"Filler Side Effects? Characteristics? You Really Need to Be Careful With Fillers. Filler Side Effects Seen Firsthand by a Plastic Surgeon" Intensive Analysis of the Bone Concavity Controversy in the Video! (feat. Chinese Paper) - 1

Not long ago, a video in which a plastic surgery clinic director shared his own claims about what he had seen and felt regarding fillers began circulating on YouTube, portals, SNS, and elsewhere, drawing a heated response. For many people who had been receiving filler procedures without thinking much of them, the content was rather shocking and enough to put them into something close to a panic.

What I want to cover here today is not whether #filler itself is the direct cause of bone concavity, that is, bone resorption, but rather a detailed look at the contents of a paper that he brought out to support his claim.

In Part 1, I will simply translate what it says, and in Part 2 I will discuss its academic value from the perspective of a board-certified plastic surgeon who performs #filler procedures.

The title of this paper is "Unexpected Chin Bone Resorption Caused by Soft Tissue Fillers," and it was published in October 2018 in China as a case report in Volume 38 of the Journal of Cosmetic and Aesthetic Surgery. If translated literally, it says:

-> Because East Asians prefer a fairy-like, pointed chin shape, they often undergo noninvasive soft tissue filler treatment or chin implant surgery for chin augmentation.

-> HA (hyaluronic acid) fillers are commonly used because they are generally safe and effective, but side effects can occur. From October 2016 to April 2018, we found nine cases in which #HAfillers were injected into the chin and caused bone resorption.

-> All nine people had received 1–3 cc of HA filler in the chin area one to three times, but no notable symptoms were observed. The areas of bone resorption were confirmed either on preoperative CT scans or directly with the eye during chin surgery, and what is interesting is that both sides of the central line in the chin were depressed.

-> The yellow arrows in the 3D CT point to the depressed areas.

-) HA filler is not particularly harmful to the body. Bone resorption caused by implants is already widely known, but bone resorption caused by HA filler has not yet been known.

Possible causes include:

1. A pressure-related phenomenon - periodic soft tissue filler injected deeply just above the bone and periosteum may act like a solid implant.

2. HA filler’s affinity for osteoclasts may disrupt the balance between bone-forming cells and bone-resorbing cells. In laboratory tests rather than in the human body, HA filler shows affinity for osteoclasts, and local clustering of these cells may induce gradual bone resorption.

3. Excessive movement of the chin muscle and poor lip function - bone resorption usually occurs a lot in the depressed areas below both canines. Because the chin muscle is not attached at the midline but to the depressed areas on both sides, it may have an effect on this bone resorption.

-> So far, we have not seen this bone resorption phenomenon in the midface or temporal regions. Therefore, regarding the possibility of bone resorption in the chin related to this:

1. Chin bone resorption may be somewhat related to continuous muscle movement. For example, bone resorption commonly seen with chin implants is rarely seen in the midface/temporal regions.

2. Soft tissue fillers are mainly injected deeply just above the bone and periosteum in the chin, but in the temporal and midface areas they are injected more superficially.

3. Therefore, there is no known information regarding bone resorption in the temporal region, so further research is needed.

I have translated the contents of the Chinese paper on bone resorption from chin fillers as literally as possible above.

In Part 2, I will share my personal opinion a little more as a plastic surgery specialist.