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DyeVL treatment (a) Before: A 73‐year‐old patient presenting with an ecchymosis 72 hr following dermal filler injection. (b) After: A 73‐year old patient 24 hr after DyeVL treatment. Demonstrating effectiveness of dye‐VL on ecchymosis even several days after ecchymosis occurrence
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An increasing number of minimally invasive cosmetic procedures, such as filler or botulinum toxin injections, are performed annually. These procedures are associated with a high risk of post‐procedure bruising or ecchymosis. Ecchymoses arise following hemorrhage and extravasation of red blood cells into the subcutaneous tissue, leading to local ski...
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Background:
Mammary hamartomas were mostly benign tumors with rare rate of recurrence and malignant transformation. Ultrasound (US)-guided vacuum-assisted breast biopsy (VABB) has been reported sufficiently safe in treating many breast benign tumors but remained undefined in mammary hamartoma for its usual underdiagnosis in US. Thus, this study ai...
Citations
... The onset of ipsilateral periocular swelling and eyelid hematoma was observed the morning after receiving the botulinum toxin injection, which occurred 12 hours prior. While the majority of tardive hematomas in cosmetic procedures or facial surgeries typically manifest within 24 h to several days after the procedure, the occurrence of a hematoma 12 h after the injection may not strictly align with the clinical definition of a delayed hematoma (11,12). Therefore, we have chosen to categorize this hematoma as a "postoperative hematoma" rather than a "tardive hematoma". ...
Hemifacial spasm (HFS) is a rare movement disorder characterized by involuntary muscle contractions on one side of the face. Compared to the high therapeutic effect, adverse effects of botulinum toxin treatment for HFS occurred rarely. However, managing HFS patients who are also taking antithrombotic drugs poses a challenge. Here, we present a case of postoperative ecchymoma of the eyelid following a botulinum toxin injection in a patient receiving daily vinpocetine and aspirin antiplatelet therapy. This case highlights the importance of considering the potential risks and formulating a treatment plan that maximizes benefit while minimizing complications in HFS patients undergoing botulinum toxin injections and taking antithrombotic medications. To the best of our knowledge, this is the first reported case of postoperative ecchymoma of the eyelid following a botulinum toxin injection. Further research and additional case reports are needed to better understand the management strategies for this patient population.
... Over the past few decades, non-invasive treatments are increasingly requested in Dermatology [1][2][3][4]. Among these, laser therapy became popular due to technologic development leading both to the availability of different light wavelengths targeting different chromophores and to protocols reducing the downtime of treatment, according to patients' requests [3][4][5][6]. ...
Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to explore morphologic and qualitative skin characteristics. Specifically, RCM can be applied to cosmetically sensitive skin areas such as the face, without the need for skin biopsies. For these reasons, apart from its current use in skin cancer diagnosis, our systematic review reveals how RCM can be employed in the field of laser treatment monitoring, being particularly suitable for the evaluation of variations in epidermis and dermis, and pigmentary and vascular characteristics of the skin. This systematic review article aims to provide an overview on current applications of RCM laser treatment monitoring, while describing RCM features identified for different applications. Studies on human subjects treated with laser treatments, monitored with RCM, were included in the current systematic review. Five groups of treatments were identified and described: skin rejuvenation, scar tissue, pigmentary disorders, vascular disorders and other. Interestingly, RCM can assist treatments with lasers targeting all chromophores in the skin and exploiting laser induced optical breakdown. Treatment monitoring encompasses assessment at baseline and examination of changes after treatment, therefore revealing details in morphologic alterations underlying different skin conditions and mechanisms of actions of laser therapy, as well as objectify results after treatment.
... 6,55 If bruising occurs, pulse dye laser treatment may be used 24 h afterward. 56 Orange-brown staining a Apply ice prior to injections. 6 Perform injections at an appropriate depth. ...
... Commonly reported AEs associated with HA filler treatment in the periorbital region include bruising, swelling, contour irregularities, and discoloration due to the Tyndall effect. 6,53 Adverse events with corresponding recommendations for prevention/treatment are listed in Table 3. 6,36,37,[53][54][55][56][57][58] In general, although most AEs resulting from HA fillers are mild and transient regardless of the area treated, serious AEs may occur. 54 Because the periorbital area is supplied by numerous arterial branches, vascular complications, such as the occlusion of the retinal arteries, may result from migration of a filler embolus. ...
Infraorbital hollows are one of the most common target areas for facial aesthetic treatment; however, they are often perceived to be challenging to treat due to the complex anatomy of the periorbital area, concurrent deformities, and risk of complications. Treatment options include surgical (eg, lower eyelid blepharoplasty with fat transposition or injections) and nonsurgical approaches (eg, fillers). Among these approaches, filler injections have become common practice because they are minimally invasive and provide long-term patient satisfaction. In particular, hyaluronic acid (HA) fillers have been shown to be safe and effective for infraorbital hollow rejuvenation. This review provides an overview of infraorbital hollows, including periorbital anatomy, etiology, clinical assessment, and overlapping deformities, such as malar mounds, festoons, and dark circles under the eyes. Patient and HA filler product selection, injection techniques, as well as potential adverse events, such as bruising/swelling, lower eyelid and malar edema, and vascular occlusions, are discussed. This review also highlights the importance of midfacial volumization to improve outcomes in the infraorbital region and in the overall aesthetic appearance. By selecting appropriate patients and attaining proficiency in periorbital anatomy and infraorbital hollow rejuvenation techniques, clinicians can safely and successfully perform HA filler injections that result in high patient satisfaction.
Level of Evidence: 5
... Обильные гематомы серьезно затрудняют условия заживления, могут являться причиной глубоких внутрикожных уплотнений и пигментации кожи. В литературе представлен опыт применения светового лечения стойких синяков или окрашивания кожи гемосидерином в результате экхимоза после нехирургических инъекционных процедур с использованием лазера на красителе (PDL), калий-титанилфосфатного лазера (KTP) или широкополосных источников света (IPL) [13,14]. ...
Purpose of the study : to evaluate the effectiveness of early laser treatment of various types of local complications after surgical blepharoplasty based on the dynamics of the clinical picture and outcome, as well as patient satisfaction indicators according to FACE-Q.
Material and methods . The study involved 24 patients with various types of local postoperative complications: scars with a tendency to hypertrophic growth (5 cases), inversion of the lower eyelid (4), seroma with undetected ligature fragments (2), aseptic inflammation of soft tissues of unknown genesis (2), neoangiogenesis in the eyelid area (3), extensive hemorrhages in the surgical intervention area (8 cases). Treatment was started on the day of the patient's treatment when the fact of the complication was established. The treatment was performed using the MultilineTM laser multiplatform using the Nd:YAP/KTP vascular laser with a combination of two wavelengths of 540 and 1079 nm and/or the Er:YAG, 2940 nm laser with SMA technology. The choice of the type of laser radiation and the interval between sessions were determined by the nature of the complication. Patients' satisfaction with the results of treatment was determined by the FACE-Q questionnaire.
Results. The results of treatment by evaluators were determined as excellent in 19 patients (79.2%) and good in 5 patients (20.8%). The outcome of the resolution of complications in all patients was a thin, flat, inconspicuous scar, persistent defects requiring additional correction were not observed. During 6 months of follow-up, the dynamics of FACE-Q indicators after laser treatment of complications showed a statistically significant improvement on all assessed scales: the general appearance of the eye, the outcome of the operation performed, the severity of side effects, psychological stress, social adaptation.
Conclusion. Laser treatment of postoperative complications of blepharoplasty allows improving the aesthetic result of the operation and restoring the psychoemotional state of the patient.
... Observational studies бирает популярность среди дерматологов и косметологов и относится к первой линии терапии при лечении телеангиоэктазий и проведении фотоомолаживающих процедур [6]. В нашем случае IPL была применена по поводу подкожного кровоизлияния, что не является обычным показанием к ее применению, однако успешное применение IPL по поводу подкожных кровоизлияний было описано ранее [7]. Тем не менее, учитывая механизм действия IPL, в такой ситуации можно было ожидать положительного эффекта данной процедуры. ...
... The bruised area usually heals within 2-3 weeks, and the skin returns to a normal color. 7 ...
... 18 Bruising is also a common adverse event associated with dermal filler or botulinum toxin injections. 6,7,[19][20][21][22][23][24] Bruising with filler injections, for example, occur with an incidence ranging from 19% to 68%. 25 Bruises after dermal filler injections, however, are typically more superficial and associated with less tissue inflammation and edema compared with post-surgery bruises. 9 A variety of medical and laser-based treatments are available to make bruises heal more quickly. ...
Background:
Cellulite 80%-98% of post-pubertal women and results in cutaneous dimples in the affected area.
Aims:
Therapies that target collagenous fibrous septae often provide successful outcomes.
Materials & methods:
Collagenase clostridium histolyticum-aaes (CCH) for injection consists of two collagenases which, under physiologic conditions, disrupt collagen structures by hydrolyzing Type I and III collagen.
Results:
Subcutaneous CCH was approved in the United States in 2020 for the treatment of moderate-to-severe cellulite in the buttocks of adult women. Although bruising is primarily an aesthetic concern, a conspicuous procedure-induced bruise may limit a patient's social activities and result in hesitation to undergo a similar cosmetic procedure in the future.
Conclusion:
The purpose of this review is to describe the available techniques for hastening bruise resolution and how they apply to resolving bruises associated with a CCH injectable.
... A bruise, also known as an ecchymosis, is a reddish or bluish discoloration of the skin arising from extravasation of blood from ruptured blood vessels. 5 Use of the right instruments for injectable dermal fillers can reduce bruising. Blunt-tipped microcannulas are recommended by some practitioners as larger cannulas and needles are more likely to transect blood vessels and cause bruising. ...
Injectable dermal fillers are in high demand. Patients undergoing this treatment are frequently burdened by bruising in the days following the procedure. Bruises associated with dermal fillers usually resolve spontaneously within 10 to 14 days, but patients want shorter downtime. We present a case of a bruise treatment with Nd:YAG laser consisting of three sessions in two day intervals, where the bruise resolved after seven days from the start of laser treatment. To date, the reports on laser therapy for bruise resolution are mostly limited to intense pulsed light and pulsed dye laser, and this case report contributes to the demonstration of Nd:YAG laser efficacy for this indication. Bruising or ecchymosis is a frequent adverse effect of injection and a primary concern to many patients considering injectable dermal fillers. Nd:YAG laser treatment can accelerate bruise resolution time and can therefore be used by medical practitioners to decrease downtime in patients undergoing this popular aesthetic procedure.
... Due to their similar clinical and pathophysiological features, the distinction between senile purpura and ecchymosis is not always clear with the potential for these terms to be used interchangeably within the literature and in practice (Rayner et al., 2015;Newall et al., 2017). Senile purpura refers to the appearance of small purple spots with defined borders measuring 0.3 -1 centimeter, while ecchymosis is characterised by reddish or bluish discolorations larger than 1 centimeter with more diffuse borders (Verner et al., 2019;Mahajan & Handa, 2020). ...
... In 2018, Narurkar [28] reported that after utilizing an IPL device in 15 subjects, there was a reduction of postfiller bruising ranging from 70% to 100% in all subjects with a mean reduction of 85%; however, there was no control group in this study. Most recently in 2019, Verner et al. [32] documented complete resolution of postinjection bruising within 48 hours on all 11 subjects using a narrow-band IPL, emitting light mainly between 500 and 600 nm. ...
... While multiple lasers and light sources target hemoglobin, such as the 585 or 595 nm PDL, the 532 or 1064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers, and IPL [32,33], only IPL produces a broad spectrum of wavelengths that targets not only oxyhemoglobin but also its breakdown products, such as biliverdin, bilirubin, and hemosiderin, each with their own absorption peaks. Absorption peaks for oxyhemoglobin include 418, 542, and 577 nm [34], while bilirubin's peak absorption spectrum is 464 nm [35], and hemosiderin ranges from 660 to 680 nm [36]. ...
... However, all of these have very limited results, if any, and there have been no large-scale studies proving their longterm efficacy for this condition. Considering IPL is used to decrease postprocedural purpura [28,32], is associated with a significantly altered expression of RNAs similar to that in youthful skin [37], decreases superficial telangiectasia [27], and increases collagen production and epidermal thickening [20], it appears to be an ideal option for the treatment and prevention of senile purpura. ...
Background and Objectives
Senile purpura is a common condition characterized by recurrent ecchymoses in the elderly on the extensor surfaces of the forearms, hands, and legs. Our objective is to assess the efficacy and safety of a protocol using intense pulsed light (BBL; Sciton Inc., Palo Alto, CA) to improve the appearance of senile purpura on subjects' extensor forearms.
Study Design/Materials and Methods
Five subjects over 65 years of age, with ecchymotic lesions measuring over 1 cm on each forearm and five younger subjects under 35 years of age, without any ecchymotic lesions, were included in the study. The subjects were treated on one randomized forearm with a new intense pulsed light protocol for four weekly sessions. Photographs and subject questionnaires were taken weekly before each treatment as well as 1 month after all treatments. Skin biopsies were taken 1 day after the last of four weekly treatments. Histological analysis, including hematoxylin and eosin, elastic van Gieson, and Masson's Trichrome staining, were carried out to assess both the epidermal thickness and dermal connective tissue structure.
The protocol consists of multiple passes using an intense pulsed light (BBL; Sciton Inc.) device in which the wavelength, filter, and fluence are adjusted for each step. Step 1 uses infrared light (800–1,400 nm), high intensity, a smooth adapter, and a constant motion technique. Step 2 employs a 590‐nm filter with two different fluences and step 3 utilizes a 560‐nm filter. The fluence of steps 2–3 is increased by 1 J each treatment if no side effects are noted.
Results
Using a new intense pulsed light protocol in subjects with senile purpura, both the number and square area of ecchymoses on the treated arm were significantly reduced (P = 0.02 and P = 0.04, respectively, paired t test) as compared with the untreated arm at 1 month after four weekly treatments. Despite this pilot study including challenging cases of subjects on both inhaled and injected corticosteroids and blood thinners, all subjects with senile purpura had at least a 50% reduction in the total square area of their ecchymoses on their treated arm. There were no significant or long‐lasting side effects, and all subjects reported satisfaction with the treatment with a desire to continue treatments on their control arm.
Blinded evaluators were able to select 100% of the time in the subjects with senile purpura, which was the treated arm as compared with the control arm when reviewing photographs from 1 month after the last treatment. In addition, several subjects were noted to have a significant improvement in the appearance of hemosiderin deposition and photodamage. Histologically, intense pulsed light treatments significantly increased epidermal thickness in elderly subjects by 21.14% (P = 0.0153, two‐tailed, paired t test), to levels comparable with young subjects. Such restoration is consistent with the other histological observations by blinded evaluators of more abundant and organized collagen fibers in the dermis and reduced aggregates of disorganized elastin fibers.
Conclusion
This new intense pulsed light protocol is safe and effective in improving the clinical appearance of senile purpura as well as preventing future lesions by improving the structure of the skin by increasing epidermal thickness and improving collagen and elastic fiber morphology. The treatment was well‐tolerated, adverse effects were minimal, and there was high patient satisfaction. Lasers Surg. Med. 2020. © 2020 Wiley Periodicals LLC
Cefuroxime is a common antibiotic often used prophylactically in orthopedic surgeries. Although antibiotic sensitivity testing before administration is done routinely, a negative test cannot rule out the possibility of a delayed hypersensitivity reaction. Our patient was a 10-year-old female, with cerebral palsy posted for correction of congenital talipes equinovarus under general anesthesia. A test dose of 0.1 mL of cefuroxime was given intradermal preoperative, which was nonreactive. Later, a full dose of antibiotic was given before the surgical incision. The intraoperative period was uneventful; however, she developed periorbital edema in the postoperative period. The Naranjo scale of 6 suggested possible adverse drug reaction, and further management was done on grounds of hypersensitivity reaction. Periorbital edema is a rare presentation of adverse drug reaction produced by cefuroxime.