Complications of collagen biostimulators in Brazil: Description of products, treatments, and evolution of 55 cases

Background Complications of temporary and permanent fillers have been extensively studied. However, there is a lack of comparative data regarding poly‐L‐lactic acid (PLLA), calcium hydroxyapatite (CaHA), and polycaprolactone (PCL) known as collagen biostimulators. Aims This study addressed the compl...

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Bibliographic Details
Published in:	Journal of cosmetic dermatology Vol. 23; no. 9; pp. 2829 - 2835
Main Authors:	Ianhez, Mayra, Goés e Silva Freire, Giselle, Sigrist, Rosa Maria Silveira, Colpas, Paula Tavares, Faria, Isabella Alves, Parada, Meire Odete Américo Brasil, Miot, Hélio Amante
Format:	Journal Article
Language:	English
Published:	England 01-09-2024
Subjects:	Adult Brazil calcium hydroxyapatite Collagen - administration & dosage Collagen - adverse effects complications Cosmetic Techniques - adverse effects dermal fillers Dermal Fillers - administration & dosage Dermal Fillers - adverse effects Durapatite - administration & dosage Durapatite - adverse effects Female Humans Hyaluronic Acid - administration & dosage Hyaluronic Acid - adverse effects Male Middle Aged nodules Polyesters - administration & dosage Polyesters - adverse effects poly‐L‐lactic acid Skin Aging - drug effects Surveys and Questionnaires - statistics & numerical data Brazil complications calcium hydroxyapatite nodules poly‐L‐lactic acid dermal fillers
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Summary:	Background Complications of temporary and permanent fillers have been extensively studied. However, there is a lack of comparative data regarding poly‐L‐lactic acid (PLLA), calcium hydroxyapatite (CaHA), and polycaprolactone (PCL) known as collagen biostimulators. Aims This study addressed the complications of collagen biostimulators concerning their diagnosis, type of product, treatment, and monitoring. Patients/Methods An electronic questionnaire was sent to Brazilian dermatologic ultrasound experts to identify complications related to biostimulators. The type of biostimulator, location of application, number of vials injected, application plan, time between injection treatment and complication, injector profile, treatment, and prognosis were assessed. Results Fifty‐five cases were identified, of which 49.1% were caused by PLLA‐Elleva®, 23.6% by CaHA (alone or combined with hyaluronic acid), 20.0% by PLLA‐Sculptra®, and 7.3% by PCL. The most affected area was the face (72.7%), with nodules being the most common clinical form (89.1%), generally occurring late (60.0%) (>1 month). Only one case was injected at an incorrect depth (musculoaponeurotic system—SMAS). Despite several treatments, including saline (45.5%), hyaluronidase (25.5%), diluted corticosteroids (23.6%), and energy‐based devices (10.9%), only five cases showed complete resolution. Hyaluronidase was beneficial in complications related to fillers when there was an association of calcium hydroxyapatite with hyaluronic acid (p < 0.01). Conclusions Complications from collagen biostimulators were more common on the face, typically manifesting about 1 month after treatment. These issues seemed to be related more to the properties of the products rather than inadequate technique. Furthermore, hyaluronidase demonstrated efficacy only in cases where there was an association with HA.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1473-2130 1473-2165 1473-2165
DOI:	10.1111/jocd.16343