For radiologist 1 on day 15, 4 of the 10 cases no longer presented any artifact of the product that could make it difficult to evaluate the thyroid on the dynamic exam. Among the 6 cases that presented difficulties on day 15, all answers were B (despite the slight technical difficulty, it was fully possible to assess the thyroid; Figure 4).
For radiologist 2 on day 15, 9 of 10 cases did no longer present any technical difficulty, and the single case that had difficulty due to posterior acoustic shadow was fully possible to evaluate (response B of the questionnaire; Figure 5).
The assessments of radiologists 1 and 2 were identical on day 60. In all treated volunteers it was still possible to observe the existence of the product, and in 100% of cases the anatomic topography of the product remained in the superficial subcutaneous plane and after this point (day 60), there were no more technical difficulties to evaluate the thyroid (Figure 6). In the assessment of day 60, one of the subjects in the control group was erroneously identified as having the presence of the product in the neck. When it was observed, by the author, a finding that was not expected in the ultrasound report, the patient was questioned and informed that, during the study, she has done an application of deoxycholic acid on the submental fat of her neck.
Since on day 60 100% of patients did not present any difficulties in the assessment of their thyroid in the ultrasonography exam, the investigators understood that there was no reason to keep the follow-up until day 180 and decided to end the study.
DISCUSSION
Cosmetic injectable treatments have grown substantially in the last few years. The botulinum toxin, the hyaluronic acid fillers, and biostimulators, for instance calcium hydroxyapatite and poly-L-lactic acid are the most frequently used products nowadays.
Calcium hydroxyapatite is a product with collagen biostimulating capacity and has been widely used for facial and body treatments. Its high safety profile, especially on nodule formation, mainly where the skin is extremely thin, such as the neck skin, makes calcium hydroxyapatite one of the major allies to the injector physicians who manage the aging of their patients.7
The dilution of this product varies according to the topographic region to be treated, the thickness of the local skin, and the injector’s experience. A new concept related to calcium hydroxyapatite has been applied to body treatment: hyperdilution, which may be from 1:2 to 1:6, according to international consensus.4,5,8
The cervical region is one of the regions that is routinely treated with hyperdiluted calcium hydroxyapatite. The neck skin is characterized to be thin, delicate, and mostly presenting a scarcity of subcutaneous tissue, just under the skin, the platysma and the superficial cervical fascia are found. The neck area to be treated with biostimulators goes from the line of the inferior mandible down to the supraclavicular line, which includes the skin just right above the thyroid gland.
The thyroid is an endocrine gland butterfly-shaped that is located below the thyroid cartilage of larynx and the tracheal rings, and posterior to the platysma muscle and/or the superficial cervical fascia.9 The ultrasound is a simple exam, but of vital importance in the diagnosis of nodules, cysts in addition to morphological, and functional assessment of the gland.
Since the anatomical plane of calcium hydroxyapatite injection is the subdermal one, obviously in the hands of experienced
Calcium hydroxyapatite is a product with collagen biostimulating capacity and has been widely used for facial and body treatments. Its high safety profile, especially on nodule formation, mainly where the skin is extremely thin, such as the neck skin, makes calcium hydroxyapatite one of the major allies to the injector physicians who manage the aging of their patients.7
The dilution of this product varies according to the topographic region to be treated, the thickness of the local skin, and the injector’s experience. A new concept related to calcium hydroxyapatite has been applied to body treatment: hyperdilution, which may be from 1:2 to 1:6, according to international consensus.4,5,8
The cervical region is one of the regions that is routinely treated with hyperdiluted calcium hydroxyapatite. The neck skin is characterized to be thin, delicate, and mostly presenting a scarcity of subcutaneous tissue, just under the skin, the platysma and the superficial cervical fascia are found. The neck area to be treated with biostimulators goes from the line of the inferior mandible down to the supraclavicular line, which includes the skin just right above the thyroid gland.
The thyroid is an endocrine gland butterfly-shaped that is located below the thyroid cartilage of larynx and the tracheal rings, and posterior to the platysma muscle and/or the superficial cervical fascia.9 The ultrasound is a simple exam, but of vital importance in the diagnosis of nodules, cysts in addition to morphological, and functional assessment of the gland.
Since the anatomical plane of calcium hydroxyapatite injection is the subdermal one, obviously in the hands of experienced
