Tissue reaction after Ellanse filler (PCL filler)

What is it about?

PCL filler with lidocaine because not enough time may be available for the lidocaine solution to act and produce an immediate effect on pain control. The most important step in this method is the pre-mixing, which can change the properties of the original filler, especially that of the filler’s CMC constituent. The properties of the CMC gel are decided by the proportions of constituent water and glycerin. If the proportion of water were increased, gel viscosity consequently decreases, and its original function as carrier gel is lost. Depending on time, temperature and pH, a CMC gel is easily contaminated by microbes or molds and there few studies proving the safety of adding normal saline to CMC gels are available. Therefore, in my simple and novel technique, tumescent solution is injected, followed by PCL filler which preserves the original CMC property. This is done after sedation of the tissue by the tumescent solution and dissection of soft tissue to create a space for the ensuing PCL injection. After pre-injection (test-injection or hydro-dissention injection) with tumescent solution, histological analysis indicated that the tissue was not irritated by the foreign body material (PCL filler) or mechanical trauma caused by the needle. This is the key mechanism for reducing tissue reactions in the tumescent injection method, and may also reduce pain and swelling during and after PCL filler injections. 10 minutes after injection of tumescent solution, the solution will undergo spread and volume change will be minimized. Therefore, it is not necessary to worry about volume change after treatment with tumescent solution.

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Why is it important?

Important differences in, pain, edema, and ecchymosis were observed between treatment by PCL Injection after pre-injection with tumescent solution (left side of face) and pre-mixing PCL filler with lidocaine (right side of face). Severe swelling (mean score, 4.8), pain (mean score, 4.7) and ecchymosis (mean score, 4.2) were observed after premixing PLC with lidocaine in the right side of the face. Most injected areas on the left side show fewer signs of swelling (mean score, 3.2), pain (mean score, 2.4), and ecchymosis (mean score, 2.7) (Table 1, Figure 1). Swelling, pain, and ecchymosis were significantly reduced in the areas injected with PCL filler after tumescent solution anesthesia on the left side. The tumescence anesthesia method prevented edema and pain after the injection of the PCL filler. No significant long-term differences were observed between the left and right sides, but there were differences in initial swelling and ecchymosis. Thus, it may be concluded that the efficacy of Ellansé was not compromised by this new method, and that it was associated with a less intense immediate tissue reaction and a reduced inflammatory reaction, as confirmed by the histological analysis of biopsy samples and clinical findings.

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