Abstract
Background:
The demand for soft tissue filler injections has experienced a significant increase in recent years. Therefore, this study used bibliometric analysis to identify prominent research areas and emerging trends within the field.
Methods:
Publications concerning research on soft tissue filler injections were collected from the Web of Science Core Collection database. Subsequently, VOSviewer 1.6.18 and CiteSpace 6.2.R4 software were used to analyze the co-authorship, co-occurrence, and citations of countries, institutions, authors, hotspot keywords, and journals associated with these studies.
Results:
A total of 1370 records pertaining to filler injection research conducted between 2000 and 2022 were identified. The United States (524 publications) emerged as the country with the highest number of publications in this field, with Mayo Clinic (37 publications) making the most substantial contribution. Dermatologic Surgery emerged as the leading journal in this field, publishing the highest number of research articles (151 publications) and also being the most frequently co-cited. Cotofana proved to be the most prolific author with 51 publications, and Lemperle emerged as the most frequently co-cited author with 628 citations (including total link strength: 6587). The most popular keywords, in descending order of popularity, were “dermal filler,” “injection,” “soft-tissue augmentation,” “complications,” and “hyaluronic acid.”
Conclusions:
The findings of this study offer a comprehensive overview of the main directions in filler injection research. Furthermore, they underscore the imperative of intensifying efforts to prevent complications linked to filler injections.
Takeaways
Question: This study used bibliometric analysis to identify prominent research areas and emerging trends within the field of filler injection.
Findings: The study analyzed the co-authorship, co-occurrence, and citations of countries, institutions, authors, hotspot keywords, and journals associated with filler injection.
Meaning: The findings of this study offer a comprehensive overview of the main directions in filler injection research.
INTRODUCTION
Soft tissue filler injections are widely acknowledged as a safe and straightforward treatment for aesthetic purposes. These fillers are derived from various materials, including hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid. Notably, the Food and Drug Administration has approved more than 30 dermal fillers.1–3 According to the American Society for Aesthetic Plastic Surgery, an estimated 3,410,730 soft tissue filler injections were performed in the United States in 2020, ranking it as the second most common minimally invasive cosmetic procedure.4 However, the growing popularity of these procedures has resulted in an increase in associated adverse events.5,6 To enhance their efficacy and minimize such complications, novel fillers, techniques, and fundamental research have been introduced.7–11 Thus, it is crucial to summarize the present research status in this field and identify areas for further investigation to facilitate the implementation of soft tissue filler injections.
Bibliometric analysis, a mathematical modeling tool, is used to monitor research trends in specific fields.12 Although bibliometrics has found extensive applications in medicine, including pneumonia,13 arthritis,14 hypertension,15 and human immunodeficiency virus disease,16 as well as in plastic surgery,17–21 no previous bibliometric study has specifically focused on soft tissue filler injections. This research topic holds a significant value for enhancing clinical treatment. The rapid development of fillers and techniques has resulted in a substantial increase in the number of published articles. Consequently, both researchers and nonresearchers can use this information to efficiently accomplish specific objectives within their respective areas of interest by studying highly influential research.
The objective of this study was to perform a bibliometric and visualization analysis in the field of soft tissue filler injections. The aim was to offer a comprehensive overview of the present research status and identify potential future perspectives in the field.
METHODS
Search Strategy
On March 7, 2023, we performed a search in the Web of Science Core Collection (WoSCC) database using the search terms “TS=((soft tissue filler injection) OR (dermal filler injection))” to identify studies published in English between January 1, 2000 and December 31, 2022. Two authors independently screened data and excluded documents irrelevant to the search strategies. We only considered original articles and reviews, resulting in 1384 retrieved records. To ensure data quality, we preprocessed the data to eliminate duplicates or inconsistencies related to the topic. After screening by three researchers, we acquired 1370 valid documents (Fig. 1).
Fig. 1.
Flowchart illustrating the article selection process for bibliometric mapping analysis and systematic review.
Analysis Tool
The data retrieved from WoSCC consisted of articles and citations, h-index, keywords, publication years, journals, authors, countries/regions, and affiliations. The articles were analyzed, and visual representation was created using VOSviewer and CiteSpace software. The bibliographic data were exported as a txt file from the WoSCC database and subsequently imported into VOSviewer and CiteSpace software to generate visualization maps. The basic metrics and visualization maps of countries,
institutions, authors, journals, and keywords were analyzed through VOSviewer and CiteSpace software. The basic metrics and visualization maps of countries, institutions, authors, journals, and keywords were analyzed through VOSviewer. A timeline view of co-cited reference was performed by CiteSpace. The size of the nodes and the thickness of the lines between the nodes represented the occurrence frequency and the degree of correlation of the relevant parameters, respectively. The nodes with the same color represented the same cluster in the visualization map.
RESULTS
The Number of Articles in the Field of Soft Tissue Filler Injection
After applying the predetermined exclusion criteria, the study included 1370 papers authored by 4557 individuals affiliated with 1870 organizations in 64 countries. These papers were published in 284 journals and were subsequently subjected to further bibliometric analyses. In total, the publications received 26,320 citations, of which 18,166 were non–self-citations. The average citations per document were 19.21, and the h-index of the publications was 69.
Distribution of Publications from 2000 to 2022
Figure 2 depicts the temporal distribution of publications in the field of soft tissue filler injection. Since 2017, the number of publications and citations in this field has shown a significant increase. It is noteworthy that there has been a substantial surge in publications and citations during this period, with the number of publications consistently surpassing 100, from 2018 to 2022. These findings indicate a growing interest among scholars in the research field of soft tissue filler injection, positioning it as a novel area of study within plastic and aesthetic research.
Fig. 2.
Annual worldwide publication output.
The National/Regional Distribution of Global Publication
Figure 3 illustrates the distribution of countries/regions with the highest number of global publications on soft tissue filler injection, whereas Table 1 provides a ranking of the top 10 most productive countries/regions. The top 10 countries accounted for 99.12% of the publications, with the United States leading in the number of published articles, followed by South Korea and Germany. Additionally, the United States, Germany, and South Korea had the highest numbers of citations, whereas France had the highest h-index. Spain and the United States tied for second and third place in terms of h-index. The distribution of countries/regions was analyzed using the VOSviewer software, focusing on those with at least five documents. This analysis identified 41 countries that met the criteria, and their relationships were visualized in a network diagram and a density map, as depicted in Figure 4.
Fig. 3.
Top 10 productive countries/regions.
Table 1.
The Top 10 Productive Countries/Regions
Rank | Country/Region | Records | Percentage (%) | H-index | Citations | Citations per Publication |
---|---|---|---|---|---|---|
1 | USA | 524 | 38.25% | 57 | 12,672 | 24.18 |
2 | South Korea | 176 | 12.85% | 22 | 1923 | 10.93 |
3 | Germany | 141 | 10.29% | 30 | 2809 | 19.92 |
4 | Italy | 103 | 7.52% | 21 | 1564 | 15.18 |
5 | China | 82 | 5.99% | 18 | 858 | 10.46 |
6 | England | 81 | 5.91% | 23 | 1622 | 20.02 |
7 | Brazil | 74 | 5.40% | 18 | 886 | 11.97 |
8 | Canada | 66 | 4.82% | 22 | 1524 | 23.09 |
9 | France | 66 | 4.82% | 25 | 1741 | 26.38 |
10 | Spain | 45 | 3.28% | 20 | 1111 | 24.69 |
Fig. 4.
Network visualization map of countries/regions.
Distribution of Affiliations
Table 2 presents the top 10 most productive affiliations. These affiliations represent three countries: the United States, South Korea, and Germany, with six of them originating from the United States. The leading affiliations were the Mayo Clinic (2.70%, 37 publications), the University of California, San Diego (2.55%, 35 publications), and the University of Munich (2.19%, 30 publications). Among them, the University of California, San Diego (USA) achieved the highest h-index (20), while the University of California, Los Angeles (USA) had the highest citation/publication ratio (41.24). To analyze the collaboration among different affiliations, a minimum threshold of 10 documents per affiliation was set, resulting in 39 affiliations meeting the criteria.
Table 2.
The Top 10 Productive Affiliations
Rank | Institution | Location | Records | Percentage | H-index | Citations | Citations Per Publication |
---|---|---|---|---|---|---|---|
1 | Mayo Clinic | USA | 37 | 2.70% | 11 | 288 | 7.78 |
2 | Univ Calif San Diego | USA | 35 | 2.55% | 20 | 1320 | 37.71 |
3 | University of Munich | Germany | 30 | 2.19% | 17 | 433 | 14.43 |
4 | Univ Calif Los Angeles | USA | 29 | 2.12% | 18 | 1196 | 41.24 |
5 | Yonsei University | South Korea | 26 | 1.90% | 11 | 348 | 13.38 |
6 | University of Miami | USA | 23 | 1.68% | 14 | 816 | 35.48 |
7 | Chung-Ang University | South Korea | 23 | 1.68% | 8 | 137 | 5.96 |
8 | University of British Columbia | England | 21 | 1.53% | 12 | 813 | 38.71 |
9 | Albany Medical College | USA | 20 | 1.46% | 13 | 437 | 21.85 |
10 | Northwestern University | USA | 20 | 1.46% | 14 | 496 | 24.80 |
Distribution of Journals and Co-cited Journals
Table 3 and Table 4 present the list of the top 10 productive and co-cited journals, respectively. Dermatologic Surgery ranked first with 151 publications, followed by the Journal of Cosmetic Dermatology (134 publications) and Plastic and Reconstructive Surgery (94 publications). Among the top 10 productive journals, Plastic and Reconstructive Surgery had the highest impact factor (IF; 5.169), h-index (36), and CPP (citations per publication; 42.50). Additionally, Dermatologic Surgery was the most frequently co-cited journal, with 5689 citations [total link strength (TLS): 134,521]. A co-citation analysis using VOSviewer was conducted to reveal the complex relationships among the journals. The analysis included 49 journals meeting the criteria of a minimum of 100 citations per source (Fig. 5).
Table 3.
The Top 10 Productive Journals
Rank | Journal | Records | Percentage | Citations | CPP | H-index | IF (2021) |
---|---|---|---|---|---|---|---|
1 | Dermatologic Surgery | 151 | 11.02% | 4177 | 27.66 | 36 | 2.914 |
2 | Journal of Cosmetic Dermatology | 134 | 9.78% | 1182 | 8.82 | 20 | 2.189 |
3 | Plastic and Reconstructive Surgery | 94 | 6.86% | 3995 | 42.50 | 42 | 5.169 |
4 | Aesthetic Plastic Surgery | 91 | 6.64% | 1684 | 18.51 | 23 | 2.708 |
5 | Journal of Drugs in Dermatology | 82 | 5.99% | 1141 | 13.91 | 20 | 1.608 |
6 | Aesthetic Surgery Journal | 75 | 5.47% | 1675 | 22.33 | 20 | 4.485 |
7 | Journal of Cosmetic and Laser Therapy | 43 | 3.14% | 713 | 16.58 | 14 | 1.982 |
8 | Facial Plastic Surgery | 36 | 2.63% | 475 | 13.19 | 13 | 1.286 |
9 | Clinical Cosmetic and Investigational Dermatology | 36 | 2.63% | 323 | 8.97 | 9 | 2.765 |
10 | Dermatologic Therapy | 26 | 1.90% | 298 | 11.46 | 8 | 3.858 |
Table 4.
Top 10 Co-cited Journals
Rank | Journal | Citations | TLS | H-index | IF (2021) |
---|---|---|---|---|---|
1 | Dermatologic Surgery | 5689 | 134,521 | 36 | 2.91 |
2 | Plastic and Reconstructive Surgery | 4417 | 107,257 | 42 | 5.17 |
3 | Aesthetic Plastic Surgery | 1583 | 46,705 | 23 | 2.708 |
4 | Aesthetic Surgery Journal | 1502 | 41,293 | 20 | 4.485 |
5 | Journal of Drugs in Dermatology | 1078 | 29,899 | 20 | 1.608 |
6 | Journal of Cosmetic Dermatology | 873 | 22,284 | 20 | 2.189 |
7 | Journal of the American Academy of Dermatology | 773 | 28,630 | 10 | 15.49 |
8 | Facial Plastic Surgery | 648 | 18,524 | 13 | 1.286 |
9 | Journal of Cosmetic and Laser Therapy | 576 | 15,831 | 14 | 1.982 |
10 | Ophthalmic Plastic and Reconstructive Surgery | 474 | 14,738 | 9 | 2.01 |
Fig. 5.
Network visualization map of co-cited journals related to soft tissue filler injection.
Distribution of Authors and Co-cited Authors
Table 5 presents the top 10 authors who have made significant contributions to the field of soft tissue filler injection, with the majority of them affiliated with institutions in the USA and Germany. Collectively, their publications amount to 231 articles, representing 16.86% of all publications. Among them, Cotofana has the highest number of publications (51 articles), followed by Frank (44 articles), and Green (23 articles). Cotofana has the highest citation count and h-index, whereas Fagien leads in the CCP rankings (44.53), followed by Cohen (32.50), and Swift (21.27).
Table 5.
The Top 10 Productive and Co-cited Authors
Rank | Author | Country | Records | Percentage | CCP | Co-cited Author | Citations | TLS | Country |
---|---|---|---|---|---|---|---|---|---|
1 | Cotofana | USA | 51 | 3.72% | 13.14 | Lemperle | 628 | 6587 | USA |
2 | Frank | Germany | 44 | 3.21% | 12.39 | Narins | 373 | 4420 | USA |
3 | Green | USA | 23 | 1.68% | 11.91 | Rohrich | 276 | 3155 | USA |
4 | Kim | South Korea | 19 | 1.39% | 6.11 | Delorenzi | 221 | 2462 | Canada |
5 | Schenck | Germany | 17 | 1.24% | 20.35 | Alijotas-Reig | 214 | 3005 | Spain |
6 | Pavicic | Germany | 16 | 1.17% | 16.81 | Carruthers | 207 | 2288 | Canada |
7 | Cohen | USA | 16 | 1.17% | 32.50 | Lowe | 205 | 2502 | USA |
8 | Swift | Canada | 15 | 1.09% | 21.27 | Cotofana | 199 | 1441 | USA |
9 | Fagien | USA | 15 | 1.09% | 44.53 | Alam | 190 | 2475 | USA |
10 | Sattler | Germany | 15 | 1.09% | 13.07 | Carruthers | 188 | 2378 | Canada |
To examine the authors’ cooperation, we conducted co-authorship analysis (Fig. 6) and co-citation analysis (Fig. 7). For co-authorship analysis, the minimum number of documents required for one affiliation was set at 5, and 117 affiliations fulfilled this criterion. In the case of co-citation analysis, the minimum number of documents required for one affiliation was set at 50, and 91 authors satisfied this criterion.
Fig. 6.
Co-authorship network visualization of authors.
Fig. 7.
Co-citation network visualization of authors.
Top 10 Highly Cited Articles
Table 6 presents a summary of the top 10 most-cited references, including the author, title, and year of publication. Dermatologic Surgery was the most prolific journal, with three publications, followed by Aesthetic Surgery Journal with two publications. The article titled “In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin,” authored by Wang and published in Archives of Dermatology, received the highest number of citations (298). Among the top 10 most-cited articles, seven focused on complications associated with filler injections.
Table 6.
The Top 10 Articles with Most Total Citations
Rank | Title | First Author | Journal | Publication Time | Citation |
---|---|---|---|---|---|
1 | In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin | Wang | Archives of Dermatology | 2007 | 298 |
2 | Avoiding and treating blindness from fillers: a review of the world literature | Beleznay | Dermatologic Surgery | 2015 | 286 |
3 | The science of hyaluronic acid dermal fillers | Tezel | Journal of Cosmetic and Laser Therapy | 2008 | 226 |
4 | Adverse reactions to injectable soft tissue permanent fillers | Christensen | Aesthetic Plastic Surgery | 2005 | 215 |
5 | Adverse reactions to dermal fillers: review | Lowe | Dermatologic Surgery | 2005 | 206 |
6 | Complications of injectable fillers, part 2: vascular complications | DeLorenzi | Aesthetic Surgery Journal | 2014 | 193 |
7 | Adverse reactions to injectable soft tissue fillers | Requena | Journal of The American Academy of Dermatology | 2011 | 189 |
8 | Hyaluronic acid, a promising skin rejuvenating biomedicine: a review of recent updates and preclinical and clinical investigations on cosmetic and nutricosmetic effects | Bukhari | International Journal of Biological Macromolecules | 2018 | 171 |
9 | Understanding, avoiding, and managing dermal filler complications | Cohen | Dermatologic Surgery | 2008 | 166 |
10 | Complications after injection of soft-tissue fillers | Ozturk | Aesthetic Surgery Journal | 2013 | 163 |
Distribution of Research Hot Spots
To systematically identify the research hotspots and developmental direction of soft tissue filler injection, we performed a co-occurrence cluster analysis based on keywords using the VOSviewer software. After applying a threshold of 20, a total of 83 keywords were included for further visual analysis. A network map was created and is displayed in Figure 8A. The analysis of keyword citation counts revealed that the most frequently used keywords were “dermal filler,” “injection,” “soft-tissue augmentation,” “complications,” and “hyaluronic acid.” The temporal diagram indicated that the research trends centered around “hyaluronic acid,” “anatomy,” “blindness,” and “prevention” (Fig. 8B). Figure 9 displays the top 25 co-occurring keywords with the strongest citation bursts. The results revealed that the keyword “skin” had the highest burst intensity (5.79), followed by “soft tissue augmentation” (22.9) and “artecoll” (8.09). Subsequently, a keyword clustering analysis was conducted to categorize the co-occurrence network of keywords into six different clusters, namely “blindness,” “double blind,” “artecoll,” “stem cells,” “dermal fillers,” and “hyaluronic acid” (Fig. 10).
Fig. 8.
Network visualization map of keyword co-occurrence. A, Cluster analysis. B, Timing analysis.
Fig. 9.
The top 25 keywords with the strongest citation bursts based on CiteSpace.
Fig. 10.
Cluster analysis of keywords.
DISCUSSION
Soft-tissue filler injection is a frequently performed aesthetic procedure and an effective treatment for facial aging and contour deformities. However, due to the steady global increase in the number of soft tissue filler treatments performed, providing a comprehensive assessment of the topic has become increasingly challenging. Bibliometric analysis, a tool that uses mathematical models to track the overall research trends in a specific field, has recently been widely applied in the field of plastic surgery.14,18–20 To the best of our knowledge, this is the first bibliometric study conducted on the topic of soft tissue filler injection. This study identified 1370 research articles on soft tissue filler injection from the WoSCC database. The articles were published between January 1, 2000, and December 31, 2022.
Our analysis showed that before 2004, there were limited publications on soft tissue filler injection, with only a small number of articles being published each year. However, the citations for these articles started increasing after 2004, indicating a growing interest among researchers in this field as a potential research hotspot (Fig. 2). Among the 41 countries/regions that have published at least five articles in this field, the United States ranked first in terms of publications, accounting for 38.25%. The United States emerged as the primary contributor in the field, holding a significant academic reputation in filler injection research. This is supported by the number of publications, h-index values, and total number of citations (Table 1), which are closely linked to the country’s scientific research capacity, social development, economic status, and other factors.
Additionally, the Mayo Clinic emerged as the top publishing institution with 2.70% of total publications (37 articles). Moreover, the University of California San Diego (USA) achieved the highest h-index of 20 and garnered 1320 citations, while the University of California Los Angeles (USA) attained the highest citation/publication ratio of 41.24. These findings underscore the significant contributions of the USA to the advancement of this field.
Among the top 10 most productive journals, Dermatologic Surgery, Journal of Cosmetic Dermatology, and Plastic and Reconstructive Surgery stood out for publishing the highest number of articles in this field. Dermatologic Surgery emerged as the leading journal, boasting the highest number of publications and citations. It claimed the top spot among the most co-cited journals, showcasing its significant influence in the field of research. Plastic and Reconstructive Surgery served as a reliable source of up-to-date knowledge, covering the latest techniques and notable advancements in all areas of plastic and reconstructive surgery. Specifically, within the field of filler injection, it boasted the highest IF (5.169), h-index (36), and CPP (42.50), signifying the presence of high-quality research within its pages.
Of the top 10 articles with the highest total citations, seven focused on filler complications,22–28 which continue to pose significant safety concerns for both cosmetic patients and physicians, highlighting the importance of this research field. Blindness is a rare and devastating complication, and possessing comprehensive anatomical knowledge is crucial for its prevention.29 These publications offered promising avenues that warrant further in-depth studies. Since 2016, there has been a surge in research interest regarding facial anatomy and vascular complications such as necrosis and blindness, making them the focal points of investigation (Figs. 9 and 11).
Fig. 11.
Timeline visualization of keyword cluster analysis results from 2000 to 2022.
In this study, we conducted an analysis of articles pertaining to soft tissue filler injection by identifying them from the WoSCC database. We explored various aspects, including co-authorship, co-occurrence, and citation patterns among countries, institutions, authors, and hot spot keywords. Nevertheless, we restricted our analysis to English-language articles and solely relied on the WoSCC, which might not encompass all relevant databases. Consequently, the accuracy of our analysis may have been influenced.
CONCLUSIONS
Soft tissue filler injection has become a prominent subject in the realms of clinical and research domains within plastic and aesthetic surgery. Obtaining a comprehensive understanding of the trends and hotspots in this field is crucial to acquire valuable information. Our study offers a broad overview of the principal research directions in this field, emphasizing the contributions of the USA, as well as its affiliated institutions and authors. Prominent journals in this field include Plastic and Reconstructive Surgery, Dermatologic Surgery, and the Journal of Cosmetic Dermatology. Additionally, complications arising from filler injection and their prevention have garnered substantial attention and represent potential areas of future research focus. This study provides novel insights that can facilitate further research in this field.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
Footnotes
Published online 2 February 2024.
Disclosure statements are at the end of this article, following the correspondence information.
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