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Impact of SARS-CoV-2 Vaccination or Infection on the Safety and Efficacy of Aesthetic Injections: A Systematic Review

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Abstract

Background

Aesthetic injections have become increasingly popular for maintaining a youthful appearance. However, with the rise of SARS-CoV-2, there have been concerns about potential complications. This study aims to summarize and understand the complications that occur in individuals who have received cosmetic injections after SARS-CoV-2 infection or vaccination. By doing so, we hope to provide recommendations to minimize these complications and ensure the safety of aesthetic treatments in the current COVID-19 era.

Methods

The PRISMA guidelines, the Preferred Reporting Program for Systematic Reviews and Meta-Analyses, were used for this review. Databases including PubMed, EMBASE, Medline, Web of Science and ScienceDirect were searched. The last search time of each database was May 10, 2023. In addition, relevant references were manually searched.

Results

A total of 26 studies containing 139 patients were searched. The complication with the highest percentage of reported patients was delayed inflammatory response (DIR) (n = 68; 48.92%), followed by diminished efficacy (n = 45; 32.37%) and filler reaction (n = 12; 8.63%). The remaining complications include hypersensitivity reactions, symptomatic hypercalcemia, sub-acute hypersensitive reactions, hyperalgesia, infection, fat necrosis and granulomatous reaction.

Conclusions

Cosmetic injectable procedures are generally safe but may have adverse effects, particularly during the pandemic. It is important for individuals to fully understand these risks beforehand. Clinicians should be knowledgeable about adverse event mechanisms and management to prevent issues. Industry leaders should strengthen risk management efforts to ensure safe and steady development of cosmetic injections. Overall, a comprehensive understanding, effective communication and risk management are crucial for the safe use of cosmetic injectable procedures.

Level of Evidence III

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Availability of Data and Material

All data analyzed during this study are included in this manuscript. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

COVID-19:

Coronavirus disease 19

ACE2:

Angiotensin-converting enzyme 2

BTA:

Botulinum toxin A

HA:

Hyaluronic acid

DIR:

Delayed inflammatory response

SES:

Silicone embolism syndrome

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Funding

This study was funded by Cultivate Innovation Fund of the Sixth Medical Center of PLA General Hospital (CXPY202123).

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Author notes

  1. Qian Wu and Peixuan Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Service, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China

    Qian Wu

  2. Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 10048, China

    Qian Wu, Peixuan Zhang, Guiwen Zhou, Qiang Fu, Ruiqi Bai, Hongfan Ding, Fanting Meng & Minliang Chen

  3. Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039, China

    Xiao Xu

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Appendix 1. Search strategy

Appendix 1. Search strategy

The combined text and medical subject heading (MeSH) terms used were: “covid” and “injection.”

PubMed

The database was searched on May 10, 2023, n = 166.

Search Strategy:

(covid OR SARS-CoV-2 OR coronavirus) AND (injection OR inject) AND (aesthetic OR cosmetic OR plastic OR filler OR toxin OR fat)

Web of Science

The database was searched on May 10, 2023, n = 193.

Search Strategy:

  1. 1.

    TOPIC: (“covid” OR “SARS-CoV-2” OR “coronavirus”)

  2. 2.

    TOPIC: (“injection” OR “inject”)

  3. 3.

    TOPIC: (“aesthetic” OR “cosmetic” OR “plastic” OR “filler” OR “toxin” OR “fat”)

  4. 4.

    4 #1 AND #2 AND #3

EMBASE

The database was searched on May 10, 2023, n = 191.

Search Strategy:

  1. 1.

    covid (396323)

  2. 2.

    SARS-CoV-2 (145783)

  3. 3.

    coronavirus (375737)

  4. 4.

    injection (820884)

  5. 5.

    inject (13722)

  6. 6.

    aesthetic (65983)

  7. 7.

    cosmetic (96735)

  8. 8.

    plastic (372147)

  9. 9.

    filler (15896)

  10. 10.

    toxin (218648)

  11. 11.

    fat (504646)

  12. 12.

    #1 OR #2 OR #3 (434457)

  13. 13.

    #4 OR #5 (827512)

  14. 14.

    #6 OR #7 OR #8 OR #9 OR #10 OR #11 (1193041)

  15. 15.

    #12 AND #13 AND #14 (191)

Ovid MEDLINE

The database was searched on May 10, 2023, n = 84.

Search Strategy:

  1. 1.

    covid (23463)

  2. 2.

    SARS-CoV-2 (27210)

  3. 3.

    coronavirus (18826)

  4. 4.

    injection (10026)

  5. 5.

    injection (9862)

  6. 6.

    aesthetic (6547)

  7. 7.

    cosmetic (6979)

  8. 8.

    plastic (10129)

  9. 9.

    filler (4879)

  10. 10.

    toxin (11040)

  11. 11.

    fat (11799)

  12. 12.

    “covid” OR “SARS-CoV-2” OR “coronavirus”

  13. 13.

    “injection” OR “inject”

  14. 14.

    “aesthetic” OR “cosmetic” OR “plastic” OR “filler” OR “toxin” OR “fat”

  15. 15.

    12 and 13 and 14

ScienceDirect

The database was searched on May 10, 2023, n = 166.

Search Strategy:

Title, abstract, keywords: ((“covid” OR “SARS-CoV-2” OR “coronavirus”) and (“injection” OR “inject”) and (“aesthetic” OR “cosmetic” OR “plastic” OR “filler” OR “toxin” OR “fat”))

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Wu, Q., Zhang, P., Zhou, G. et al. Impact of SARS-CoV-2 Vaccination or Infection on the Safety and Efficacy of Aesthetic Injections: A Systematic Review. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-023-03769-2

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  • DOI: https://doi.org/10.1007/s00266-023-03769-2

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