04/07/2025
不論是玻尿酸或膠原蛋白刺激劑(PLLA/PDLLA/ellanse/RDS)，都是快速回復組織流失的偉大發明。然而，再怎麼優秀的醫師，總會遇到注射治療上的問題，雖然機率不高，比方說與正常人不一樣的血管而有血腫或血管栓塞、超乎預期過長的填充物持久度甚至位移、過量注射結節腫漲…等狀況，有些是個人體質，但更有甚者，也與醫師的技術脫不了關係。
近來有些填充併發症的處理，最常見的就是顆粒、團塊結節等問題，特別拿了豬肉與超音波、降解酶做了個臨床小測試：
玻尿酸施打後可以在超音波見到異質回音團塊，然而由於其簡單恒定的結構，使用降解酶在超音波的精準施打後，就能立即切斷玻尿酸本體β-1,4共價鍵，簡單說就是把大條的玻尿酸給直接送進絞碎機變成許許多多的粉末而被人體代謝，且速度非常立即，在打完降解酶後，適當的按摩就能在不到3分鐘內看到立即的效果。
反觀膠原蛋白刺激劑，在立即施打後就因為其緻密的材質，在超音波可見高回音團塊，雖然如果當下施打就有問題可以立即用生理鹽水沖散後按摩散開減少硬化團塊的發生；然而，大約2週至2個月之後，人體就會開始對膠原蛋白刺激劑產生作用而開始生成膠原蛋白後，形成較緻密的架構而完全無法簡單的用生理鹽水沖散或按摩來處理了。此時使用類固醇的必要性就出現了，很多患者會問我為什麼用類固醇來治療，其實，是藉由類固醇會抑制纖維母細胞對膠原蛋白刺激劑的反應，並增加膠原蛋白的分解所致。然而，由於類固醇的抑制範圍與消融程度無法量化與控制，因此我臨床施打時，一定會從低劑量治療，而且"一定要用超音波"，不然如果亂打，就像在晚上帶墨鏡丟飛鏢連鏢靶都看不到，當然容易造成該消的不消，不該消的正常組織塌陷而讓問題嚴重，表面凹凸，這也是我堅持使用超音波處理併發症的本質。
Both hyaluronic acid (HA) and collagen stimulators (such as PLLA, PDLLA, Ellansé, and Radiesse) are remarkable advancements for rapidly restoring lost tissue volume. However, even the most skilled practitioners can encounter injection-related negative issues.
Recently, increasing numbers of managing filler complications, with lumps, bumps, and nodules being the most common. I recently conducted a small clinical test using pork tissue, ultrasound, and hyaluronidase, triamcinolone (injectable steroid) to illustrate the differences in managing complications from HA versus collagen stimulators.
Hyaluronic Acid (HA) Fillers and Their Management
Upon injection, hyaluronic acid can be visualized as "heterogeneous echogenic masses" under ultrasound. However, due to its simple and consistent structure, hyaluronidase can precisely target and immediately cleave the β-1,4-glycosidic bonds connecting each HA molecule. Simply put, this breaks down the large HA molecules into numerous smaller fragments that the body can readily metabolize. This process is incredibly fast; with appropriate massage after precise hyaluronidase injection, noticeable results can be seen in less than 3 minutes.
Collagen Stimulators and Their Management
In contrast, collagen stimulators appear as "hyperechoic masses" on ultrasound immediately after injection due to their dense material. If nodule arises within days of injection, immediate dispersion with saline solution and massage can help reduce the formation of hardened lumps. However, approximately 2-4 weeks later, human body begins to react to the collagen stimulator, initiating collagen synthesis. This creates a denser complicated framework that cannot be easily dispersed or massaged away with saline.
At this point, intralesional triamcinolone become necessary. Many patients ask why I use injectable steroid for treatment. Essentially, steroid work by inhibiting the fibroblasts response to the collagen stimulator and increasing collagen degradation at the same time. However, the extent and degree of steroid-induced inhibition and breakdown cannot be precisely quantified or controlled. Therefore, when I administer steroid clinically, I always start with a lower dose and always use ultrasound guidance. Injecting blindly is like throwing darts while wearing sunglasses in the dark – you can't even see the target. This significantly increases the risk of treatment failure while causing unwanted atrophy of normal tissue, worsening the problem and leading to surface irregularities. This is why I insist on using ultrasound to manage these complications.
#賦真妍皮膚專科診所院長
#填充注射副作用處理 #玻尿酸過多 #超音波精準降解
