Hyaluronic acid fillers are widely used in cosmetic surgery to add volume and enhance facial contour. There appears to be little described regarding their use for noncosmetic applications. Four patients are presented in whom hyaluronic acid fillers were used to improve acquired contour deformities.
Patient 1 was a 45-year-old woman who underwent a left frontal craniotomy for clipping of an aneurysm. Although the left bone fragment was replaced, it was not fixed, and displaced posteriorly. She was left with a 3 × 4-cm circular defect of her left forehead (Fig. 1). There was also a smaller contour deformity superomedial to this defect where the burr hole had been performed. She declined neurosurgical repair. These depressions were filled with hyaluronic acid (Fig. 2), leading to a marked improvement in her forehead contour. The procedure was subsequently repeated 2 years later.
On both occasions, she also received prophylactic antibiotics. There were no complications. She was delighted with the improvement in contour.
Patient 2 also had a craniotomy, apparently for complications related to bilharzia. He subsequently developed osteitis requiring removal of a large section (10 × 7 cm) of his right frontoparietal skull, leaving him with a large contour deformity of this area. Dural pulsation was observed in some areas of the skull defect. He was referred to a neurosurgeon, who advised him that surgical repair was a very high-risk procedure.
Intradermal hyaluronic acid injections were performed in two sessions, 2 months apart, leading to a marked improvement in forehead/skull contour and improved self-confidence. On both occasions, the patient also received prophylactic antibiotics.
Patient 3 was a 27-year-old man with Poland syndrome and pectus excavatum. A latissimus dorsi flap had been performed but, although this improved his chest/breast, he still had a contour deformity, especially medially and inferior to the clavicle.
He is a thin individual and a heavy smoker. One session of fat grafting had been performed a few years previously with limited improvement. His requirements were much larger; 50 ml of filler was injected in three sessions.
Patient 4 was a 57-year-old woman who presented with incomplete recovery after Bell palsy. As a consequence of the palsy, she had facial asymmetry and a more pronounced nasolabial fold on the affected side because of soft-tissue descent. Hyaluronic acid was used for malar augmentation, in addition to botulinum toxin. She reports an increase in self-confidence and more symmetry, especially at rest.
The first three patients presented with acquired contour deformities, two involving the face. The alternative treatment would have been fat grafting. However, this is a surgical procedure with unpredictable results.
In the two patients who had contour deformities of the forehead/skull with underlying dura, fat grafting would have risked perforating the dura, or wound infection, with its attendant problems. Hyaluronic acid fillers offer a simple, office procedure to correct a contour deformity. It should be performed as a sterile procedure. The disadvantage is the need to have the procedure repeated, with its attendant costs.
The author has no financial interest to declare in relation to the content of this article. The author has no funding to declare.
Don A. Hudson, F.R.C.S., F.C.S.(S.A.), M.Med.
100 Fairfield Suite
Claremont, 7800 Cape Town, South Africa
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