Evidence map›Paper›PMID 36759325›Full record

ArticleAesthetic surgery journal2023

Making Sense of Late Tissue Nodules Associated With Hyaluronic Acid Injections.

Greg J Goodman, Cara B McDonald, Adrian Lim, Catherine E Porter, Anand K Deva, Mark Magnusson, Anita Patel, Sarah Hart, Peter Callan, Alice Rudd and 15 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Aesthetic surgery journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
2.9field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
  4. Review
  5. Article
  6. Review
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors at 12 institutions in 3 countries.

Greg J GoodmanHonorary professor at the University College of London, London, United Kingdom.ORCID 0000-0003-4089-9690
Cara B McDonaldDermatologist, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Adrian LimPracticing dermatologist, Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Catherine E PorterCosmetic physician in private practice in Sydney, New South Wales, Australia.
Anand K DevaProfessor, Department of Plastic and Reconstructive Surgery, Macquarie University, Sydney, Australia.
Mark MagnussonAssociate professor, Department of Plastic and Reconstructive Surgery, Griffiths University Southport, Queensland, Australia.ORCID 0000-0001-5777-8284
Anita PatelDermatologist in Private practice in Bondi Junction, New South Wales, Australia.
Sarah HartAesthetic physician in private practice in Auckland, the North Island, New Zealand.
Peter CallanSpecialist plastic surgeon in private practice in Geelong, Victoria, Australia.ORCID 0000-0002-4858-4274
Alice RuddDermatologist, Department of Dermatology, Alfred Hospital Prahran Victoria, Victoria, Australia.
Stefania RobertsAesthetic physician in private practice in Melbourne, Victoria, Australia.
Katy WallaceNurse practitioner at a private dermatology practice in South Yarra, Victoria, Australia.
Philip BekhorDermatologist, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
Michael ClagueCosmetic nurse in private practice in South Yarra, Victoria, Australia.
Linda WilliamsCosmetic physician in private practice in East Brisbane, Queensland, Australia.
Niamh CorduffPlastic surgeon in private practice in Geelong, Victoria, Australia.
Nina WinesPrincipal dermatologist in private practice in Sydney, New South Wales, Australia.
Firas Al-NiaimiDermatologist, Department of Dermatology, Aalborg University, Aalborg, Denmark.
Sabrina G FabiDermatologist, Department of Dermatology, University of California San Diego, La Jolla, CA, USA.
Howard M StudnibergDermatologist in private practice in Sydney, New South Wales, Australia.
Saxon SmithDermatologist at the Sydney Clinical School, ANU Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
Angelo TsirbasOculoplastic surgeon in Sydney, New South Wales, Australia.
Sean ArendseCosmetic physician in private practice in Melbourne, Victoria, Australia.
Antoinette CiconteDermatologist at Eastern Health Hospital, Box Hill and Canterbury, Victoria, Australia.
Terence PoonDermatologist in private practice in Sydney, New South Wales, Australia.
Geelong Hospital · AUAalborg University · DKAustralian National University · AUBond University · AUEastern Health · AUGriffith University · AUMacquarie University · AURoyal North Shore Hospital · AUSt Vincent's Hospital Melbourne · AUThe Alfred Hospital · AUThe University of Melbourne · AUUniversity of California San Diego · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe pathogenesis of delayed-onset tissue nodules (DTNs) due to hyaluronic acid (HA) injections is uncertain.

objectivesTo formulate a rational theory for DTN development and their avoidance and treatment.

methodsA multidisciplinary and multicountry DTN consensus panel was established, with 20 questions posed and consensus sought. Consensus was set at 75% agreement.

resultsConsensus was reached in 16 of 20 questions regarding the pathogenesis of DTNs, forming the basis for a classification and treatment guide.

conclusionsThe group believes that filler, pathogens, and inflammation are all involved in DTNs and that DTNs most likely are infection initiated with a variable immune response. Injected filler may incorporate surface bacteria, either a commensal or a true pathogen, if the skin barrier is altered. The initially high molecular weight HA filler is degraded to low molecular weight HA (LMWHA) at the edge of the filler. Commensals positioned within the filler bolus may be well tolerated until the filler is degraded and the commensal becomes visible to the immune system. LMWHA is particularly inflammatory in the presence of any local bacteria. Commensals may still be tolerated unless the immune system is generally heightened by viremia or vaccination. Systemic pathogenic bacteremia may also interact with the filler peripheral LMWHA, activating Toll-like receptors that induce DTN formation. Given this scenario, attention to practitioner and patient hygiene and early systemic infection treatment deserve attention. Classification and treatment systems were devised by considering each of the 3 factors-filler, inflammation, and infection-separately. LEVEL OF EVIDENCE: 4:

Indexed as

Cosmetic TechniquesDermal FillersHumansHyaluronic AcidInflammationInjectionsDermal FillersHyaluronic Acid

Identifiers

PMID36759325
PMCPMC10184938
OpenAlexW4319825951

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.