Абстракт

Objectives: ● To review the clinical presentation and classification of fibrosis following EBD treatments. ● To discuss the proposed mechanisms underlying fibrosis formation after thermal and non-thermal energy delivery. ● To present a practical assessment framework for differentiating fibrosis phenotypes. ● To introduce a stepwise treatment algorithm based on severity, chronicity, and clinical presentation. ● To share clinical insights and outcomes derived from real-world adverse event management. Introduction: Fibrosis is an uncommon but clinically significant adverse event following energy-based device (EBD) treatments. Although most cases improve spontaneously over time, persistent fibrosis may result in contour irregularities, tissue tethering, pain, functional limitations, and patient dissatisfaction. Current literature offers limited guidance regarding standardized assessment and management. This presentation summarizes a practical treatment algorithm developed through extensive clinical experience managing EBD-related adverse events across a broad range of technologies. Materials / method: This work represents a retrospective synthesis of clinical experience accumulated through the evaluation and management of fibrosis-related adverse events following energy-based procedures. Cases were reviewed over multiple years in the context of an international adverse event consultation service and through collaboration with experienced physicians from multiple specialties. Observations included fibrosis following radiofrequency, plasma, laser, ultrasound, and combined-energy treatments. Management strategies were analyzed based on clinical response and practical applicability. Results: Fibrosis presentations were found to vary considerably in severity, depth, chronicity, and associated symptoms. Successful management required accurate identification of fibrosis subtype and stage. Mild and early fibrosis often responded to conservative measures including observation, massage, physical therapy, and adjunctive energy-based treatments. More established fibrosis frequently benefited from combination approaches incorporating subcision, corticosteroids, enzymatic therapies, regenerative treatments, and targeted energy delivery. Conclusion: Fibrosis following energy-based treatments represents a heterogeneous condition that requires individualized management. A structured assessment strategy allows clinicians to identify fibrosis patterns and select appropriate interventions based on disease stage and severity. The proposed algorithm offers a practical framework derived from extensive real-world experience and may help improve consistency in the management of this challenging complication. Further prospective studies are needed to validate treatment pathways and establish evidence-based guidelines.