title: Complications After Facial Injections With Permanent Fillers: Important Limitations and Considerations of MRI Evaluation.
abstract: BACKGROUND
  Soft-tissue fillers have become more prevalent for facial augmentation in the last 2 decades, even though complications of permanent fillers can be challenging to treat. An investigative imaging tool could aid in assessing the nature and extent of these complications when clinical findings are ambiguous.
  
  
  OBJECTIVE
  The authors analyzed the value of magnetic resonance imaging (MRI) in the assessment of delayed-onset complications after injection of patients with permanent fillers.
  
  
  METHODS
  Thirty-two patients with complications related to facial fillers were evaluated in this prospective cohort study. Their medical history was documented, and MRI was conducted before treatment of the complications. Radiologists were informed of the injection sites but were blinded to the results of other clinical evaluations. Levels of agreement between clinical and radiologic findings were calculated with the Jaccard similarity coefficient.
  
  
  RESULTS
  A total of 107 site-specific clinicoradiologic evaluations were analyzed. The level of agreement was assessed as strong for deposits without complications and noninflammatory nodules (combined 85%), moderate for abscesses (60%), fair for low-grade inflammations (32%), and slight for migrations (9%). Results from the MRI examinations aided in subsequent treatment decisions in 11% of cases.
  
  
  CONCLUSIONS
  Study results show that MRI may be useful for diagnosing complications associated with fillers that have migratory potential, for depiction of the extent of deposits before treatment, and for follow-up of low-grade inflammation and abscesses after surgery.
  
  
  METHODS
  3.
authors.affiliation: Dr J.A. Kadouch is a resident, Division of Dermatology, Free University Medical Center, Amsterdam, Netherlands j.kadouch@vumc.nl.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Kadouch
authors.affiliation: Dr Tutein Nolthenius is a resident in a teaching hospital, Division of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.
authors.forename: Charlotte J
authors.initials: CJ
authors.lastname: Tutein Nolthenius
authors.affiliation: Dr D.J. Kadouch is a resident, Division of Dermatology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kadouch
authors.affiliation: Dr van der Woude is a radiologist in a teaching hospital, Division of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.
authors.forename: Henk-Jan
authors.initials: HJ
authors.lastname: van der Woude
authors.affiliation: Dr Karim is a plastic surgeon in private practice in Amstelveen, Netherlands.
authors.forename: Refaat B
authors.initials: RB
authors.lastname: Karim
authors.affiliation: Dr Hoekzema is the Head of the Division of Dermatology, Free University Medical Center and Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Rick
authors.initials: R
authors.lastname: Hoekzema
mesh_terms: D000328:Adult; D000368:Aged; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D005549:Foreign-Body Reaction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007279:Injections, Subcutaneous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012060:Rejuvenation; D015203:Reproducibility of Results; D016896:Treatment Outcome
chemical_list: D000067548:Dermal Fillers
keywords: filler complication; filler migration; magnetic resonance imaging; permanent filler