Objectives: The authors assessed the deposition pattern of HA in adipose tissue both by ultrasound and histologically, as well as the tissue response at short and intermediate term. The effects of strong finger pressure after injection (as for the purpose of remodelling) on ultrasound results were also compared to the histology.
Introduction: Despite the high numbers of patients are injected worldwide with Hyaluronic acid (HA) fillers, few data are available on filler spread an histologic features after subcutaneous injection. More attention is being given to ultrasound examination, which may be helpful for more targeted injection, avoidance of complications, and detection of filler long after the treatment.
Materials / method: In five candidates for abdominoplasty or breast reduction, two brands of HA were injected subcutaneously in the area of excision 6 to 98 days before surgery. Ultrasound measurements and films with a 12 MHz linear probe were compared to postoperative histologic findings. Tissue response was scored semiquantitatively.
Results: Real-time ultrasound showed a slightly different deposition pattern of the two brands. Histologically, both were present in large pools of the same magnitude and looked the same. Linear retrograde injection sometimes resulted in a globular deposit, due to elastic recoil of septae. After remodeling and over time, HA deposits became difficult if not impossible to detect by 12 MHz ultrasound, whereas the histology showed that firm remodeling of the tissue immediately after injection or time had no significant effect on filler spread or tissue response.
Conclusion: HA deposition in adipose tissue occurs in much larger pools than in the dermis. Reshaping by finger pressure may have less effect than expected. Ultrasound examination with a 12 MHz probe is mostly helpful during and immediately after the injection, less so after filler remodeling, or over time. This effect is worth a verification in studies with the current high frequency probes.
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