The value of magnetic resonance imaging (MRI) and its three-dimensional imaging in the removal of injectables

  With the intensive development of minimally invasive facial cosmetic surgery, the application of dermal fillers has become more and more widespread, such as the filling of wrinkles, depressions, and defects on the body surface. With the passage of time, there are more and more problems after various types of fillers, and many operated patients have various symptoms, such as local skin itching, pain, repeated redness and swelling, acne-like dermatitis, etc. Especially in various beauty salon clubs, various fillers of unknown composition are posing as regular fillers, bringing various kinds of risk factors to more and more beauty seekers, especially the wandering nature and toxicity of fillers, causing many This has caused great fear among patients. It has also led to more patients going to regular medical institutions to ask for removal of fillers.  However, due to limitations in diagnostic tools, the removal process is often accompanied by secondary damage, low clearance rate and other adverse consequences. In patients with facial cosmetic injections, the small volume of injected dose cannot be satisfactorily shown by conventional examination.  X-rays are convenient and inexpensive, but in cases where the composition of the injectable is unknown, most of them cannot be imaged under X-rays, or are only high-density or equal-density, with irregular clump-like or cloud-like shadows, and the boundaries with the surrounding tissues are not very clear, and in some cases calcified shadows are still visible, making it difficult to judge the morphology and distribution of the injectable in the tissues; B-ultrasound has a higher resolution for soft tissues and can clearly B ultrasound has high resolution for soft tissues, and can clearly show the structure of each layer in the tissue and the location, size and shape of the injection cavity, and can dynamically observe, but the intuition is also poor; CT has high resolution for bone tissue, and CT imaging has a high diagnostic rate for bone powder and other fillers, but the amount of radiation is large.  X-rays, B-ultrasound, CT, MRI plain scan, etc. in clinical applications only provide image information of a certain section, and it is difficult to form a three-dimensional intuitive image of the injected material, thus making it difficult to remove and leaving a greater risk in the process of removal, and the uncertainty of the scope of the injected material in the tissue also increases the possibility of damaging the surrounding normal tissue. MRI has the advantages of no radiation, high soft tissue resolution, and multi-directional imaging, and is now used as the examination of choice for the diagnosis of various cosmetic injection complications. Through preoperative MRI flat-scan and 3D reconstruction of the patient’s facial filler area, the scope and boundary of the filler can be accurately evaluated in combination with local conditions. The disadvantage is that the consultation and examination period is longer, but it can provide the most comprehensive information to the surgeon to select the best surgical incision, achieve the least surgical trauma and maximize the surgical removal effect, and at the same time, normal tissue damage can be avoided to the greatest extent possible. Compared to traditional blurring methods it is able to reduce the number of misses and remove the injected material more completely.