagen can grow around the thread in separate fibers, which leads to solid fibrous cords. This appears at 3-4 weeks. Once they are detected, it is necessary to begin immediate treatment, which will be selected by your doctor.

“Threads promote fibrosis!” Is this so?Clinic of Plastic Surgery Grishkyan David RubenovichJune 4

Goal and tasks

Purpose of the study: to develop an algorithm for diagnosing and treating undesirable consequences of facial contouring using gels based on hyaluronic acid.

Tasks:

• introduce ultrasound diagnostics (USD) of complications of contour plastic surgery into the practice of a cosmetologist;
• find ultrasound signs (US signs) characteristic for the differential diagnosis of various pathological conditions;
• find an alternative way to correct complications of contouring;
• increase the accuracy of drug administration directly into the filler area;
• minimize the risks of allergic and inflammatory reactions when treating undesirable consequences of contouring;
• ensure a painless procedure for correcting undesirable results of contouring;

Reasons for the formation of uncontrolled fibrosis:

1. Medical error or poor quality material. This consequence can be eliminated by removing the thread.

2. Wound infection during the rehabilitation period. In this case, antibacterial drugs prescribed by the doctor will help.

3. Formation of hematomas. In this case, the doctor pumps out excess accumulated fluid with a syringe.

Photos before and after thread lifting. Photo from the website of D.R. Grishkyan. There are contraindications, specialist consultation is required

Immediate complications of lip contouring

Erythema

Erythema may persist for 1–2 hours depending on the product injected, the depth of injection, and the patient's response to the procedure. The patient can hide the redness after the injection site has healed using makeup.

Edema

Swelling may persist for 2–12 hours depending on the filler injected and its amount. Hyaluronic acid fillers lead to more pronounced swelling of the lips, which is due to the ability of HA to bind water. To reduce swelling, patients may use cold compresses after the procedure.

Why does fibrosis form after fillers?

After injections, compactions are observed in the first days. This is because the drug has not yet been distributed. But, if the lump appears in the form of a lump and lasts for more than a week, then you need to contact your surgeon.

Causes of fibrosis:

• rejection of a foreign substance.
• vascular damage;
• incorrect technique for administering the drug;
• violation of sanitary standards, etc.

Photos before and after thread lifting.
Photo from the website of D.R. Grishkyan. There are contraindications, specialist consultation is required. You can see more before and after photos in the photo gallery

Fibrosis after fillers: what is the danger? David Rubenovich Grishkyan Plastic Surgery Clinic May 8

Tissue fibrosis after hyaluronic acid - how to cope with the complication?

Paracelsus once noted that everything is poison and everything is medicine, the only difference is the dose. This statement is equally true for drugs from the pharmaceutical industry intended to treat diseases, and for products used in modern aesthetic cosmetology.

Fibrosis after hyaluronic acid (HA) is tissue scarring in the injection area, which becomes noticeable after 3-4 weeks. Such a process can be both an expected effect from the introduction of fillers, and a serious aesthetic complication of the procedure: it all depends on how active it is and how noticeable it is from the outside. What are the reasons for this reaction of our body to “beauty injections” and is it dangerous? Is it possible to do without treatment and what to do to avoid this phenomenon at all? All answers are in the TecRussia.ru review:

↑ What is fibrosis and why does it occur?

In simple terms, we are talking about the active growth of connective tissue. In fact, this is a scar, but in our case it appears not at the site of mechanical damage, but in those areas where the injected hyaluronic acid stimulates the growth of collagen and elastin fibers. In moderation, these fibers thicken the skin and increase its ability to resist gravitational ptosis (sinking of the oval under the influence of gravity). In excess, they lead to the formation of fibrous nodules, most often this happens for one of two reasons:

• An individual characteristic of the body is a tendency to form hypertrophic and keloid scars. If it is present, it is undesirable to carry out contour plastic surgery.
• Inflammation in the injection area. In this case, the immune system tries to isolate the lesion from the surrounding healthy area and from the entire body as a whole through the growth of new connective tissue, which forms a kind of protective capsule.

The most common causes of inflammatory processes include:

• penetration into wounds from injections of microbes and fungi;
• the body’s reaction to the excipients in the filler – preservatives, components used to crosslink hyaluronic acid molecules with each other, etc.;
• tissue damage during the procedure when introducing an excess volume of gel and other technical defects in performing injections.

Another reason for the development of fibrous nodules can be damage to the skin and underlying tissues from needles: in rare cases, such microtraumas, in combination with the stimulating effect of sodium hyaluronate, also provoke increased scarring.

↑ What could be the consequences?

This is not dangerous for health, but it does not have the best effect on appearance:

• In the simplest cases, fibrous formations under the skin (lumps or bumps) will only be slightly palpable during an examination or cosmetic procedure.
• In more complex cases, obvious protrusions are formed, which are clearly visible from the outside and cannot be masked with the help of foundation.
• Usually, even fairly large lumps persist for a month or two and gradually dissolve. If this does not happen, you will have to get used to them, or remove them using physical procedures, injections, or even surgery.

↑ Characteristic signs and symptoms

Post-injection fibrosis is a fairly dense nodule that is not inflamed, painless on palpation and does not shift when pressed. It can form on a wide variety of areas of the face - and it does not matter whether the filler was injected there or migrated as a result of massage and contraction of facial muscles.

• Lumps and lumps after fillers: why do they appear and what should be the treatment?

Most often, the problem occurs on the lips and in adjacent tissues, along the lower jaw and nasolabial folds, and less often in the area of ​​the cheeks and forehead. Unpleasant formations can be easily palpated, but whether they will be noticeable visually largely depends on the shape and intensity of the pathology:

• mesh, in which small scar areas are evenly distributed in the tissues;
• small-focal: several larger formations are determined at the site of filler injection or migration;
• nodular, when fibrosis occupies a very significant area - most of the cheek, lip or other anatomical area.

The first signs of a problem do not appear immediately after injections: it takes at least 2-3 weeks to activate cell division and fiber production. If the symptoms described above appeared in the first days after the procedure, most likely these are simply accumulations of a dense gel that was not injected deeply enough. But redness of the skin over them, an increase in local temperature, and pain are more serious signs of tissue infection or the development of a filler rejection reaction, for which you should urgently seek medical help.

↑ Can fibrosis go away on its own and what should be the treatment?

It is almost impossible to give a reliable general prognosis without examining a specific patient and knowing the details of a previously performed procedure. In most cases, no specific therapy is required, and nodules and bumps resolve without residue several months after their appearance. But there is also a less favorable option - the lump grows quickly, then over the course of several months its size stabilizes and then no positive changes occur without treatment.

Therefore, if nodules appear in the area where the gel was injected several weeks or months after the injections, you should definitely consult a doctor (preferably the cosmetologist who performed the initial contouring procedure). It is not always possible to determine the type and causes of the appearance of such a formation only by touch, therefore, in addition to an in-person examination, an ultrasound may be needed. Depending on the data obtained, as well as the severity of the process, its prevalence and growth rate, the doctor’s tactics may be as follows:

• if it turns out that the compaction is caused by a simple accumulation of gel in the depths of the tissues, a special massage is prescribed for a more even distribution of the filler or hyaluronidase is administered for its accelerated resorption;
• if these are still fibrous formations, but small in size and without a tendency to rapid growth, the patient is left under observation in order to determine the nature of local changes and choose the most appropriate treatment tactics if necessary;
• if it is obvious that “it will not heal on its own”, excess hyaluronic acid is quickly removed from the body in order to reduce their stimulating effect on the growth of connective tissue fibers and/or the administration of drugs to resolve the formed subcutaneous scar begins.

↑ What is done when it is necessary to remove fillers from tissues

The shorter the duration of action of the injected gel, the lower the risk of formation and enlargement of fibrosis. There are two ways to speed up the destruction and resorption of hyaluronic acid-based preparations:

• introduction of hyaluronidase (a special enzyme that destroys HA) - by injection or by electrophoresis;
• performing physiotherapeutic and thermal procedures that locally accelerate metabolism in tissues.

The use of hyaluronidase gives a quick effect: within a couple of days it breaks down all excess HA. With a clearly localized location of the gel, injections are the best option, and in the case of migration of tissue fillers, electrophoresis is indicated, with the help of which the active substance can be evenly distributed over a larger area.

• How to remove hyaluronic acid from lips?
• Return to how it was: remove fillers with Lidaza

Physiotherapy and thermal effects - such as darsonvalization or microcurrent therapy - do not give such quick results. However, they are much safer for people with concomitant pathologies, for example, with a tendency to allergies.

↑ Preparations for resorption of fibrosis

There are two main options - the same hyaluronidase (Lidase is usually used) and glucocorticosteroid hormones (the most popular drug of this type in cosmetology is Diprospan). The first remedy acts more gently, but the result is less pronounced. Many doctors do not like steroids because of a common complication from their administration: if the dose is calculated incorrectly, there is a possibility that instead of compactions, sunken areas will form in the tissues.

• Possible complications after contouring and ways to correct them

The overall effectiveness of both drugs is largely determined by the timing of the start of treatment - the sooner, the better. 8-12 months after the onset of fibrosis, the result of their use may be zero.

↑ In what cases is surgery needed?

Localized areas of fibrosis, clearly demarcated from unchanged tissue, can be removed surgically. This is a radical method, which is indicated only for large scar formations that significantly deform the patient’s appearance and cannot be corrected by other means. This usually happens due to serious complications of an infectious nature, which are practically excluded when performing contour plastic surgery in a beauty salon or clinic.

Typically, such seals can be removed through incisions made on the side of the mouth. This allows you to avoid any marks on the face, but does not guarantee that new dense scars will not form inside (especially if the patient is predisposed to keloids).

↑ Is there reliable prevention?

The growth of connective tissue is caused not only and not so much by hyaluronic acid, but by impurities contained in the gel, infection of wounds, defects in injection technique, as well as the individual characteristics of the patient’s body. In this regard , the risk of developing fibrosis can be significantly reduced if you follow the following recommendations:

• choose a highly qualified specialist with specialized education and extensive work experience;
• do not hide from your doctor existing diseases and other conditions that may be a contraindication to contour plastic surgery;
• Discuss in advance with your cosmetologist possible complications and ways to eliminate them: a doctor who is prepared for an emergency situation will not avoid this conversation and hush up obvious things;
• Make sure that the package of the drug is opened in front of you, immediately before administration. Make sure that the expiration date has not expired;
• Follow the rules of preparation for the procedure and recommendations for facial care after its completion.

It would seem that everything is simple. However, the desire to save money often takes precedence over common sense and we agree to do injections “at home”, we decide to introduce unknown, “but also good” drugs, so as not to “pay for the brand name”. The result: the patient often does not remember what was injected or how it was done, while the “specialist” who performed the procedure does not answer calls and messages. And eliminating the consequences of such savings is always more difficult than preventing their occurrence.

Technique for increasing lip volume

How does the procedure for correcting the shape and volume of lips work in practice? Contour plastic surgery is carried out by injecting hyaluronic acid at the tip of a needle, takes no more than half an hour, and the result is obvious after two days. Taking into account the threshold of pain sensitivity, an anesthetic cream is used, applied to previously cleansed and disinfected skin.

The injection technique is determined by the planned result after lip augmentation and the age of the patient. The filler is injected under the skin, causing tissue swelling. At the same time, the cosmetologist performs a massage, which makes it possible to evenly distribute the filler in the tissues. After the procedure, the injected surface is prophylactically protected with an antiseptic from the possible addition of a secondary infection. The success of hyaluronic plastic surgery depends on the doctor’s ability to maintain a balance between filling the lip contour and symmetry of distribution.

Recently, the “Parisian” technique has become popular. Its fundamental difference lies in the vertical introduction of filler, which gives the lips a natural appearance, preserving their natural relief. The undoubted advantage of the technique is the speed of implementation (10 - 15 minutes) and the fact that the result is easily corrected. After lip augmentation, the original shape is returned within a day.

The optimal result is achieved by observing a sense of proportion, that is, the ability to stop in time. Correct correction visually rejuvenates patients and makes them more attractive. Lips pumped with hyaluronic acid cause a smile or bewilderment.