Complications following silicone injections for augmentation of the contours of the face

We report 5 patients who have had severe inflammatory reactions following the injection of liquid silicone for augmentation of the facial contour. We offer an approach to the treatment of this complication which, although not resulting in complete resolution, has at least markedly ameliorated these patients' signs and symptoms.     

Acquired strabismus following cosmetic blepharoplasty

The purpose of this study was to report on 12 patients with acquired strabismus following cosmetic blepharoplasty and to identify patterns of strabismus related to the surgical procedure. Clinical ophthalmologic examinations were performed to specifically clarify the type of strabismus. Operative reports of the blepharoplasty procedures were reviewed. Patients were followed for a minimum of 3 months after the blepharoplasty procedure before surgical intervention was considered. Operative findings at corrective strabismus surgery were noted and an attempt was made to correlate these findings with the clinical ophthalmologic examination and the blepharoplasty surgical procedure. Twelve cases of persistent vertical strabismus occurred following blepharoplasty procedures. Five patients had clinical findings consistent with the diagnosis of acquired superior oblique palsy; one of these five patients also showed signs of an acquired Brown syndrome. Seven patients developed an incomitant vertical deviation consistent with an inferior rectus paresis. Strabismus occurred after conventional lower lid, upper lid, and four-lid blepharoplasty with or without laser blepharoplasty. Acquired strabismus accompanied by persistent diplopia may occur as a complication of cosmetic blepharoplasty. Extraocular muscle damage resulting in either superior oblique muscle palsy or inferior rectus paresis was noted in these patients. In some cases, patients with inferior rectus paresis also showed mechanical restriction to upward rotation of the globe.     

Infection of proplast malar implants following dental injections.

Two cases of late infections of malar implants are reported following dental work. Inadvertent inoculation of the implants by mouth organisms during injections for local dental anesthesia is implicated as the causative factor. Patients should warn their dentists that a malar alloplast has been inserted. Alternative techniques of maxillary dental anesthesia should be entertained, and antibiotic prophylaxis should be considered.     

Human antibody response following multiple injections of bovine collagen

The enzyme-linked immunosorbent assay (ELISA) was selected to further characterize the human antibody response to Zyderm (ZCI). Our studies have involved both patients and volunteers. Five patients with delayed cutaneous hypersensitivity reactions to Zyderm were positive for anti-Zyderm antibody. Six of nine patients treated with Zyderm who never displayed cutaneous reactions did develop significant levels of anti-Zyderm serum antibody. Some of these patients progressively increased their antibody levels. None of the volunteers who received multiple skin-test doses (0.1 cc) of Zyderm developed significant levels of anti-Zyderm antibody. Polyvalent anti-Zyderm antibody titers among patients with positive ELISA absorbance ranged from 1:16 to greater than 1:128. All were positive for antibodies of the IgG subtype; half were positive for the IgA subtype. None was positive for IgM or IgE subtype. We did not observe cross-reactivity between patient anti-bovine collagen sera and commercially prepared antibodies to human anti-collagen types I, II, and III. Given the frequency of current Zyderm use, it seems evident that for most patients, biologic exposure to collagen does not pose a health hazard. Nevertheless, because of the scarcity of data pertaining to the long-term significance of humoral anti-Zyderm antibodies, physicians and patients should be aware that unanswered questions remain whenever clinical use of injectable collagen is recommended.     

Unsatisfactory forehead scar following face lift

The W-plasty scar revision technique has been found to be effective in the repair of the difficult and cosmetically unsatisfactory hairline scar following the ill-advised face lift technique that excises forehead skin.