Introduction: The use of hyaluronic acid fillers (HA) for esthetic corrections has exponentially grown in recent years. Skin ultrasound (US) is an effective method to identify the filler and its complications. A particular type of adverse effect, characterized by late, persistent edema of an intermittent nature, has been lately observed. Objective: To describe a delayed complication due to easy HA fillers, named by the authors as Persistent, Intermitent Delayed Swelling (PIDS). Methods: From October 2016 to July 2017, US examinations performed at Cavallieri Clinic were selected and referred for evaluation of post-filler complications. Questionnaires were sent to requesting physicians for clinical data collection. Results: Of 108 exams, 33 cases of local subcutaneous edema associated with the presence of HA fillers were identified. Episodes of edema were referred to as recurrent, in the previously affected area, or at another injection site. Conclusion: The authors propose a specific nomenclature: PIDS to refer to this late adverse reaction to HA fillers, which includes delayed and intermittent local swelling, triggered by specific conditions, that persists for as long the HA remains in the subcutaneous tissue.

Keywords: DERMAL FILLERS; HYALURONIC ACID; ADVERSE EFFECTS; SKIN ULTRASOUND

To simplify the procedure and increase lip augmentation safety, we have developed the KISS - Keep Injection Simple and Safe lip filler technique. To be simple, the method recommends only the evaluation of four anatomical parameters and the filling of five labial areas. To be safe, the injection is performed only in the supramuscular plane, using cannulas with a blunt tip, inserted in four entries: two in the upper lip and two in the lower lip. Fillers are injected in specific anatomical vectors for lips volumization, projection, contour improvement, and support of cupid’s bow and lip corners.

Keywords: Hyaluronic acid; Dermal fillers; Lip