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Background <p>Facial overfilled syndrome (FOS), a complication of excessive hyaluronic acid (HA) filler use, poses challenges in aesthetic medicine due to its gradual onset and impact on facial contours. Traditional hyaluronidase injections to dissolve excess HA often lack precision, risking suboptimal outcomes. This study evaluates the efficacy of three-dimensional magnetic resonance imaging (3D-MRI)-guided HA localization in guiding precise hyaluronidase administration.</p> Methods <p>In this retrospective case–control study (January 2019–December 2024), 50 patients with FOS were divided into two groups: 3D-MRI-guided hyaluronidase injection (M+ group, <i>n</i>=25) and non-guided injection (M− group, <i>n</i>=25). Outcomes were assessed via 2D/3D photography, 3D images and 3D-MRI volumetric analysis, the Global Aesthetic Improvement Scale (GAIS), patient satisfaction surveys, and safety evaluations at 1 and 2 months posttreatment.</p> Results <p>Both groups showed improved facial contours posttreatment, with no significant difference in GAIS scores (M+: 1.62 ± 0.32 vs. M−: 1.68 ± 0.53, <i>p</i> &gt; 0.05) or adverse events (e.g., mild swelling, bruising). The M+ group demonstrated precise HA localization, with notable volume reductions (e.g., forehead: 31.6–7.9 mL at 2 months). Patient satisfaction was high in both groups (M+: 1.62 ± 0.31 vs. M−: 1.74 ± 0.58 at 1 month, <i>p</i> &gt; 0.05). The average number of treatments (M+: 1.12 ± 0.33 vs. M−: 1.61 ± 0.67) and average treatment duration (M+: 12.64 ± 2.02 vs. M−: 19.27 ± 5.34) in the M+ group were significantly lower than those in the M− group (<i>p</i> &lt; 0.05).</p> Conclusion <p>3D-MRI guidance enhances the precision of hyaluronidase injections for FOS, offering objective insights into HA distribution. While clinical outcomes were comparable between groups, 3D-MRI provides a promising tool for tailored treatment, warranting further exploration in aesthetic practice.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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Three-Dimensional Magnetic Resonance Imaging-Guided Localization of Hyaluronic Acid Hydrogel for Precision in Hyaluronidase Injection: A Retrospective Case–Control Study

  • 期刊论文

  • 发表日期：

    2025年10月8日

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  • Ya-Hong Chen,
  • Chu-Hsin Chen,
  • Jia-Rong Zhang,
  • Shuang-Bai Zhou,
  • Kai Liu

摘要

Background

Facial overfilled syndrome (FOS), a complication of excessive hyaluronic acid (HA) filler use, poses challenges in aesthetic medicine due to its gradual onset and impact on facial contours. Traditional hyaluronidase injections to dissolve excess HA often lack precision, risking suboptimal outcomes. This study evaluates the efficacy of three-dimensional magnetic resonance imaging (3D-MRI)-guided HA localization in guiding precise hyaluronidase administration.

Methods

In this retrospective case–control study (January 2019–December 2024), 50 patients with FOS were divided into two groups: 3D-MRI-guided hyaluronidase injection (M+ group, n=25) and non-guided injection (M− group, n=25). Outcomes were assessed via 2D/3D photography, 3D images and 3D-MRI volumetric analysis, the Global Aesthetic Improvement Scale (GAIS), patient satisfaction surveys, and safety evaluations at 1 and 2 months posttreatment.

Results

Both groups showed improved facial contours posttreatment, with no significant difference in GAIS scores (M+: 1.62 ± 0.32 vs. M−: 1.68 ± 0.53, p > 0.05) or adverse events (e.g., mild swelling, bruising). The M+ group demonstrated precise HA localization, with notable volume reductions (e.g., forehead: 31.6–7.9 mL at 2 months). Patient satisfaction was high in both groups (M+: 1.62 ± 0.31 vs. M−: 1.74 ± 0.58 at 1 month, p > 0.05). The average number of treatments (M+: 1.12 ± 0.33 vs. M−: 1.61 ± 0.67) and average treatment duration (M+: 12.64 ± 2.02 vs. M−: 19.27 ± 5.34) in the M+ group were significantly lower than those in the M− group (p < 0.05).

Conclusion

3D-MRI guidance enhances the precision of hyaluronidase injections for FOS, offering objective insights into HA distribution. While clinical outcomes were comparable between groups, 3D-MRI provides a promising tool for tailored treatment, warranting further exploration in aesthetic practice.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266.