“Fiblast” (Fibroblast) is a human bFGF material developed in Japan and it is approved by the Ministry of Health, Labor and Welfare for use in the treatment of decubitus ulcers (burn ulcers, lower leg ulcers) in the plastic surgery field.

Recently medical institutions of beauty medical care have used this material out of approval. Even in our clinic, patients receiving a subcutaneous injection of this substance at another clinics come and complain “lumps” of the injected sites. It is difficult to remove a lump caused by subcutaneous injection of fibroblasts and removal is difficult even with invasive treatment. I think whether it is better to pay attention to subcutaneous injection of the fibroblast material that is used for non-approval use.

Regarding PRP, the substances derived from your own blood, it is necessary to submit a third category registration on regenerative medicine by the Ministry of Health, Labor and Welfare, and I think that some approved medical institutions can still do such treatment. However, it is recent general opinion that the sustained effect by subcutaneous infusion as said earlier can not be expected.

We are using only Swedish Restylane and Juvederm made in France, which is approved as a subcutaneous infusion in the Ministry of Health, Labor and Welfare. Even if problems arise, there are degradative enzymes, and it is rare to cause permanent lumps and the like.

The director of our plastic surgery clinic came to Japan from the United States back in 2005. Just ten years ago I gave a lecture on safe hyaluronic acid therapy etc. to the doctors as a lecturer at a seminar on beauty care procedures such as hyaluronic acid. At that time, there was a report that there was already high risk of injection of hyaluronic acid-containing injections into the surroundings of the eyebrows in the United States.

There are few small arteries that are dominant in the vicinity of the eyebrows, and there is no supply of blood flow from the other side with side chains to each other (the end- artery). When injected material enters such a blood vessel, surrounding tissues die (necrosis). Also, since the artery around the eyebrows is located close to the arteriovenous of the orbit (in the dent of the eye), multiple examples in which the injected substance enters the eye artery for reflux to cause blindness It has been reported.

In the case of hyaluronic acid, there is still an enzyme agent that dissolves it, but there are cases where it can not be saved with other injectables, especially those of semi-permanent type.

The same problem may actually occur not only in the glabellar region but also anywhere in the center of the face. There are several technical key points when injecting subcutaneous infusions such as hyaluronic acid, and for those who do not master it, these risks are even higher.

In general terms, I think that treatment of these subcutaneous infusions should be done by specialists (board-certified dermatologists or plastic surgeons) who are familiar with cosmetic medicine (also attending academic societies) doctors. At our clinic, we explain the possible dangers to patients when treating that part, and we are doing the treatment.

Dr. Kure is the only US board-certified plastic surgeon in Japan.

About 10 years ago when we began preparing the clinic in Japan, we inofrmed on the safety of subcutaneous infusions such as hyaluronic acid in the US at a lecture meeting for doctors, but at that time I have mentioned the serious complications of blindness and skin necrosis many times.
In the United States some of these complications had already been announced.
Although hyaluronic acid itself is generally a safe dermal filler, it is rarely happened that there are events in which facial blood vessels become clogged due to treatment to the vicinity of the eyebrows and nose.
Although highly skilled technique is required for such injections, hyaluronic acid still has some medicines to dissolve it, but in many cases it can be reduced somehow, because there are no such drugs for permanent type of infusions , It will be a serious consequence when a problem occurs.
In our hospital, we do not use it as injectable material except for hyaluronic acid made from USA or France or autologous fat.

Hyaluronic acid is a type of polysaccharide and its basic chemical structure is the same as that originally found in human skin.
Because the force to attract moisture is strong, even a small amount of treatment may cause expansion effect beyond injection volume.
However, since the nasolabial lines formed after many years are deep subcutaneously deeply contained like a scar, it may be difficult to completely eliminate this with subcutaneous injectables.
Although I look at the situation with injection of about 1 cc usually, it can be said that the nasolabial lines should improve according to the injection volume.

It is extremely rare that unexpected swelling occurs by injecting hyaluronic acid. In that case there is a possibility of allergic reaction (which is said to be very difficult in theory).

In some cases it may be necessary to inject an enzyme agent that degrades hyaluronic acid.

More commonly seen are “lumps” and “bruises”, but the lump is more common when hard filler is used or the skin is thin at the injection site.

Regarding bruises, if you are taking medications or supplements that have blood-thinning action (Vitamin E, fish oil, aspirin, etc.), those who came to treatment after stopping them for more than one week It is safe.
If that is not the case, We think that big bruises will not happen often.

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Before applying hyaluronic acid injection, we apply local anesthetic cream to the area to be treated and wait for a while before treatment.

This will relieve pain considerably, but if you prefer treatment that is more painless, block anesthesia may be given.

The fillers that we use in our clinic usually contain local anesthesia as well. If you are very sensitive to slight pain, you may take oral pain killer ahead of time as an option.

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