News from our plastic surgery practice
News from 2024
News from 2023
In the spirit of holistic treatment, we now offer you the new system Alpha Cooling® Professional as a whole-body cooling application for improved regeneration after exercise. It works solely by cooling down the palms of the hands and was originally developed to improve performance and for rapid regeneration in sport. It was quickly established that test subjects also experienced the disappearance of other complaints. See for yourself at a trial appointment.
In addition to her board activities for the German Society for Aesthetic Plastic Surgery, Dr Montanari has been a member of the 40-strong team of speakers at the DGBT - German Society for Aesthetic Botulinum and Filler Therapy since this year.
On Friday, 10 November 2023 and Saturday, 11 November 2023, she held a botulinum and filler course for the training and further education of colleagues together with her fellow speaker Prof. Dr Peter Arne Gerber. The special thing about these courses is that they are certified and therefore recognised by the Medical Association.
In its current list of doctors for 2023, Focus magazine has recognised Dr Michaela Montanari for the fourth time in a row in the "Botox & Filler" category and in the "Intimate Surgery" category. Dr Montanari has consistently been one of the top doctors in Germany in this category since 2017.
If you would like to find out more about the survey procedure for the Focus seals, you can find it here: Focus list of doctors Survey method
From 1 June, you will find Dr Michaela Montanari and her team in the beautiful ambience of Villa Krockhaus at Krockhausstraße 7 in Bochum.
Here we offer you
🔵 Free parking directly in front of the villa
🔵 Even more discretion thanks to the location
🔵 Feel-good ambience in spacious rooms
🔵 Separate access to Montanari Cosmetics
Appointments can be made from 1 June 2023 - we look forward to seeing you!
The magazine "Stern" awarded Dr Michaela Montanari both in the category "Botox treatment" and once again in the category "Intimate surgery" in the special edition "Good doctors for me 2023".
Dr Michaela Montanari is also one of the top doctors in Germany in the "Botox & Filler" category for the third time in a row. In addition to the Focus seal for "Botox & Filler", Dr Montanari has been one of the top doctors for "Intimate Surgery" for over 6 years.
On top of this, Dr Montanari was awarded the jameda quality certificate, as she is recommended particularly frequently by patients via the doctors' portal. This is why she is one of the top 10 doctors in Bochum.
If you would like to find out more about the survey procedure for the Focus seals, you can find it here: https://focus-gesundheit.de/top-mediziner/methodik
Anyone interested in how this independent doctor's recommendation comes about can read about it here: https://www.minq-media.de/methodik/
Messages from 2022
The practice of Dr Michaela Montanari has once again been awarded the MOOCI seal. MOOCI only recommends doctors who have been checked in advance by an independent advisory board of renowned doctors and lawyers to ensure that they fulfil the necessary qualifications.
The test criteria include an internal quality check and a check for GDPR-compliant data protection. However, the number of lectures on medical topics, memberships in specialist societies, scientific publications in medical journals and evidence of regular participation in further training also play a role in the assessment.
Mastery of modern procedures (valid DFP diploma | continuous, relevant further and advanced training within the specialisms)
You can find more on this topic here: https://www.mooci.org/
Michaela Montanari, MD, held a workshop on facial filler injections with her colleague Matthias Aust, MD, "Facial Harmony without surgery - the injectables guide for natural-looking results" at the 52nd Annual Meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and 26th Annual Meeting of the Association of German Aesthetic Plastic Surgeons (VDÄPC).
She also chaired the session on Friday, 30 November 2022 "Injections: Fillers and Toxins" together with her esteemed colleagues Dr Noah and Dr Taufig and guided the congress participants through the programme.
Dr Michaela Montanari has been listed as a top specialist on myBody.de for over 10 years and has therefore been awarded the myBody quality seal.
In addition to her numerous other awards - Focus Top Doctor in the categories "Botox & Filler" and "Intimate Surgery", the quality seal of the DGPRÄC (German Society of Plastic, Reconstructive and Aesthetic Surgeons) and the Radiesse® Competence Centre and Belotero® Competence Centre awards - she also advises the editors of mybody.de with her expertise in the field of aesthetic plastic surgery.
As there are now numerous so-called "quality seals" in the field of aesthetic medicine, which often appears opaque to many patients, myBody follows a strict selection process from the outset, which emphasises different quality criteria in the selection of specialists.
The medical requirements include professional qualifications, regular training activities and specialisations, which must be clearly documented. Standards also apply to materials, products, technical equipment and emergency management. This includes ensuring that all doctors have a state-certified and recognised specialist title, that competent and detailed medical advice is provided and that high-quality medical products are used that comply with the requirements and the applicable legal situation. The so-called "Mystery Check" is used to check whether the seal holders fulfil all quality promises.
You can find out more about myBody's selection criteria here:
https://www.mybody.de/qualitaetssiegel-aesthetische-chirurgie.html
And here you can go directly to the profile of Dr Michaela Montanari:
WDR Servicezeit "fit and healthy" - Radiesse® and Ultherapy®
09.05.2022, 18:15 from minute 8:00
For the second time in a row, Dr Michaela Montanari is one of the top doctors in Germany in the "Botox & Filler" category.
Among other things, the ratings took into account: the range of treatments offered by the doctors, how often a doctor was recommended by colleagues and patients, how much they publish scientifically, whether they carry out clinical studies and information on patient services and digital offerings.
In addition to the Focus seal for "Botox & Filler", Dr Montanari has been one of the top doctors for intimate surgery for over 5 years.
If you would like to find out more about the survey procedure for the Focus seals, you can find it here: https://focus-gesundheit.de/top-mediziner/methodik
Every face is individual - and that's exactly how it should be treated! We look forward to helping you with the Eautohaemotherapy PRP Vampire Lifting and the biocompatible one, high-purity hyaluronic acid PROFHILO® two new and particularly well-tolerated treatments for a visibly firmer and more radiant complexion. The best thing is that in addition to the face, both methods can also be used to treat other areas of the body such as the hands, décolleté, neck and much more. Find out more about the two new treatment methods here:
- PROFHILO® - the biocompatible anti-ageing hyaluronic acid freshness boost for the skin
- The PRP Vampire Lift - Natural skin rejuvenation with autologous blood
Dr Michaela Montanari will be happy to advise you on which method is right for you.
Messages from 2021
Dr Montanari gave lectures and chaired the 49th annual conference of the DGÄPC (German Society for Aesthetic Plastic Surgery) in Bielefeld
Dr Montanari was honoured at the 49th Annual Meeting of the DGÄPC (German Society for Aesthetic Plastic Surgery) in Bielefeld was elected to the Executive Board.
Dr Montanari is among the TOP doctors in Germany 2021 and has been awarded for Botox & Filler and intimate surgery.
FOCUS Gesundheit recommends doctors who are leaders in their speciality to its readers and users.
Many thanks to FOCUS, the Factfield GmbH research institute and the dear colleagues and patients who recommended Dr Montanari.
The two chairpersons of the NRW regional association of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), Dr Michaela Montanari and Prof. Marcus Lehnhardt, have organised a webinar entitled: Plastic Surgery Update 2021 and will be hosting it together.
Interesting and current topics such as Covid 19 vaccination update (Prof. Dr M. Gunzer) and social media: plastic surgery between medicine and business (Dr S. Allert) are on the agenda!
Time: 24.03.2021, 18.00-19.30 hrs
Dr Michaela Montanari and her practice are members of the elite medical association Premium Kliniken & Praxen. This is a quality alliance of first-class medical specialists in Germany and Switzerland.
Membership of this elite medical association is only possible on the recommendation of a committee of renowned experts in the respective speciality.
Messages from 2020
EMSCULPT is a non-invasive body shaping procedure from the USA that allows both women and men to build muscle and burn fat.
Non-invasively, an increase in muscle mass of 16% and a reduction in the fat layer of 19% can be achieved. The procedure is suitable for the abdomen, buttocks, upper arms and calves.
The procedure is performed without surgery or anaesthesia and has been tested in the USA.
Please contact us if you are interested!
We are delighted about the FOCUS recommendation 2020- Recommended doctors in the region
Many thanks to the editors of FOCUS-GESUNDHEIT and the many dear patients.
The research included, among other things, recommendations from doctors, professional experience, scientific commitment, patient service, patient satisfaction, accessibility and quality management.
The Harmony counselling tool is an individual and certified counselling service with a transparent treatment concept.
Only qualified doctors with extensive experience in the field of aesthetic medicine who have been specially certified for this purpose are authorised to carry out Harmony consultations.
Thank you very much!
Messages from 2019
Dr Montanari has been named a recommended doctor in the current Gala Beautify for the areas of face, breast, stomach, legs, bottom and intimate areas.
Dr Montanari was accepted into the oldest professional association in this field at the 47th annual conference in Cologne. To become a member of the DGÄPC, you must fulfil strict membership criteria and have made a name for yourself in the field of aesthetic plastic surgery. A great honour!!!
On 14 September 2019, an Ultherapy workshop will take place in our practice for further training for doctors. Lecture and live demonstrations by Dr Montanari.
Ultherapy is an innovative, non-invasive procedure for tightening and smoothing the skin. Sagging areas of skin on the face, neck and décolleté are gently and effectively tightened with this device.
The gentle Hydra4FaceRThe new skin care concept offers an innovative, non-invasive method to restore the skin's health and beauty. The revolutionary skin care concept developed in the USA comprises four treatment steps for cleansing and moisturising with an immediate glow effect. Regular treatments specifically reduce skin pores and acne, minimise UV damage and hyperpigmentation and tighten and rejuvenate the skin, strengthening the skin tone.
Dr Michaela Montanari is one of the top doctors in Germany for the third time in a row. This is the result of a comprehensive study carried out by the independent research institute MINQ on behalf of the news magazine FOCUS. Dr Michaela Montanari is distinguished by her outstanding achievements in the field of intimate surgery.
The doctors who are among the most highly recommended in the country in the Germany-wide FOCUS comparison receive the "TOP MEDIC 2019" award.
Dr Montanari has been repeatedly recommended by colleagues and patients alike in the field of intimate surgery.
Dr Michaela Montanari is one of the most recommended doctors in the region for plastic and aesthetic surgery. This was determined by Focus Gesundheit in co-operation with the Hamburg Health Foundation on the basis of 225,000 outpatient doctors throughout Germany.
We now also offer the pelvic floor lift treatment with Emsella
Messages from 2018
Dear patients,
For your information, we would like to inform you about the current status of texturised implants from ALLERGAN.
On 16 December 2018, the approval for textured (roughened) breast implants and tissue expanders from the manufacturer Allergan was not extended. However, the CE certificate for smooth implants was extended.
If you wear a coated ALLERGAN implant and have no symptoms, there is currently no cause for concern according to the current state of knowledge!
Symptoms and behavioural advice:
Please come to my consultation if there is a strong accumulation of fluid in the breast at least one year after implantation.
We recommend annual routine check-ups, regardless of symptoms.
Dr Michaela Montanari will be giving a lecture on 13 November 2018 from 12:15 - 14:00: "Intimate surgery - medical necessity or female demand/aesthetics?Chair of Christian Social Teaching, Faculty of Protestant Theology, Ruhr University Bochum
09.10.2018 Expert interview with Dr Montanari on intimate surgery
Dr Michaela Montanari chaired the intimate surgery session with Dr S. Emmes, secretary of the session Dr D. mon O'Dey, at the 49th Annual Meeting of the DGPRAEC (German Society of Plastic, Reconstructive and Aesthetic Surgeons, 23rd Annual Meeting of the VDÄPC (Association of German Aesthetic Plastic Surgeons) in Bochum from 14:00 - 15:30 at the Ruhr Congress Bochum.
In this context, she gave a lecture on the topic: "Combination of intravaginal radiofrequency and non-invasive electromagnetic waves (HIFEM)".
Dr Michaela Montanari is one of the top doctors in Germany. This is the result of a comprehensive study carried out by the independent research institute MINQ on behalf of the news magazine FOCUS. Dr Michaela Montanari excels in the field of intimate surgery.
The doctors who are among the most highly recommended in the country in the Germany-wide FOCUS comparison receive the "TOP MEDIC 2018" award.
Dr Montanari has been repeatedly recommended by colleagues and patients alike in the field of intimate surgery.
We would like to thank our patients and dear colleagues for their recommendations!!!
Dr Michaela Montanari was in charge of the Merz Aesthetics - Summer Academy in Austria on 9 June 2018 the workshop "Atraumatic Lip Augmentation with Belotero & Mid-Face Treatment with Radiesse" with hands-on training.
Venue of the event: Loisium Resort Südsteiermark, 8461 Ehrenhausen, Austria
"Love of beauty is taste. The creation of beauty is art." Ralph Waldo Emerson
Many years ago, Merz Aesthetics Austria set itself the task of passing on precisely this skill to interested doctors and founded the "Merz Aesthetics - Injection Academy". As part of this, a small-scale expert exchange/hands-on workshop is held several times a year - and the "crowning glory" is the annual "Merz Aesthetics - Summer Academy"!
The "Summer Academy" offers selected doctors the opportunity to deepen their expertise in aesthetics. Short lectures on current topics, workshops with different focal points and a wealth of experience international workshop leader and the personal exchange of experiences in a pleasant environment are the focus of the event.
We are delighted to be the first in Germany to offer BTL Emsella treatments for tightening the pelvic floor and treating incontinence in our practice with immediate effect. The non-invasive FDA-cleared treatment has been a big hit in the USA so far. The treatment is carried out fully clothed.
High-intensity, focussed electromagnetic energy can be used to stimulate the pelvic floor muscles in a targeted, non-invasive way. We recommend 6 sessions, 2 of which should be carried out in a week.
Please contact us if you are interested!
Information on the new BTL EMSELLA treatment.
Our thanks for the helpful support go to Dr Ernesto Delgado Cidranes, who already performs this treatment in Madrid, and to the company BTL, which was the first to place this treatment chair in our practice in Germany.
On Friday, 13 April 2018, Dr Michaela Montanari gave a lecture on the topic of "Radiofrequency treatment in the genital area" at the 6th annual conference of GAERID (German Society for Aesthetic and Reconstructive Intimate Surgery), held at the Holiday Inn Hotel Munich
Dr Montanari and Dr Schlossberger also chaired the session: Non-surgical intimate areas
On Wednesday, 7 February 2018, the entire practice team completed a training course with practical exercises on resuscitation and emergency management in the doctor's surgery.
Even if we refresh this management annually, we still hope not to have to use it!
Nevertheless, your safety is important to us!
Refresher course - Hygiene in the medical practice "Hygiene Officer Doctor", Dortmund.
Dr Michaela Montanari and practice team
More than 1 million Ultherapy treatments have now been carried out worldwide. As we successfully carry out a large number of treatments in our practice, we have been ceremoniously presented with the "golden 1" award by the Merz company. We are delighted - thank you very much!
Ultherapy is a non-invasive procedure for skin tightening and skin smoothing using micro-focussed ultrasound. Good results can be achieved with just one treatment.
Feel free to contact us if required!
Messages from 2017
Dr Montanari has been included in the popular list of doctors in the intimate surgery section of the Munich news magazine Focus and is therefore listed among the top doctors in Germany.
The Focus list of doctors is an important and reputable guide for patients and colleagues.
We are delighted to receive this award and would like to thank our patients and colleagues!
Messages from 2016
BTL EXILIS ELITE™ is a non-invasive treatment system that combines two proven physical elements such as ultrasound and radiofrequency with integrated cooling. This combination is combined in one applicator. This enables the simultaneous application of fat reduction and skin tightening and is suitable for all areas of the body.
A tightening of the genital area is also possible without any problems using a special probe.
In combination with X-WAVE acoustic wave therapy (shock wave therapy), a new, gentle and effective technique against the unloved orange peel skin (cellulite) is possible.
After treatment, you are immediately fit for socialising and have no downtime to worry about.
Please contact us if you are interested!
<img class="“newspic" alignright“ src="“https://www.dr-montanari.de/upload/thumbs/images/IMG_3435.JPG“" alt=""16.04.2016" Ästhetik update 2016 berlin“ border="“0″" />Dr Montanari was a moderator, speaker and workshop leader at the Berlin Aesthetics Update 2016 on 16 April 2016. The event took place at the Berlin Brandenburg Academy of Sciences at Gendarmenmarkt with 134 participating doctors.
The entire practice team took part in the Aesthetics Update 2016 in Berlin.
Messages from 2015
CULT BLONDINE SOPHIA WOLLERSHEIM - Beauty trifecta for the jungle camp?
"Beauty trifecta for the jungle camp?"
Bild.de, November 2015
CULT BLONDE SOPHIA WOLLERSHEIM
Photo: www.BILD.de
Düsseldorf - She has already gone under the knife 16 times with a cosmetic surgeon (three breast augmentations alone): Sophia (28), wife of Düsseldorf's red light "king" Bert Wollersheim (64).
But now the TV actress has had three makeovers in a fortnight! The blonde doesn't want to reveal why she has suddenly had so much done all at once, but speaks vaguely of a "new project". According to BILD, it can only be the "jungle camp" (RTL).
Photo: Stefan Schejok"/>
Sophia after treatment with Dr Montanari
Photo: Stefan Schejok
► In Dr Michaela Montanari's private practice in Bochum, Sophia's complexion was rejuvenated by needling (needle pricks to combat wrinkles), her lips were lightly injected and the sweat glands under her arm were sclerosed.
Source: Bild.de, 25 November 2015
Bert Wollersheim more beautiful than ever
"Bert Wollersheim more beautiful than ever"
Ultherapy, September 2015
After a facelift: Bert Wollersheim more beautiful than ever
Photo: www.newspic.de
Thanks to a facelift, Düsseldorf's red light king Bert Wollersheim looks fresh and wrinkle-free in front of the camera again. The 64-year-old had his face rejuvenated by Bochum cosmetic surgeon Dr Michaela Montanari with injections and ultrasound. The follow-up examination was on Thursday. The result: all taut! The procedure was a birthday present from his wife Sophia (26). The TV actress also had a little makeover there: with a micro-needling for a beautiful complexion - and a fat-removing injection in her bottom.
Source: Bild.de, 17 September 2015
On 14 August 2015, Bert and Sophia Wollersheim underwent treatment at Dr Montanari's practice. The two were accompanied by the RTL - Explosiv - team. The focus was on treatment with Ultherapy - lifting without surgery.
Ultherapy is suitable for all those who do not yet want to undergo surgery but still want a fresher, younger appearance.
Sagging areas of skin, e.g. on the face, neck, décolleté and upper arms, can be gently and effectively tightened using this innovative treatment method. Focussed ultrasound is used to tighten tissue and produce new collagen. This procedure has been approved by the US Food and Drug Administration (FDA) as the only non-invasive lifting procedure to date. Dr Montanari's practice is one of the few in Germany to use this innovative form of treatment.
On Thursday, 9 April 2015, a report on intimate surgery was broadcast on WDR television in the programme frauTV from 22:00-22:30. Dr M. Montanari gave her opinion on the subject of labiaplasty.
Dr Michaela Montanari is now a full member of the German Society for Intimate Surgery and Genital Aesthetics E.V .
The DGINTIM has set itself the task of collecting theoretical and practical knowledge about intimate surgery, critically analysing it and developing guidelines. This provides an additional quality structure in the field of aesthetic intimate surgery.
On 21.03.2015 the workshop will take place under the direction of Dr Montanari: Advanced Volume4Volume Radiesse & new techniques.
Venue: MKG Fachwerk Berlin, Dr Gregor Jeske & Team
On 20.03.2015 the workshop will take place under the direction of Dr Montanari: Advanced Radiesse for first-time users - tips and tricks in Hanover.
Venue: Private medical practice Isernhagen- Süd ,Dr Brigitt Biebers
As part of the 6th Merz expert meeting "From professional to virtuoso", Dr Michaela Montanari gave a lecture on "Radiesse - more than a volume filler" to 500 registered medical participants in Frankfurt am Main.
Messages from 2014
On 10 December 2014, the training event for doctors took place from 4.00 pm in the private practice for plastic and aesthetic surgery at Humboldtstraße 70, 44787 Bochum. The event is moderated by Dr Montanari and consists of a theoretical lecture part and a practical part with live treatment.
On 19 November 2014, the entire practice team underwent further training in the area of "Emergencies and resuscitation in the doctor's surgery" in order to keep up to date in this area.
Dr Michaela Montanari will lead the above-mentioned workshop with a lecture and live treatments in Berlin on 15 November 2014, starting at 3 p.m. in the Ellington Hotel
As part of the 27th Annual Meeting of the Society for Aesthetic Surgery Germany EV (GÄCD) on 18.10.2014 in Cologne, venue Hyatt Regency Cologne, Dr Montanari will hold a workshop from 11.00-12.30 with a lecture and treatment on a model. Title: Current Aesthetics - Trends in Minimally Invasive Injection Procedures. Room : Rheinhessen
The following lecture is scheduled for 1.30 pm as part of the auditorium lectures: Update on Radiesse and possible combinations with hyaluronic acid fillers
Breast augmentation, liposuction and wrinkle treatments are now common plastic and aesthetic surgery procedures that are recognised by society. However, the situation is different with intimate surgery. Many women still consider intimate surgery, such as labiaplasty or vaginal tightening, to be a taboo subject, even if they feel uncomfortable with the condition of their intimate area.
Many affected women avoid professional counselling - the shame and fear of an operation in the most intimate area of the body is too great. However, impairments in the pubic area can lead to physical and psychological stress in the long term.
Expert discussion on the subject of genital surgery / labia reduction with Dr Montanari
The portal for aesthetics and health "My Body" has conducted an expert interview with Dr Michaela Montanari on the subject of genital surgery / labia reduction.
"Hyaluronic acid supplementation with Hyal® ACP for ageing skin and solar elastosis on the décolleté"
Plastic Surgery, July 2014
With increasing age, the skin gradually loses important physiological functions, as a result of which elasticity, resilience and moisture decrease and wrinkles appear - a visible indicator of skin ageing. Intrinsic factors such as genetic disposition and extrinsic factors such as alcohol, nicotine, lifestyle, sleeping habits and, in particular, sunlight exposure are involved in the ageing process. The extrinsic factors act synergistically with the intrinsic factors and thus accelerate the formation of wrinkles.
Hyaluronic acid stimulates the regenerative capacity and maintains the skin's vitality
Hyaluronic acid (HA) is a glycosaminoglycan and natural component of the dermal matrix that plays a central role in maintaining the skin's moisture and elasticity. In addition to a high water-binding capacity, hyaluronic acid has an activating effect on fibroblast and keratinocyte functions - mediated by specific receptor interactions. Among other things, this stimulates collagen and elastin biosynthesis, improves the skin's ability to regenerate and boosts its vitality.
Skin ageing is accompanied by a loss of hyaluronic acid function
Studies by several research groups confirm that decreasing hyaluronic acid activity is of essential importance in skin ageing. It was shown that the content of dermal hyaluronic acid decreases in the course of intrinsic ageing processes [2, 3]. Another group described an age-dependent change in the histolocalisation of hyaluronic acid in the skin as well as chemical alterations due to the binding of hyaluronic acid to HA binding proteins [4], resulting in a loss of water binding capacity and the ability to interact with specific receptors.
UV radiation is the most important extrinsic ageing factor and is able to inhibit the hyaluronic acid synthesis capacity of fibroblasts [6]. Chronic UV exposure also led to a redistribution of hyaluronic acid in the skin, whereby hyaluronic acid accumulated in elastotic material of the dermis surface, while it was lost from the deeper dermal matrix [1]. Altered hyaluronic acid homeostasis associated with downregulation of HA receptors in photo-ageing has been described elsewhere [7]. In summary, it can be deduced from the above findings that the vital functions of hyaluronic acid, which are essential for the skin, are lost during ageing processes. It is therefore plausible to assume that supplementation with hyaluronic acid can at least partially counteract intrinsic and extrinsic skin ageing (especially photo-ageing).
The décolleté places high demands on a rejuvenation treatment with fillers
The décolleté is particularly susceptible to signs of ageing due to its special localisation and structural characteristics. The comparatively thin skin in this sensitive area is only sparsely lined with supporting fatty tissue. Tensile forces on the female breast during movement or when sleeping on the side are stresses that contribute to the formation of "creases" and can affect the aesthetic appearance even at a younger age. In addition, many people underestimate the exposure of the décolleté to sunlight and often neglect effective UV protection. Solar collagenosis is therefore very common in this region.
In recent years, patients have frequently asked us for aesthetic correction of the décolleté. In view of the anatomical features and the large surface area of the décolleté, biodegradable hyaluronic acid-based filling materials are our first choice for smoothing the skin relief in this region. They are very fluid and are well suited for injecting fine lines and, after appropriate processing, for volume augmentation of wrinkles with greater depth and for levelling out large areas of volume loss. In contrast, we do not consider permanent fillers to be indicated - we do not consider them because of the higher risk of late complications [5]. In the following, we present a patient with solar elastosis of the décolleté who was treated with Hyal® ACP, an autocrosslinked biodegradable hyaluronic acid. As Hyal ACP is manufactured without additional chemical cross-linking agents - i.e. without harmful foreign substances - this product offers maximum safety and was selected by us for extensive use on the décolleté.
Treatment of elastotic ageing skin on the décolleté significantly reduced deep wrinkles and signs of photodermatosis
A 64-year-old female patient, a smoker, presented to us with clearly visible photodermatosis and partially deep wrinkles on the décolleté. The treatments with Hyal ACP were carried out intradermally on the décolleté including the lower neck region after local anaesthesia with tetracaine cream using injection needles (Becton Dickinson 4 mm, 30 G) - depending on the requirements in a linear or punctual injection technique at a puncture angle of approximately 40 to 45 degrees. Approximately two millilitres of Hyal ACP (two-percent hyaluronic acid sodium salt solution) were used per session, corresponding to two pre-filled syringes per session. The injections took place on weeks 0, 2 and 6. After two and eight weeks, the skin findings were compared with the initial findings at week 0 - in each case before the Hyal ACP injections.
At the beginning, the patient's skin showed the following findings on a four-point scale (0 = not present, 1 = mild, 2 = moderate, 3 = severe): Actinic elastosis (2 points), loss of elasticity (2 points) and age-related skin dryness (2 points). In addition, the skin appeared clearly reddened due to frequent exposure to sunlight (Fig. 1). After just two weeks, the findings of actinic elastosis, loss of elasticity and age-related skin dryness had each improved by one point from moderate to mild (Fig. 2). The improved skin appearance remained unchanged over the entire treatment period until the last appointment after eight weeks. The photo documentation shows a significantly younger appearance of the skin and a much smoother surface structure due to the reduced wrinkle depth and improved elasticity (Fig. 1b). Although the patient continued to be exposed to sunlight during the treatment period, the reddening of the décolleté had visibly diminished eight weeks after the start of treatment. Apart from slight injection-related swelling, which subsided after a few days, there were no side effects. The patient rated the pain intensity on an 11-point scale (from 0 = no pain to 10 = very severe pain) as almost painless with two points.
Hyal ACP has a high priority in the rejuvenation treatment of the décolleté
We have had good experience with the use of Hyal ACP on the décolleté for various reasons: firstly, the good injectability and tolerability of the injected material offers a high degree of safety when used on this very sensitive area of skin. On the other hand, Hyal ACP makes it possible to counteract elastotic skin changes, which occur particularly early in the décolleté area as a result of sun exposure. The excellent spreadability and high fluidity of Hyal ACP supports the regeneration process in the area. The treatment cycles described by us can be repeated at intervals of around six months for long-term skin rejuvenation.
In the patient described here, Hyal ACP produced an impressive visual rejuvenation of the skin on the décolleté. With reference to the positive stimulation of keratinocytes found by Wohlrab et al [8] in in vitro studies, positive effects can also be expected in vivo and thus provide indications of a possible strengthening of the barrier function by Hyal ACP. Whether intradermal treatment with hyaluronic acid also has positive effects on other age-related losses of physiological skin functions, such as reduced blood circulation, declining immune function, increased susceptibility to infection and impaired wound healing, should be investigated in larger-scale long-term studies.
Source: Plastic Surgery, July 2014
Dr Michaela Montanari will lead the above-mentioned workshop and lecture
Dr Michaela Montanari will lead the above-mentioned workshop and lecture
Interview on the subject of breast augmentation
Interview with Dr Montanari
Messages from 2013
The event for doctors will take place on 30.11.013 in the private practice for plastic and aesthetic surgery in Bochum. Dr Montanari will guide you through the programme with a lecture, live treatment and hands-on training.
On 23.11.2013, the workshop on wrinkle treatment by experienced doctors will take place at the Laser Centre Berlin-Köpenick. The moderator, live demonstration and hands-on training will be provided by expert Dr Michaela Montanari from Bochum.
On 22 November 2013, the workshop on wrinkle treatment for doctors with the indication mouth will take place at the MKG-Fachwerk, Berlin. Moderation, live demonstration and hands-on training will be provided by the expert Dr Michaela Montanari.
On 20 November 2013, the closed practice team completed further training on the management of emergency measures in medical practices with practical emergency exercises.
On 6 November 2013, the workshop "Radiesse training for advanced doctors" will take place in the private practice for plastic and aesthetic surgery. Dr Montanari will use models to demonstrate special techniques for injecting various regions, including the use of atraumatic cannulas.
Dr Michaela Montanari and her practice for plastic and aesthetic surgery are featured in the special Beauty supplement of the Women's magazine Gala (issue 39 - 19/09/2013) presented in a portrait.
Lecture Volume4Volume - XIII Spring Academy of the Association of German Aesthetic Plastic Surgeons
Ultherapy is suitable for all those who do not yet want to undergo surgery but still want a fresher, younger appearance.
Sagging areas of skin, e.g. on the face, neck, décolleté and upper arms, can be gently and effectively tightened using this innovative treatment method. Focussed ultrasound is used to tighten tissue and produce new collagen. This procedure has been approved by the US Food and Drug Administration (FDA) as the only non-invasive lifting procedure to date. Dr Montanari's practice is one of the few in Germany to use this innovative form of treatment.
Messages from 2012
Messages from 2011
"Beauty doesn't just come from within"
Woman In The City 11.2011, page 30
In addition to natural skin ageing, stress factors, smoking and sun/solarium are also responsible for the development of wrinkles. Nowadays, however, you don't have to suffer from annoying facial wrinkles. There are various treatments available for the treatment of annoying facial wrinkles (frown lines, forehead wrinkles, nasolabial folds, mouth area) through to lip augmentation and volume enhancement in the face, which can even partially replace a facelift and problem areas on the décolleté or hands.
The product range for wrinkle treatment is very large, with new products being added at regular intervals, so that the market now comprises over 150 different products. The user is therefore forced to critically scrutinise these products with regard to their health safety. But quality in wrinkle treatment is the top priority In addition to her many years of running the wrinkle consultation in Düsseldorf, Dr Montanari runs courses for doctors on wrinkle injections and is a member of the nationwide council of experts on the treatment of complications following fillers.
A free information event on this topic will take place on 15 November 2011 at 6.30 p.m. at the practice, with a request for advance registration.
Source: Woman In The City 11.2011, page 30
"The V effect - volume substitution restores a youthful appearance to the face"
ÄsthetikaForum August 2011
As part of the ageing process, the skin not only loses tone and elasticity, but all the layers involved also atrophy. It is therefore not enough to fill in individual wrinkles. Radiesse filler is ideal for correcting lost volume.
Source: ÄsthetikaForum, August 2011
"Wrinkle treatment - what works best where?"
Dermatology & Plastic Surgery 4 I 2011
Today, facial wrinkles can be treated in a variety of ways. While botulinum toxin A is suitable for treating mimic wrinkles, static wrinkles require cross-linked hyaluronic acid or a filler based on calcium hydroxyapatite.
There are numerous options available today for the treatment of facial wrinkles. However, as Dr Michaela Montanari, plastic surgeon in Bochum, emphasises, the large number of products requires regular and critical examination of the constantly growing range. Botulinum toxin A is suitable for the prevention and treatment of mimic wrinkles. It is usually applied to the upper part of the face. However, botulinum toxin can also be used in the lower half of the face, although this requires experience, according to Dr Montanari. Above all, it is important not to impair the patient's natural facial expressions. It is also important to consider the safety profile of the specific product in view of the numerous options available. Another option is natural hyaluronic acid for biorevitalisation and mesotherapy of larger areas of skin.
Dr Montanari: "However, there are signs of skin ageing for which native hyaluronic acid is not sufficient." Cross-linked hyaluronic acid, on the other hand, is suitable for augmenting individual, static wrinkles. Which product is the most suitable in a specific case depends on the depth of the wrinkles. Finally, calcium hydroxyapatite can be used to augment deep wrinkles and even perform a so-called "liquid face lift" and restore facial structures. "There is now a consensus that resorbable fillers should be used. The aim of these procedures is to satisfy the patient, so care should be taken to use the right materials", says Dr Montanari.
The Merz programme covers the entire spectrum of substances available for wrinkle treatment. Bocouture® is pure botulinum toxin A, contains only active neurotoxin, is free of complex proteins and is characterised by rapid onset of action and high stability. Bocouture® is approved for the treatment of glabellar lines and can be stored at room temperature. No cold chain is required, which eliminates the risk of treatment failure or product destruction due to errors in maintaining the cold chain. Due to the low content of foreign proteins, BTX-A from Merz has a low immunogenic potential.
Belotero® is the first filler with innovative CPM® technology (Cohesive Polydensified Matrix) and is available in soft, basic and intense versions. This makes Belotero® suitable for correcting both small superficial and deep wrinkles. Belotero® intense can also be used for volume build-up and contour levelling. Thanks to the CPM® technology, the degradable, multi-cross-linked hyaluronic acid in Belotero® is processed into a cohesive gel with different viscosities that is particularly easy to inject into the skin. Thanks toCPM® , the injected Belotero® gel is particularly stable and ensures a long-lasting cosmetic result.
Radiesse® is a volume filler consisting of a gel matrix (cellulose-based with water and glycerine) and the active ingredient calcium hydroxyapatite. Both components are biocompatible and completely biodegradable. Radiesse ® does not contain any animal products, so an allergy test is not necessary before use. The effectiveness in the form of an effective volume build-up to correct volume and contour deficits is confirmed by comprehensive studies. Radiesse® has been approved by the FDA since 2006.
"Radiesse® has gained an important place in our daily practice in facial volume substitution and is an excellent complement to Belotero products", comments Dr Markus Klöppel from the Department of Plastic Surgery at Martha-Maria Hospital in Munich.
Source: Report: Reno Barth - Symposium of Merz Pharmaceuticals GmbH, "Wrinkle treatment: What works best where?", 30 September 2011,
and "Wrinkle correction and volume substitution in the face", 1 October 2011, Frankfurt/Main - 49th Annual Conference of the ÖGPÄRC, Innsbruck - der110400
"The secret of attractiveness and charisma"
Sausage King, 01/2011
When the first rays of sunshine beckon, experience shows that people take a more critical look at their appearance. Both men and women check the suitability of their figure and skin, because everyone wants to look fresh, fit and healthy.
Given that freshness and well-being are reflected in your appearance, it is no secret that attractiveness and success in your private and professional life are closely linked. It is therefore not surprising that people are looking for ways to get much closer to this goal. A combination of high-quality, healthy nutrition with vitamins and trace elements as well as exercise and fitness seems to be an indispensable prerequisite. Unfortunately, this often doesn't achieve everything, so people look for simple but effective ways to correct their beauty. And sometimes you can give nature a little help. In addition to targeted wrinkle treatments or facial volume enhancements, there are also various toning and revitalisation measures to make your skin appear fresher and firmer.
Source: Wurst König, 01/2011
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"Complications caused by permanent fillers in the face - alternatives"
Plastic Surgery 06/2010, Kaden-Verlag
Authors: Michaela Montanari, Andreas Arens, Jutta Liebau
Complications in the facial area caused by the injection of permanent fillers are often associated with disfiguring effects for the patient and a therapeutic challenge for the doctors treating them. The first treatments to alter the face were carried out as early as 1900. This certainly took place under different conditions, with different methods and different products than is the case today. Since then, the development of the product range has been in a constant state of flux. New products are launched on the market at regular intervals, so that there is now a large number of degradable and non-degradable filling substances. Although these materials are CE-certified medical products that are subject to the Medical Devices Act [1] in terms of their potential requirements, they are not prescription drugs. Users are therefore obliged to critically examine the products they use, particularly with regard to their health safety.
Late complications occur more frequently with the use of permanent fillers compared to non-permanent fillers
Indications for the use of filling materials include aesthetic aspects. The focus here is on treatments that aim to maintain youthfulness and attractiveness even in old age. The frequently held view that an attractive appearance helps to achieve success in professional life and can therefore be conducive to a professional career should also not be neglected these days. It is therefore not surprising that men are also increasingly undergoing such primarily aesthetic treatments. On the other hand, there are medical indications, for example to compensate for the formation of wrinkles after severe weight loss, for fat distribution disorders (lipodystrophies) or autoimmune diseases associated with tissue dystrophies (e.g. lupus profundus) as well as acquired or congenital facial asymmetries (e.g. facial nerve palsy).
Non-biodegradable filling materials, so-called permanent fillers, can be divided into three groups:
- Injectable silicone (PMS 350®, Bioplastique®)
- Preparations containing methacrylic (Artecoll®)
- Mixed products of absorbable and permanent substances (Dermalive®, Evolution®)
In contrast to non-permanent fillers, late complications occur more frequently with the use of permanent fillers. These often develop years after treatment and often lead to unforeseeable, permanent and dramatic problems for the patient. As a result, complex surgical measures are often required, involving multiple surgical steps and complex reconstructive procedures, particularly in the facial area. In our clinic, we regularly see patients with complications following the use of permanent filling materials in the face and other areas of the body. The following are some examples of pronounced consequences after injections of various permanent filling materials (Artecoll®, Dermalive® and DIY silicone) in the face.
Four years after the Artecoll treatment, disturbing hardenings and lumps developed
The first example shows a 50-year-old female patient after augmentation of her glabellar fold with Artecoll. This treatment was carried out ten years earlier for aesthetic reasons. It was not until four years later that disturbing hardening and lumps developed in the injected area. These granulomas were subsequently excised externally several times. With a pronounced tendency for these nodules to recur, the patient presented to our consultation with disturbing and painful granulomas. The patient was psychologically distressed. Soft tissue indurations were disturbing and prolapsed into the medial corner of the eyelid (Fig. 1a-c). The scars following excisions in the glabellar region were also disturbing. The current appearance caused the patient much more suffering than before the initial aesthetic treatment. Due to the multiple unsuccessful extirpations, we initially carried out conservative treatment with strictly intralesional cortisone therapy at six-week intervals. The course of a possible regression of the granulomas due to the cortisone therapy should be awaited before further interventions.
In a 47-year-old female patient, large, hard tumours were found on both sides of the cheekbone/cheek region
The next case study concerns a 47-year-old female patient who underwent augmentation of her zygomatic regions with Dermalive ten years ago. A few years after the treatment, she developed recurrent abscesses with persistent fistula on the left side (Fig. 2a-k). Furthermore, the patient complained of severe pain in the zygomatic region. The clinical examination revealed large, hard tumours on both sides of the zygomatic cheek region, which were not displaceable on the support. Surgical revision with a preauricular approach was performed to remove the soft tissue tumours. The surgical procedure revealed pronounced diffuse adhesions with infiltration of the zygomatic periosteum and the surrounding musculature, in particular the major and minor zygomatic muscles and surrounding vessels and nerves, so that we were unable to perform a complete extirpation. As the soft tissue trauma caused by the operation was already very pronounced, we initially limited the procedure to the removal of the largest foreign body conglomerates. Histological processing of the specimen revealed the suspected foreign body reaction. In the further course, there was a clear regression of the initially very pronounced soft tissue swelling and haematoma. The patient requested a repeat operation with the aim of further removing the infiltrating granulomas. The second operation was performed one year later with residual granuloma removal, lid edge elevation on the left by means of wedge excision on the lower eyelid and suspension of an entepithelialised tarsal strip on the bony orbital rim. The resulting contour asymmetry was corrected with an autologous fat transplant (45 ml) six months later.
The patient revealed that augmentation with a medical device had been too expensive for her
The medical history of a 46-year-old female patient who presented with redness, telangiectasia, multiple soft tissue indurations and pain in the face and chest following injection of liquid silicone five years ago was impressive (Fig. 3a-f). She also complained of progressive visual field loss. The patient told us that augmentation of the two body regions with a medical device had been too expensive for her. For this reason, she went to a DIY store and purchased a liquid silicone product. She had not thought about the possible differences between DIY products and medical products. Finally, a good acquaintance - after explicit enquiry, the woman explained that it was not a doctor - injected her with this product for beautification. Multiple foreign body granulomas were removed during an operation lasting several hours. Over the course of the operation, there was a significant improvement in the symptoms, in particular the visual field restriction and the telangiectasia. The last case example illustrates the need for a precise medical history in order to determine which products were used.
Hyaluronic acid can be used to achieve aesthetic results that are satisfactory for the patient
In contrast to resorbable fillers, the use of permanent materials generally requires a single treatment, which ideally produces a reaction-free result. Nevertheless, treatments with permanent filling materials are associated with a higher complication rate [2] and the risk of late effects [3] with irreversible soft tissue damage. For this reason, we believe that alternative procedures for volume augmentation should be considered. Autologous substances such as autologous fat or dermis grafts as well as heterologous biodegradable materials such as hyaluronic acid or collagen are available for this purpose and can lead to satisfactory results with few complications [4]. In our experience, hyaluronic acid can be used to achieve aesthetic results that are satisfactory for the patient. Possible side effects are essentially limited to reversible complications that can occur when using such products. These include redness, swelling, pain and haematomas. We have not observed any allergic reactions, skin necrosis, infections or discolouration in our patients.
If the malar fat body shrinks, the patient's own fat can be used to compensate for the volume deficit
Another option for levelling out contour irregularities is the use of autologous fat [5, 6]. HIV patients in particular suffer from stigmatisation due to the loss of the malar fat body - most likely in the context of antiviral medication. Here, autologous fat can be used to achieve good compensation of the volume deficit (Fig. 4a,b).
Another option for using autologous tissue as a filling material is the use of dermis grafts as a resorption-resistant filling material. In lupus panniculitis, a rare autoimmune disease that is often associated with systemic lupus erythematosus, scarring of the subcutaneous fat and the deep dermis leads to corresponding defects with predilection in the face and extremities, which can be easily compensated for with a dermis graft. In the case of any pre-existing scars, this provides a suitable approach for harvesting an appropriate graft. In the patient presented (Fig. 5- f), we were able to harvest a 12 x 8 cm graft from the lower abdomen via an existing section scar, deepithelialised and divided so that adequate volume augmentation was available for both halves of the face. Fixation was carried out with a knot using a preparation swab.
Complications should always be reported in filler portals
To summarise, permanent fillers carry the risk of pronounced late complications - often associated with irreversible soft tissue damage. Due to the variety of materials available today, we therefore do not recommend the use of permanent fillers. Instead, degradable substances or the body's own tissue should be used, which in our experience can only lead to reversible complications such as swelling, redness or haematomas.
Complications that are observed after the use of permanent and non-permanent filling materials should always be reported in so-called filler portals such as www.bfarm.de, www. zentralregister-filler.de, www.fillerwelt.de. In addition to the product manufacturers, doctors as users and aftercare providers of such complications as well as the patients themselves should feel addressed. Once the complications and filling substances have been registered, they will be analysed to provide users and patients with valuable information on the frequency of side effects, the type of complications following wrinkle injections in particular and information on treatment options. Due to the growing number of products available and the current increase in treatment numbers, the use of such reporting registers is an indispensable tool for carrying out reliable, low-complication and therefore patient-orientated treatments.
Literature
- Medical Devices Act (in the version published on 7 August 2002 (Federal Law Gazette I, p. 3146), last amended by Article 6 of the Act of 29 July 2009 (Federal Law Gazette I, p. 2326). [http://bundesrecht.juris.de/ bundesrecht/mpg/gesamt.pdf]
- Heinz BC, Ladhoff U, Kahl CH, et al (2008) Incident reports on injectable filling materials, evaluation of the medical device monitoring and reporting system in Germany. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 51: 787-792 (Federal Institute for Drugs and Medical Devices, Bonn)
- Wiest LG (2009) Spectrum of complications after treatment with injectable filling materials. J Aesthet Chir 2: 95-104
- Lemperle G, Morhenn VB, Charrier U (2003) Human histology and persistence of various injectable filler substances for soft tissue augmentation. Aesth Plast Surg 27: 354
- Coleman SR (1995) Long term survival of fat transplants: Controlled demonstrations. Aesth Plast Surg 19: 421-425
- Coleman SR (1997) Facial recontouring with lipostructure. Clin Plast Surg 24: 347-367
Source: Plastische Chirurgie 06/2010, Kaden-Verlag
"Complications caused by permanent fillers in the face - alternatives"
Face International magazine of orofacial esthetics, 3/2010, Oemus Verlag
Authors: Dr Michaela Montanari, Dr Andreas Arens, Prof. Dr Jutta Liebau, Düsseldorf
Complications in the facial area caused by the injection of permanent fillers are often associated with disfiguring effects for the patient and a therapeutic challenge for the treating physicians.
The first treatments to change the face were carried out as early as 1900. This certainly took place under different conditions, with different methods and different products than is the case today. Since then, the development of the product range has been in a constant state of flux. New products are launched on the market at regular intervals, so that there is now a wide range of degradable and non-degradable filling substances. Although these materials are CE-certified medical devices that are subject to the Medical Devices Act1 with regard to their potential requirements, they are not prescription drugs. Users are obliged to critically examine the products they use, particularly with regard to their health safety.
Indications for the use of filling materials include aesthetic aspects. The focus here is on treatments to maintain youthfulness and attractiveness even in old age. The frequent view that an attractive appearance can help to achieve success in professional life and thus promote a professional career should also not be ignored nowadays. It is therefore not surprising that men are also increasingly undergoing these treatments.
On the other hand, there is a medical indication, for example, in the compensation of wrinkle formation after severe weight loss, fat distribution disorders (lipodystrophies), autoimmune diseases associated with tissue dystrophies (e.g. lupus profundus), as well as acquired or congenital facial asymmetries (e.g. facial nerve palsy).
Non-biodegradable filling materials, so-called permanent fillers, can be divided into three groups:
- Injectable silicone (PMS 350®, Bioplastique®)
- Preparations containing methacrylic (Artecoll®)
- Mixed products of absorbable and permanent substances (Dermalive®, Evolution®)
In contrast to non-permanent fillers, late complications occur more frequently with the use of permanent fillers. These often develop years after treatment and often lead to unforeseeable, permanent and dramatic problems for the patient. As a result, complex surgical measures are often required, combined with multiple surgical steps and complex reconstructive procedures, particularly in the facial area.
We regularly see patients with complications following the application of permanent filling materials to the face and other areas of the body in our consultation hours.
In the following, examples with pronounced consequences after injections of permanent filling materials (Artecoll®, Dermalive® and DIY silicone) in the face are demonstrated.
Case study 1
Example 1 shows a 50-year-old female patient after augmentation of her glabellar fold with Artecoll®. This treatment was carried out ten years ago for aesthetic reasons. It was not until four years later that disturbing hardening and lumps developed in the injected area. These granulomas were subsequently excised externally several times. With a pronounced tendency for these nodules to recur, the patient presented to our consultation with disturbing and painful granulomas. The patient was psychologically distressed. Soft tissue indurations were disturbing and prolapsed into the medial corner of the eyelid (Fig. 1a-c). The scars following excisions in the glabellar region were also disturbing. The current appearance caused the patient much more suffering than before the initial aesthetic treatment.
Due to the multiple unsuccessful extirpations, we initially carried out conservative treatment with strictly intralesional cortisone therapy at six-week intervals. The course of a possible regression of the granulomas due to the cortisone therapy should be awaited before further interventions.
Case study 2
The other case study concerns a 47-year-old female patient who had her zygomatic regions augmented with Dermalive® ten years ago. A few years after the treatment, she developed recurrent abscesses with persistent fistula on the left side (Fig. 2a-c). Furthermore, the patient complained of severe pain in the zygomatic region. Clinical examination revealed large, hard tumours on both sides in the zygomatic cheek region, which were not displaceable on the underlying surface.
Surgical revision with a preauricular approach was performed to remove the soft tissue tumours. The surgical procedure revealed pronounced diffuse adhesions with infiltration of the zygomatic periosteum and the surrounding musculature, in particular the zygomatic major and minor muscles (Fig. 3), and surrounding vessels and nerves, so that we were unable to perform a complete extirpation. The soft tissue trauma caused by the operation was already very pronounced (Fig. 4), so we initially limited the procedure to removal of the largest foreign body conglomerate (Fig. 5). Histological processing of the specimen revealed the suspected foreign body reaction.
In the further course, there was a clear regression of the initially very pronounced soft tissue swelling and haematomas. The patient requested a repeat operation with the aim of further possible removal of the infiltrating granulomas. The second operation was performed one year later with residual granuloma removal, lid edge elevation on the left by means of wedge excision on the lower eyelid and suspension of an entepithelialised tarsal strip on the bony orbital rim (Fig. 6a, b).
The resulting contour asymmetry was equalised with an autologous fat graft (45 ml) six months later (Fig. 7a-c).
Case study 3
The medical history of a 46-year-old female patient who presented with redness, telangiectasia, multiple soft tissue indurations and pain in the face (Fig. 8a-c) and breast following injection of liquid silicone five years ago was impressive. She also complained of progressive visual field loss.
The patient told us that the augmentation of the two body regions with a medical product had been too expensive for her. For this reason, she went to a DIY store and purchased a liquid silicone product. She had not thought about the possible differences between DIY products and medical products. Finally, a good acquaintance (who was not a doctor after she expressly asked) injected her with this product for beautification.
Multiple foreign body granulomas were removed during an operation lasting several hours. In the further course (Fig. 9, 10) there was a significant improvement in the symptoms, in particular the visual field restriction and the telangiectasia (Fig. 11).
The last case study certainly clearly demonstrates the need for a precise medical history in order to determine which products were used.
Compared to resorbable fillers, the use of permanent materials generally requires a single treatment, which ideally produces a reaction-free result. Nevertheless, treatments with permanent filling materials are associated with a higher complication rate.2 and the risk of late effects3 with irreversible soft tissue damage.
Alternative procedures for volume augmentation
For this reason, we believe that alternative procedures for volume augmentation should be considered. Autologous substances such as autologous fat or dermis grafts or heterologous biodegradable materials (hyaluronic acid, collagen) are available for this purpose and can lead to satisfactory results with few complications.4
In our experience, good and satisfactory results can be achieved with hyaluronic acid. Possible complications are essentially limited to the general complications that can occur when using such products. These include redness, swelling, pain and haematomas. We have not observed any allergic reactions, skin necrosis, infections or discolouration in our patients.
Another option for levelling out contour irregularities is the use of autologous fat.5, 6
Case study 4
HIV patients in particular suffer from stigmatisation due to the loss of the malar fat body, which is most likely to occur during antiviral medication. Here, the volume deficit can be well compensated for with autologous fat (Fig. 12a and b).
Case study 5
Another option for using autologous tissue as a filling material is to use dermis grafts as a resorption-resistant filling material.
In lupus panniculitis, a rare autoimmune disease that is often associated with systemic lupus erythematosus, scarring of the subcutaneous fat and the deep dermis leads to corresponding defects with predilection on the face and extremities, which can be easily compensated for with a dermis graft. In the case of any pre-existing scars, this provides a suitable approach for harvesting an appropriate graft. In the patient shown in the images (Fig. 13a and b), we were able to harvest a 12 x 8 cm graft from the lower abdomen by accessing an existing section scar, deepithelialising and dividing it so that adequate volume augmentation was available for both halves of the face (Fig. 14 a-c). Fixation was achieved by knotting using a dissection swab (Fig. 15).
Conclusion
To summarise, permanent fillers carry the risk of pronounced late complications, often associated with irreversible soft tissue damage. Due to the variety of materials available, we do not recommend the use of permanent fillers over the use of biodegradable substances and the body's own tissue.
Instead, degradable substances or the body's own tissue should be used, which in our opinion can only lead to reversible complications.
Complications that occur and are observed after the use of permanent and non-permanent filling materials should be reported in so-called filler portals such as www. bfarm.de, www.zentralregister-filler.de, www.fillerwelt.de. In addition to the product manufacturers, doctors should feel addressed as users and aftercare providers of corresponding complications as well as the patients themselves. Once the complications and filling substances have been registered, they are analysed to provide users and patients with valuable information on the frequency of side effects, the type of complications after wrinkle injections in particular and information on treatment options.
Due to the growing variety of available product ranges and the current increase in treatments, the use of such registers is an indispensable tool for carrying out reliable, low-complication and therefore patient-orientated treatments.
Literature
[1] Medical Devices Act in the version published on 7 August 2002 (Federal Law Gazette I p. 3146), last amended by Article 6 of the Act of 29 July 2009 (Federal Law Gazette I p. 2326), status: revised by notification of 7.8.2002 I 3146; last amended by Art. 6 G of 29.7.2009 I 2326
[2] B. C. Heinz1 - U. Ladhoff1 - Ch. Kahl2 - B. Rzany2 - D. von Mallek1, Bundesgesundheitsbl - Gesundheitsforsch - Gesundheitsschutz 2008 - 51:787-792, 1Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, BRD - 2 dEBM, Klinik für Dermatologie, Venerologie und Allergologie, Charité Berlin, BRD Incident reports on injectable filling materials, evaluation of the medical device monitoring and reporting system in Germany
[3] Wiest, L.G. (2009) Spectrum of complications after treatment with injectable filling materials J Aesthet Chir 2:95-104
[4] Lemperle G, Morhenn VB, Charrier U (2003) Human histology and persistence of various injectable filler sunstances for soft tissue augmentation, Aesth Plast Surg 27:354
[5] Coleman SR (1995) Long term survival of fat transplants: Controlled demonstrations. Aesthetic Plast Surg: 421-425
[6] Coleman SR (1997) Facial recontouring with lipostucture, Clin. Plast Surg. 24,2: 347-67
Source: face, 3_2010