Abstract
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.
Keywords
permanent filler - filler removal - filler complications - facial reconstruction -
aesthetic surgery
