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The role of permanent fillers in aesthetic facial augmentation remains controversial. While some patients experience good long-term results, others can develop complications such as hard nodules, undesired overfilling, irregularities and even inflammatory reactions. While more commonly used temporary injectable fillers can also experience these same issues, they are more easily reversed either by secondary injection therapies or with more time by their inevitable absorption.

The needed removal of permanent facial fillers almost always has to be a surgical one. While steroid and 5-FU injections may be helpful int reducing symptoms from the permanent material, they do not have a removal effect. Surgical removal poses issues of creating visible scars to do so and must be considered carefully.

In the May 2019 issue of Aesthetic Surgery Journal an article was published entitled ‘Surgical Lip Remodeling After Injection of Permanent Filler’. Over a six (6) year period the author describes his surgical experience in treating the adverse effects of permanent filler injections by open excision. In thirty-eight (38) patients or almost seventy (70) lips, no infections were seen. Complications included wound dehiscence (1.5%), hematoma (1.5%) and the need for a secondary touchup later. (3%) Softening of the lip took an average of four (4) months while return of natural lip movement took longer at six (6) to nine (9) months after surgery. Complete removal of all permanent filler was not achievable in every patient.

If severe enough, the open excision of permanent filler materials may be indicated. While incisional placement can be problematic for some facial areas fortunately in then lips more favorable areas are available. Either placement at the horizontal vermilion-cutaneous junction or wet-dry mucosal junction or through smaller vertical dry vermilion lines can be used. All of these areas heal fairly well and adverse scarring is not usually a problem. This article highlights two important points for patients considering this type of excisional lip procedure….1) all filler material may not be able to be removed and 2) cutting through and around the orbiculares muscle will cause some temporary lip movement or sensory loss that will take considerable time to fully resolve.

Dr. Barry Eppley

Indianapolis, Indiana

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