Reações adversas vasculares e não vasculares a preenchedores de face: revisão sistemática de relatos de caso
Data
2022-11-24
Autores
Cruz, Ana Paula Silveira 
Orientadores
Yarak, Samira
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Fundamento: O preenchimento cutâneo facial é um dos procedimentos cosméticos
minimamente invasivos mais comuns. Apresenta popularidade crescente por
promover o rejuvenescimento da pele com menor downtime. Entretanto, à medida
que as indicações, o número de produtos comercialmente disponíveis e o número de
procedimentos realizados aumentam há, proporcionalmente, um aumento do risco
de surgimento de reações adversas moderadas a graves a esses biomateriais.
Objetivo: Identificar e analisar os relatos de caso sobre reações adversas
vasculares e não vasculares causadas por preenchedores e bioestimuladores em
face, e seus tratamentos. A partir do conhecimento destes dados epidemiológicos,
identificar possíveis fatores que poderiam causar ou potencializar determinadas
reações adversas, e identificar condutas ou tratamentos com maior ou menor
sucesso na resolução desses casos. Métodos: Revisão sistemática de relatos e
série de casos realizada segundo a metodologia proposta pelo Cochrane Handbook
for Systematic Reviews of Interventions sobre reações adversas vasculares e não
vasculares causadas por intervenções estéticas do tipo preenchimento cutâneo na
face de adultos previamente hígidos, realizado por qualquer profissional de Saúde,
em qualquer intervalo de tempo após a realização do procedimento. As seguintes
bases de dados eletrônicas foram buscadas: Medline, Embase, CENTRAL,
clinicaltrials.gov, Opengrey e Anais de congressos da área. O processo de seleção e
extração dos dados foi realizado em duplicata de forma independente. Um formulário
de extração de dados padronizado foi utilizado e a avaliação da qualidade da
publicação dos relatos e das séries de casos incluídos foi feita utilizando a
ferramenta CARE. Resultados: Foram incluídos 378 casos (relatados em 251
estudos) de reações adversas vasculares e não vasculares. Destes, 96 casos foram
de reações vasculares, 270 de não vasculares e 12 casos não identificaram o tipo de
reação. Nas reações vasculares, foi possível observar o predomínio das reações
causadas por Ácido Hialurônico. No entanto, a gordura autóloga apresentou maior
risco de causar perda visual, evento adverso mais impactante para o paciente.
Dentre as reações adversas não vasculares, foi possível observar o predomínio das
reações tardias e, nestas, uma prevalência maior do uso de substâncias não
biodegradáveis. Os tratamentos descritos, tanto para as reações não vasculares
viii
como vasculares, foram uma combinação de medicamentos e/ou procedimentos, o
que dificultou análises mais aprofundadas a respeito dos tratamentos de maior
sucesso.. Conclusões: Os profissionais devem ter conhecimento adequado das
reações adversas vasculares e não vasculares que apresentam risco moderado a
grave. O entendimento dessas reações adversas possibilitará manejo precoce na
condução da prevenção.
Background: Facial skin filling is one of the most common minimally invasive cosmetic procedures. It has growing popularity for promoting skin rejuvenation with less downtime. However, as the indications suggest, as the number of commercially available products and the number of procedures performed increase, there is a proportionally increased risk of moderate to severe adverse reactions to these biomaterials. Objective: To identify and analyze case reports on vascular and non-vascular adverse reactions caused by fillers and biostimulators on the face, and their treatments. From the knowledge of these epidemiological data, identify possible factors that could cause or aggravate certain adverse reactions, and identify conducts or treatments with greater or lesser success in solving these cases. Methods: Systematic review of reports and case series carried out according to the methodology proposed by the Cochrane Handbook for Systematic Reviews of Interventions on vascular and non-vascular adverse reactions caused by the application of skin fillers on the face of previously healthy adults, performed by any health care professional. The following electronic databases were searched: Medline, Embase, CENTRAL, clinicaltrials.gov, Opengrey and Annals of congresses in the area. The process of selecting and extracting the data was performed in duplicate independently. A standardized data extraction form was used and the publication quality assessment of the included case reports and series was performed using the CARE tool. Results: 378 cases (reported in 251 studies) of vascular and non-vascular adverse reactions were included. Of these, 96 cases were vascular reactions, 270 non-vascular reactions and 12 cases did not identify the type of reaction. In vascular reactions, it was possible to observe the predominance of reactions caused by hyaluronic acid. However, autologous fat had a higher risk of causing visual loss, the most impacting adverse event for the patient. Among the non-vascular adverse reactions, it was possible to observe the predominance of late reactions and, in these, a higher prevalence of the use of non-biodegradable substances. The treatments described, both for non-vascular and vascular reactions, were a combination of drugs and/or procedures, which made in-depth analysis of the most successful treatments challenging. Conclusions: Professionals should have adequate knowledge of vascular and non-vascular adverse reactions that present moderate to severe risk. The understanding of these adverse reactions will enable early management in the conduct of prevention.
Background: Facial skin filling is one of the most common minimally invasive cosmetic procedures. It has growing popularity for promoting skin rejuvenation with less downtime. However, as the indications suggest, as the number of commercially available products and the number of procedures performed increase, there is a proportionally increased risk of moderate to severe adverse reactions to these biomaterials. Objective: To identify and analyze case reports on vascular and non-vascular adverse reactions caused by fillers and biostimulators on the face, and their treatments. From the knowledge of these epidemiological data, identify possible factors that could cause or aggravate certain adverse reactions, and identify conducts or treatments with greater or lesser success in solving these cases. Methods: Systematic review of reports and case series carried out according to the methodology proposed by the Cochrane Handbook for Systematic Reviews of Interventions on vascular and non-vascular adverse reactions caused by the application of skin fillers on the face of previously healthy adults, performed by any health care professional. The following electronic databases were searched: Medline, Embase, CENTRAL, clinicaltrials.gov, Opengrey and Annals of congresses in the area. The process of selecting and extracting the data was performed in duplicate independently. A standardized data extraction form was used and the publication quality assessment of the included case reports and series was performed using the CARE tool. Results: 378 cases (reported in 251 studies) of vascular and non-vascular adverse reactions were included. Of these, 96 cases were vascular reactions, 270 non-vascular reactions and 12 cases did not identify the type of reaction. In vascular reactions, it was possible to observe the predominance of reactions caused by hyaluronic acid. However, autologous fat had a higher risk of causing visual loss, the most impacting adverse event for the patient. Among the non-vascular adverse reactions, it was possible to observe the predominance of late reactions and, in these, a higher prevalence of the use of non-biodegradable substances. The treatments described, both for non-vascular and vascular reactions, were a combination of drugs and/or procedures, which made in-depth analysis of the most successful treatments challenging. Conclusions: Professionals should have adequate knowledge of vascular and non-vascular adverse reactions that present moderate to severe risk. The understanding of these adverse reactions will enable early management in the conduct of prevention.