Daily Cosmetic Research Analysis
Across cosmetic medicine, a massive real-world retrospective analysis quantified the rarity and anatomical distribution of severe complications after hyaluronic acid fillers. Methodologically, upright 3D surface imaging showed acceptable accuracy for breast volume measurement versus CT, and a single-arm study reported short-term efficacy and safety of HIFU for submental fat reduction in Asian patients.
Summary
Across cosmetic medicine, a massive real-world retrospective analysis quantified the rarity and anatomical distribution of severe complications after hyaluronic acid fillers. Methodologically, upright 3D surface imaging showed acceptable accuracy for breast volume measurement versus CT, and a single-arm study reported short-term efficacy and safety of HIFU for submental fat reduction in Asian patients.
Research Themes
- Aesthetic procedure safety and risk quantification
- Objective outcome measurement in cosmetic surgery
- Non-invasive contouring technologies
Selected Articles
1. Serious Complications of Hyaluronic Acid Fillers-A Retrospective Study of 290,307 Cases.
In a nationwide, multi-clinic retrospective dataset of 290,307 HA filler injections, only 12 severe complications occurred (0.0041%), predominantly vascular events in the forehead region. These real-world data refine risk counseling and highlight high-risk anatomic zones.
Impact: This is one of the largest real-world safety datasets for HA fillers, providing precise incidence estimates and anatomical distribution of severe events. It directly informs practitioner technique and patient consent.
Clinical Implications: Severe complications are exceedingly rare, but forehead injections carry disproportionate vascular risk. Use aspiration, cannulas in high-risk zones, slow low-pressure injections, and immediate management protocols for suspected vascular occlusion.
Key Findings
- Overall severe complication incidence was 0.0041% across 290,307 HA injections.
- Vascular events clustered in the forehead (8/10 vascular obstruction cases).
- Only two infections were recorded (chin and nasolabial fold).
Methodological Strengths
- Exceptionally large denominator enabling precise rare-event estimation
- Centralized database across multiple clinics with uniform case capture period (Oct 2020–Apr 2024)
Limitations
- Retrospective design susceptible to underreporting and missing covariates
- Limited procedural granularity (e.g., injection technique, product type, injector experience)
Future Directions: Prospective registries with standardized reporting should stratify risk by facial subunit, injection plane, device (needle vs cannula), and product rheology, and evaluate mitigation bundles.
BACKGROUND: Hyaluronic acid (HA) injection as a facial filler is widely used for facial contouring and is generally believed to be safe and effective. Although extremely rare, serious complications, such as infection, skin necrosis due to vascular occlusion, and blindness, sometimes occur. No study has examined the rate of severe complications in high-volume cases in a single center. We analyzed large-scale data from a group of clinics throughout the country to evaluate the rate of severe complications associated with HA injections. METHODS: This retrospective study included the data of 209,083 patients (290,307 injection sites) from our database between October 2020 and April 2024. We analyzed 12 cases of serious complications, such as infection and vascular obstruction. RESULTS: There were 290,307 HA injections, including 2 cases of infection and 10 cases of vascular obstruction. The incidence of severe complications was 0.0041%. There was one case each of infection of the chin and nasolabial folds (NLF), 1 case of vascular embolization of the NLF and nose, and 8 cases of vascular embolization of the forehead. CONCLUSIONS: The rate of severe complications associated with HA injections was low. However, more attention is necessary to further lower the complication rates.
2. Use of Three-Dimensional Surface Imaging to Measure Breast Volume in the Upright Position With Acceptable Accuracy.
3D surface imaging demonstrated acceptable accuracy for upright breast volume measurement, with correlation to CT at r=0.83 and validation on plastic phantoms. While MRI-CT correlation was superior (r=0.997), 3DSI performance was comparable to mammography-CT correlations.
Impact: Provides a practical, radiation-free method to quantify breast volume in the physiological (upright) position, enabling standardized pre/postoperative assessment in cosmetic breast surgery.
Clinical Implications: 3DSI can streamline outcome auditing and patient counseling without imaging in non-physiologic positions or radiation exposure, though MRI remains the precision reference.
Key Findings
- 3DSI-to-CT correlation for breast volume was r=0.83 in patients.
- Phantom testing confirmed measurement accuracy of 3DSI.
- MRI-to-CT correlation was r=0.997, and MMG-to-CT was r=0.84, positioning 3DSI comparable to MMG.
Methodological Strengths
- Two-step validation with known-volume phantoms and multi-modality patient imaging
- Direct correlation against CT, MRI, and MMG benchmarks
Limitations
- Small sample size (n=30) and single-center design
- Different imaging positions across modalities may introduce systematic bias
Future Directions: Multi-center studies should assess test-retest reliability, inter-operator variability, and predictive validity for surgical planning and outcomes.
OBJECTIVE: The utility of three-dimensional surface imaging (3DSI) for measuring breast volume in the upright position has not been established. MATERIALS AND METHODS: First, the accuracy of 3DSI measurements was evaluated using plastic models with known breast volumes. Then, the breast volumes of 30 patients were measured using 3DSI in the upright position, computed tomography (CT) in the supine position, magnetic resonance imaging (MRI) in the prone position, and mammography (MMG) of the compressed breast. To determine the impact of 3DSI measurements, the correlation coefficients between 3DSI and CT, between MMG and CT, and between MRI and CT were calculated. RESULTS: The accuracy of 3DSI measurements was confirmed using plastic models. The correlation coefficients between 3DSI and CT, between MRI and CT, and between MMG and CT were 0.83, 0.997, and 0.84, respectively. Although the breast volume measured by 3DSI was closely associated with that measured by CT, this correlation was weaker than that between the MRI- and CT-measured volumes and comparable with that between the MMG- and CT-measured volumes. CONCLUSION: 3DSI can be used to measure breast volume in the upright position with clinically acceptable accuracy for the evaluation of cosmetic surgical outcomes.
3. Efficacy and Safety of High-Intensity Focused Ultrasound (HIFU) on Reduction of Unwanted Submental Fat in Asian Patients.
In 30 Asian patients, a single HIFU session yielded significant improvement in clinician-rated submental fat severity (p<0.000005) and high patient-reported improvement (82%), with no serious adverse events over 4 weeks. Objective 3D volume assessments complemented clinician/patient scales.
Impact: Supports a non-invasive option for submental contouring with objective and subjective short-term benefits in an Asian cohort, informing patient selection and counseling.
Clinical Implications: HIFU can be considered for patients seeking non-surgical submental contouring, with expectations set for short-term improvements and minimal downtime; longer-term durability remains to be defined.
Key Findings
- Clinician-rated submental fat severity (CR-SMFRS) improved significantly after one HIFU session (p<0.000005).
- Patient self-rated improvement reached 82% at 4 weeks.
- No serious adverse events; expected minor effects resolved within 2 weeks.
Methodological Strengths
- Use of both objective 3D volume (Vectra) and validated clinician/patient rating scales
- Standardized device parameters with two focal depths (4.5 mm, 6.0 mm) in MP mode
Limitations
- Single-arm, non-randomized study without a control group
- Short follow-up (4 weeks) and small sample size limit durability and generalizability
Future Directions: Randomized controlled trials with longer follow-up should compare HIFU against other modalities (e.g., deoxycholic acid, cryolipolysis) and define durability, optimal parameters, and subgroup responders.
BACKGROUND: There are several treatment options to improve a double chin, such as contour injections, thread lifting, and double chin liposuction. However, the results of these treatments can be minimal or have a short-lasting effect. Additionally, these treatments may lead to worsened scarring due to repeated skin penetration and can cause prolonged discomfort. The high-intensity focused ultrasound (HIFU) is a non-invasive ultrasound lifting treatment that can improve a double chin without the need for surgical procedures, so the HIFU is considered a very safe way to reduce the submental volume. OBJECTIVE: This study aimed to identify the clinical and photographic changes observed among patients who received HIFU treatment and to evaluate the efficacy and safety of HIFU for submental fat reduction. METHODS: Thirty patients, aged from 25 to 60 years (20 females and 10 males), participated in a 4-week follow-up (n=30). High-intensity focused ultrasound treatment was performed on submental fat using two different focal depth transducers, 4.5 mm and 6.0 mm, with MP (Micro Pulsed) mode. We assessed the treatment effects using Vectra for volume measurement, CR-SMFRS (Clinician Report-Submental Fat Rating Scale) on a 5-point scale (0-4), SSRS (Subject Self-Rating Scale) on a 4-point scale (0-3), as well as monitoring weight and photography. Adverse events were evaluated using questionnaires. RESULTS: A total of 30 patients were enrolled in this evaluation at the follow-up visit (4 weeks). The proportion of treatment patients satisfied with appearances and significant submental fat reduction was apparent when comparing the initial CR-SMFRS ratings to the final CR- SMFRS ratings. Initially, CR-SMFRS ratings were categorized as 10 mild, 10 moderate, 8 severe, and 2 extreme. After one session of treatment, the final ratings showed improved submental fat conditions, with 16 mild, 8 moderate, 5 severe, and 1 extreme. This change indicated a significant improvement, with a p-value of <0.000005. The SSRS showed an 82% improvement level, and most patients experienced immediate improvements. No significant side effects or adverse events were reported. Expected common side effects were noted but resolved within 2 weeks. CONCLUSION: The HIFU treatment using the 4.5 and 6.0 mm focal depth transducers was safe and effective in reducing the submental fat based on the results. LEVEL OF EVIDENCE: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .