#315 National Season ##315晚会: Cosmetic Needles or Disfiguring ## Medical Beauty ## Beauty ## Plastic Surgery ##注射美容 #
CCTV 315 Gala once again exposed complaints in the medical beauty industry, non-injectable beauty needles, cosmetic needles or disfigurement.
In the face of the widely sought after and rising medical beauty industry that is constantly heating up, but there is frequent chaos behind it, have you practiced medical beauty if you love beauty?
What should I be extra careful about?
How can adverse events and complications in medical aesthetic microsurgery be avoided?
The team of Wang Xiaojun, director of the Department of Plastic and Aesthetic Surgery of Peking Union Medical College Hospital, has published a monograph on medical aesthetic surgery and related complications, and now shares the following:
With the development of the mainland economy and the improvement of people's living standards, the medical cosmetology industry is becoming more and more popular, and medical cosmetology has become one of the fastest growing disciplines in contemporary medicine. People seek medical beauty for the pursuit of aesthetic appearance, but at the same time, the potential risk of complications can also pose a certain harm to health. This article summarizes the complications related to medical aesthetic surgery in order to bring cautionary attention to clinical diagnosis and treatment.
Do you know about medical cosmetology?
Medical cosmetology aims to maintain, modify and reshape the appearance of human beauty through medical means, which can be roughly subdivided into cosmetic surgery, cosmetic dermatology, cosmetic dentistry and aesthetic Chinese medicine.
Among them, cosmetic surgery is the main body, which includes minimally invasive treatment such as photoelectric therapy, injection, thread technology, and the use of plastic surgery to reshape the facial features and various parts of the body.
While medical aesthetic-related procedures and surgeries are generally considered low-risk treatments, there is still a risk of complications, some of which can even pose a life-threatening risk to the patient. With the rapid development of the medical beauty industry, the incidence of complications is also increasing.
What are the complications of "microsurgery"?
Phototherapy, injection and thread technology and other medical cosmetology methods commonly known as "micro-plastic surgery", because of its simple operation, significant effect, and has the advantages of small trauma, fast recovery and low risk, has become the main way of medical cosmetology.
According to the statistics of the United States in 2012, the number of minimally invasive medical cosmetology consumers accounted for 89.3% of all medical cosmetology consumers, of which 86% were injectable cosmetology. Although minimally invasive medical cosmetology is safe and reliable, complications are also coexisting and need to be paid full clinical attention.
1 Optotherapy
Laser, radiofrequency, plasma, etc. are currently widely used in clinical practice medical beauty photoelectric treatment, through high energy to change the collagen fiber and elastic fiber molecular structure of the dermis layer of the skin, promote collagen and elastin proliferation, or block the blood vessels in the lesion site, wrinkles, stains, acne, telangiectasia, scars, skin laxity, hair removal and other effects are remarkable. Although photoelectric therapy has the advantages of less trauma, fast recovery, and high safety, the high energy of photoelectric can more or less cause damage to the skin.
Previous retrospective results showed that the most common short-term complications after photoelectric therapy were skin erythema and crusting (95.38%), which lasted an average of 4~5 days and were self-limited. In addition, complications such as burning sensation (92.30%), local dry skin (72.30%), and local swelling (60.4%~69.2%) were also common.
In most cases, these complications are temporary and can be relieved gradually with reasonable and timely care, but sometimes permanent complications such as long-term pigmentation, scarring, urticaria, contact dermatitis, and eye damage may occur.
2 Cosmetic injections
Injection cosmetology refers to the use of percutaneous injection to inject specific injections or biological materials into the target position to achieve youthful medical aesthetic treatment, the main advantages of which are small trauma, convenient and easy, high safety and fast recovery.
(1) Botulinum toxin
Although the safety of botulinum toxin injection has been generally recognized, related complications occur from time to time, including edema, ecchymosis, pain, allergies at the injection site, muscle weakness near the injection site, and local serious complications including eyelid drooping, eyebrow asymmetry, facial paralysis, etc., which can generally be self-limited with botulinum toxin metabolism.
However, a very small number of patients will develop serious complications, such as several cases of deep vein thrombosis after botulinum toxin injection in the extremities. With the increase in the clinical use of botulinum toxin, post-injection (usually informal) systemic poisoning events also occur.
The image comes from the Internet and is for learning and communication only
(2) Fill class
Filler injection is a hot field in the medical beauty industry in recent years, and commonly used fillers include hyaluronic acid, collagen, L-polylactic acid (PLLA), polymethyl methacrylate (PMMA), autologous fat, etc.
The image comes from the Internet and is for learning and communication only
Common complications include pain, swelling, and bruising at the injection site, and local ice can significantly reduce the above symptoms and generally heal itself;
When the injection level is too shallow, the injection amount is uneven and the shaping is improper, the injection site may be uneven, and in severe cases, subcutaneous nodules and even granuloma formation may occur.
The probability of granuloma after filling is 0.01%~0.34%, and its formation is mainly related to injection technology, aseptic operation technology, individual immune status and injection materials, and some granulomas can be combined with inflammatory manifestations such as redness, swelling, heat and pain, and need active anti-infection treatment.
According to the clinical classification of granulomas, treatment can be performed by removal of injections, local occlusion of hormones, systemic interferon/immunosuppressant, phototherapy, etc., and the specific plan should be decided according to the individual patient.
The complications of vascular embolism in filler injection require great clinical attention. Although its incidence is not high, it may lead to irreversible serious consequences, injection needs to choose the appropriate level, do a good retraction test, avoid important vascular nerves, while paying attention to injection skills, small dose, slow injection is appropriate.
(1) Hyaluronic acid
Hyaluronic acid injection filling is one of the important methods of medical cosmetology, injected into the skin folds to plump the skin contour, in addition to stimulating collagen proliferation, improve the appearance of the skin. Injection into the deep subcutaneous layer such as nasolabial folds and tear troughs, or even superficial periosteum, can play a solvent filling effect, restore skin volume, and reshape facial contour.
Hyaluronic acid can be broken down by hyaluronidase, so in the event of complications such as granulomas and vascular embolism, local or intravascular injection of hyaluronidase can be tried.
If hyaluronic acid injection is too shallow, the local skin may appear blue due to the "Tyndall phenomenon".
(2) Collagen
Collagen is a kind of natural protein, is the main component of skin tissue, has good biocompatibility, and can interact with cells, induce the proliferation and differentiation of epithelial cells and transplantation, is one of the ideal materials for correcting facial soft tissue defects.
In addition to the risks of bruising, swelling, infection, nodules and other risks common in injection cosmetology, the special thing about collagen fillers is that they are mainly made of bovine and pig skin, and heterogeneous proteins can still cause allergies and immune reactions, so allergy tests are required before use.
Its raw materials also carry potential risks such as infectious diseases, requiring comprehensive raw material quarantine and virus testing. Due to the rapid degradation of collagen, it has been gradually replaced by emerging products in recent years.
③ PLLA
PLLA is a new type of biodegradable material, which itself is a strong hydrophobic substance, has poor adhesion to cells, and can be degraded to form lactic acid.
At the beginning of the injection, there may be a slight inflammatory reaction in the face, but because it stimulates collagen production, the treatment effect will not appear for several months, but the effect will last for a long time.
This product can form nodules visible to the naked eye after injection, so it cannot be used in the periorbital or lip area, and massage the injection site can reduce the formation of nodules.
④ PMMA
PMMA is an inert filler, PMMA microspheres are mainly used to improve facial hollowness, deep wrinkles, or cheekbone filling. Generally, PMMA is injected into the subdermis layer using tunneling technology, and it should be injected into the deep periosteum during filling and shaping treatment, and the injection site is fixed with transparent tape to prevent the filler from shifting.
Permanent nonabsorbable fillers are generally restricted in the United States, and Aretcoll is the only nonabsorbable filler approved by the U.S. Food and Drug Administration in 2006, which is composed of bovine collagen and PMMA, so allergy testing is required before injection.
(5) Fat itself
Autologous fat grafting is also ideal for contouring, with the lower abdomen and inner thighs being the preferred areas for facial fat filling. Since the fat particles will be partially absorbed by the autologous tissue after surgery, the injection amount should be increased by 10%~30% compared with the demand to achieve better filling effect.
The image comes from the Internet and is for learning and communication only
Postoperative bruising and edema are usually inevitable, usually lasting from 2 weeks to several months, and can often be self-limited after treatment such as elevation of the surgical area, ice, and compression bandaging.
If the local fat injection is too much or the intraoperative aseptic operation is improper, it is easy to lead to fat necrosis and infection in the affected area, although such cases are not common, but the consequences are serious and need to be paid enough attention.
In addition, liposuction and autologous fat grafting of the trunk should also pay attention to the appearance of necrotizing fasciitis, and fat embolism is the most serious complication of autologous fat grafting.
(3) Line technology
Thread technology, also known as thread beauty technology, that is, "thread carving", was first proposed in 1999 and has been widely used and developed in the past 10 years.
By embedding threads in different layers of the body surface, thread technology not only strongly lifts sagging soft tissues, but also stimulates collagen production to achieve aesthetic effects such as tightening sagging tissues, filling depressions, improving skin texture and sculpting body contours.
The most common complications after suture lift include pain, bruising, edema, etc., which can usually be self-limited within 7~10 days after symptomatic treatment.
The following complications due to improper intraoperative procedures or poor postoperative care require special treatment:
(1) Postoperative thread head exposure, usually caused by not adhering to the skin when cutting the thread or the position of the thread is too shallow. Disinfect as soon as possible and "press and cut the thread", or bury new threads in the deep layers.
(2) Hematoma, nerve or parotid duct injury, usually caused by improper puncture. The surgeon is required to be fully familiar with the anatomical position and level of important facial structures, and after the hematoma appears, it should be mainly pressurized to stop bleeding and ice, if the hematoma is large, it needs to be incised and drained; Nerve damage can usually be treated with nutritional neurotherapy for 3~4 weeks; Parotid gland injuries require compression dressing, and patients are asked to chew less, eat less acidic foods, and consult a dentist if symptoms persist.
(3) Severe skin stretching, unevenness or left and right asymmetry need to be buried or filled to obtain better shaping effect.
How to prevent and treat complications of aesthetic surgery?
(1) Improve the technical level of medical beauty practitioners
Lack of knowledge and experience of the medical aesthetic surgeon or operator with drugs, techniques, instruments or surgical methods is the root cause of complications. Surgeons need to strictly grasp the indications and contraindications of various medical aesthetic technologies, be familiar with anatomy, and standardize operations. For the complications that may be caused by various operations, they should be recognized in time and properly and actively dealt with to minimize the harm caused by complications.
(2) Strengthen post-operative care for medical cosmetology
Medical aesthetic post-operative care is also an important part of reducing complications. Postoperative care for inpatients is mainly done by specialist nurses, which requires medical institutions to accumulate nursing experience in relevant cases to improve the quality of postoperative care. Outpatient surgeries are a major feature of the industry, which requires practitioners to fully inform patients of their postoperative care methods after surgery.
(3) Strengthen psychological counseling for patients
For all patients, a detailed diagnosis should be made before treatment, full communication with patients should be established, a good relationship of mutual trust should be established, and treatment treatment should be jointly determined. As an optional surgery, the patient's psychological state is different from that of patients with other diseases, and if they encounter postoperative complications, they should strengthen communication, fully empathize, gain full trust of patients, and assist in the treatment of subsequent complications.
epilogue
Medical cosmetology is a noble cause to maintain healthy beauty and life beauty, and is an important part of health care. In recent years, while medical cosmetology has developed rapidly, its complications have also brought great challenges to clinical diagnosis and treatment. Therefore, medical cosmetology workers should continue to strengthen learning, improve their business capabilities while enhancing risk prevention awareness, and avoid the occurrence of related complications to the greatest extent.
· Original author: Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital Chang Guojing, Yu Nanze, Long Xiao, Wang Xiaojun
· Corresponding author: Wang Xiaojun
Edited by 丨 Liu Yang Zhao Na
Reviewers 丨 Li Na Li Yule Dong Zhe
Executive Producer 丨 Wu Wenming
【Copyright Statement】
"Union Medical Journal" advocates respect and protection of intellectual property rights, welcome reprint, quotation, but need to obtain the authorization of this platform. If you have doubts about the content and copyright of the article, please send an email to [email protected], and we will communicate with you in a timely manner. The graphic content is only for communication and learning, and is not for profit; Popular science content is only used for the popularization of public health knowledge, and readers should not be used as the basis for individual diagnosis and treatment, and dispose of it by themselves, so as not to delay treatment. For medical treatment related needs, please visit the Peking Union Medical College Hospital APP online or offline.