A Closer Look at Cosmetic Plastic Procedures and Implants, Its Imaging Techniques, Detection and Management of Potential Complications: Radiological Point of View
- 1. Radiology and Medical Imaging Department, Fatima College of Health Sciences, United Arab Emirates
Citation
Khan HU, Ali FAA (2024) A Closer Look at Cosmetic Plastic Procedures and Implants, Its Imaging Techniques, Detection and Management of Potential Complications: Radiological Point of View. JSM Gen Surg Cases Images 6(1): 1050.
INTRODUCTION
Consulting the material and products utilized in cosmetic procedures can help the radiologist recognize the diverse shapes and sizes of these materials used not only for breast, buttock, lip, face, skin, calves, chest, arms, and penis augmentation, but also localized materials injected to fill facial lines, nasolabial and melo-labial grooves, or relieve depressed scars. Sometimes, these materials are used for an elusive specific requested result. With the option of having images of almost any organ with or without a contrast agent as an essential and unspecialized exam in a modern emergency healthcare service, the habit of analyzing these patients and knowing the many complications that can arise is crucial in radiology as the presence of these implants impact the radiological results. Nevertheless, Imaging of cosmetic plastic procedures and implants in the body is important in a variety of scenarios, including the initial evaluation of patients with cosmetic complaints, possible complications of recent cosmetic procedures, and surveillance for complications of older nonabsorbable implants. There is a great spectrum of foreign materials that may be found on the imaging studies of these patients, and it is important to recognize if the implant is recent and absorbable. We should expect edema and induration from the recent inflammatory response to the material, as well as the expected time span of the implant presence, to avoid further invasive workup or surgery.
IMAGING IN COSMETIC PLASTIC PROCEDURES
In cosmetic plastic procedures, various imaging techniques are employed to evaluate and monitor the outcomes of aesthetic interventions. These imaging modalities include X-rays, ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PETCT) [1]. These techniques are used to identify and assess the appearance of facial aesthetic procedures or fillers, as well as their potential complications, such as foreign-body reactions [2]. For instance, CT and MRI can be used to evaluate the configuration and attenuation of solid silicone implants, which typically appear ellipsoid in shape, hyperattenuating on CT images, and hypointense on T1- and T2-weighted MR images [3]. Ultrasound is particularly useful in evaluating the sonographic outcomes of common cosmetic and plastic surgery procedures [4]. Additionally, imaging techniques can incidentally detect the results of facial dermal injections or injectable facial fillers [5]. These imaging tools enable healthcare professionals to visualize internal structures, facilitating diagnosis, treatment planning, and post-operative monitoring.
Imaging considerations for different types of cosmetic procedures
Imaging of implants in the body, including breast implants, facial implants, and buttock implants, is a crucial aspect of evaluating their complications or evidence of failure [3]. Breast implant imaging has been extensively discussed in the literature, with Magnetic Resonance Imaging (MRI) being used to evaluate silicone implant rupture. Facial implants, including cosmetic facial implants and grafts, can also be imaged to assess their expected and complicated outcomes [6]. Additionally, body implants, such as muscular enhancement procedures like silicone arm, calf, and pectoral implants, can be imaged using various modalities. High-resolution ultrasound can be used to screen for breast implant concerns as seen in figure 1 [7].
Figure 1: Implant-associated fibromatosis in a 49-year-old woman with a history of risk-reducing bilateral mastectomy for lobular carcinsoma in situ and silicone implant reconstruction with a palpable mass in the right inframammary region. (a) US image demonstrates a heterogeneously hypoechoic mass (yellow arrow) abutting the implant (red arrow).
Several complications have been indicated to be associated with the body implants. Also, there are different ways of detection and management of implant complications, specifically focusing on infection, rupture, and capsular contracture.
BREAST AUGMENTATION
Breast augmentation, also known as augmentation mammoplasty, is a surgical procedure designed to enhance the size and shape of a woman’s breasts. This is typically achieved through the insertion of breast implants or fat transfer. The goal of breast augmentation is to improve the overall aesthetic appearance of the breasts, boosting self-confidence and selfesteem.
RHINOPLASTY
Rhinoplasty, commonly referred to as a “nose job,” is a surgical procedure aimed at reshaping the nose to improve its function and appearance. This may involve modifying the shape of the nasal bridge, tip, or nostrils to achieve a more harmonious facial balance. Rhinoplasty can also help alleviate breathing difficulties or correct nasal deformities.
LIPOSUCTION
Liposuction is a cosmetic surgical procedure that removes excess fat from specific areas of the body, such as the abdomen, thighs, arms, or neck. This is typically achieved using a cannula and suction device to remove unwanted fat cells. Liposuction can help improve body contours, reduce the appearance of cellulite, and enhance overall body shape.
FACELIFT
A facelift, also known as rhytidectomy, is a surgical procedure designed to rejuvenate the appearance of the face and neck. This involves the removal of excess skin, tightening of underlying tissues, and repositioning of facial muscles to reduce signs of aging, such as wrinkles, fine lines, and sagging skin.
The goal of a facelift is to restore a more youthful and refreshed appearance.
Please let me know if you’d like me to provide more information on any of these procedures or if you have any specific questions.
Infection caused by implants
Implant-related infections are a significant concern in the medical field, with a reported incidence rate ranging from 1% to 5% [8]. Early detection and prompt management are crucial to prevent severe consequences, including implant failure and patient morbidity. The following signs and symptoms may indicate an implant infection:
• Erythema, swelling, or warmth around the implant site.
• Purulent discharge or abscess formation.
• Fever or chills.
• Pain or tenderness at the implant site.
• Delayed wound healing or dehiscence.
To manage implant infections, a multidisciplinary approach is essential, involving surgeons, infectious disease specialists, and other healthcare professionals. Treatment options may include:
• Antibiotic therapy, tailored to the causative organism.
• Implant removal, with or without replacement.
• Debridement and irrigation of the affected area.
• Wound care and dressing changes.
Implant rupture
Implant rupture is a rare but potentially catastrophic complication, particularly in breast implant surgery. The reported incidence rate varies depending on the implant type and duration of implantation [9]. Signs and symptoms of implant rupture may include:
• Changes in breast shape or size
• Asymmetry or deformity
• Pain or discomfort
• Swelling or bruising
• Implant deflation or leakage
• Management of implant rupture typically involves surgical intervention, including:
• Implant removal and replacement
• Capsulectomy, if necessary
• Repair of any associated tissue damage
Capsular contracture
Capsular contracture is a common complication of implant surgery, characterized by the formation of a thick, fibrous capsule around the implant. This can lead to implant deformation, pain, and aesthetic dissatisfaction. The Baker grading system is commonly used to classify capsular contracture severity.
Management of capsular contracture may involve:
• Conservative treatment, including massage and compression therapy.
• Surgical intervention, including capsulectomy and implant replacement.
• Use of textured or cohesive gel implants to reduce the risk of capsular contracture.
The detection and management of implant complications require a thorough understanding of the signs, symptoms, and treatment options. A multidisciplinary approach and prompt intervention are essential to prevent severe consequences and ensure optimal patient outcomes.
In a number of situations, including as the initial assessment of patients with cosmetic complaints, potential complications from recent cosmetic surgeries, and monitoring for difficulties from older non-absorbable implants, imaging of cosmetic plastic procedures and implants within the body is crucial. The imaging studies of these individuals may reveal a wide range of foreign materials, and it’s critical to determine whether the implant is new and absorbable. In order to prevent more invasive workup or surgery, we should anticipate edema and induration due to the recent inflammatory response to the material as well as the anticipated duration of the implant presence.
REFERENCES
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