{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:31:20Z","timestamp":1791520280671,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Facial overfilled syndrome is an adverse event following minimally invasive soft tissue filler injections. It presents in most cases as excess midfacial volume and\/or as unnatural smile which is difficult to detect due to the absence of standardized evaluation methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To showcase how to identify, evaluate, and treat facial overfilled syndrome by utilizing facial ultrasound and simultaneous hyaluronidase injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010eight consecutive patients (26 females, 2 males) were enrolled in this study in which facial ultrasound was performed to evaluate the location previously implanted filler material. The position of the oral commissure was objectively measured in relation to bony landmarks, and the severity of lateral canthal lines was assessed by independent and blinded raters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The material was identified in 35.7% inside the subdermal fatty layer, in 28.6% inside the deep supra\u2010periosteal fatty layer, in 10.7% inside the fibrous layer deep to the subdermal fatty layer, whereas in 25.0%, the product was not possible to locate clearly inside one specific layer. On average, 81.6\u2009I.U. [range: 75\u2013150] of hyaluronidase were injected. Lateral canthal line severity was before the treatment 2.28 (1.4) and was after the hyaluronidase treatment 2.02 (1.3) with <jats:italic>p<\/jats:italic>\u2009=\u20090.578. The position of the oral commissure increased by 0.60\u2009cm in vertical and by 0.30\u2009cm in horizontal directions (both <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Facial overfilled syndrome following aesthetic soft tissue filler injections can present as excess midfacial volume but also as unnatural smile. Targeted hyaluronidase injections into the culprit pockets inside the midfacial soft tissues have shown to re\u2010establish a natural smile, to reduce excess midfacial volume, and to decrease lateral canthal line severity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.16013","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T12:30:22Z","timestamp":1695990622000},"page":"3252-3260","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Treating facial overfilled syndrome with impaired facial expression\u2014Presenting clinical experience with ultrasound imaging"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5512-1956","authenticated-orcid":false,"given":"Leonie","family":"Schelke","sequence":"first","affiliation":[{"name":"Department of Dermatology Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Harris","sequence":"additional","affiliation":[{"name":"Harris Clinic Crouch Hall Road Surgery  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Cartier","sequence":"additional","affiliation":[{"name":"Clinic of Dermatology  Arras France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4892-2376","authenticated-orcid":false,"given":"Michael","family":"Alfertshofer","sequence":"additional","affiliation":[{"name":"Division of Hand, Plastic and Aesthetic Surgery Ludwig\u2010Maximilians\u2010University Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwah","family":"Doestzada","sequence":"additional","affiliation":[{"name":"Aestec  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7210-6566","authenticated-orcid":false,"given":"Sebastian","family":"Cotofana","sequence":"additional","affiliation":[{"name":"Department of Dermatology Erasmus University Medical Center  Rotterdam The Netherlands"},{"name":"Centre for Cutaneous Research Blizard Institute Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Velthuis","sequence":"additional","affiliation":[{"name":"Department of Dermatology Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S276676"},{"key":"e_1_2_10_3_1","unstructured":"International Society of Aesthetic Plastic Surgerons (ISAPS).ISAPS International Survey on Aesthetic\/Cosmetic Procedures Performed in 2020. 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