In this episode Ryan and Toxo dissect the fascinating underbelly of illegal cosmetic procedures and breakdown the toxicities that arise from them.

Intro

• Case report of hemolysis after sodium deoxycholate injection 
• History

Epidemiology

• ASPS stats
• Florida Unlicensed Activity Unit 
• Cost of surgeon fee for buttock implant 2018

Recent new stories

• Botox and Bubbles grifter
• Quick bio on cases mentioned in show

Common injection practices

• Feminizing body contouring (pumping parties)
• Synthol muscles
• Capsule face cosmetics

Toxicity

• Infection
• Self explanatory

Filler embolism

• Review 1, Review 2, Review 3
• Filler lodges in pulmonary vasculature->clotting, bleeding, inflammation
• 95% occur within 72 hours
• Primarily respiratory symptoms (cough/hypoxemia)
• Chest x ray ground glass opacity
• Treat with supportive care (oxygen all the way through ECMO) +/- steroids
• Filler Blindness
• CRAO from body filler
• No effective treatment (exception, can use hyaluronidase if filler is hyaluronic acid)

Granuloma

• Inflammatory nodules from prolonged filler exposure
• May occur months to year after injection
• Illegal cosmetic= frequently lipogranuloma due to oil being present in many illegal cosmetic
• Granulomatous hypercalcemia
• Excess calcitriol production from ganuloma causes hyperCA
• Can be extremely delayed (up to 28 years)
• Recurrence up to 45%
• Treat with standard therapies (fluid, bisphosphonate) + steroids and/or ketoconazole to turn down granuloma CYP27B1 calcitriol production

Case from the show

• Some details changed for educational purposes

Music in this episode from pixabay.com

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• Email: Toxtalk1@gmail.com

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