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Novel eyelid volume-enhancing technique offers alternative to surgery
Ophthal Plast Reconstr Surg. 2011;27(2):69-73.
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Use of hyaluronic acid filler for tear trough rejuvenation showed high utility and safety as an alternative to lower eyelid surgery, a study found.
Cosmetic treatment of the aging lower eyelid has shifted away from surgical excision of soft tissues and excess skin and toward volume replacement or redistribution, the study authors said.
"Patient acceptance of this procedure is high, and demand is likely to increase as awareness grows, reflecting the ongoing movement toward less invasive facial rejuvenation treatments," they said. "Counseling patients on the choice between surgery and other, less invasive techniques will be one of the new challenges faced by oculofacial surgeons."
The prospective study included 198 eyes of 100 patients. Mean patient age was 47.8 years.
Primary patient complaints were hollows, dark circles, fatigued appearance and aging appearance.
Patients underwent injection of hyaluronic acid filler gel (Perlane, Q-Med) into the preperiosteal space, anterior to the inferior orbital rim. Mean injection volume was 0.59 mL per eye (range: 0.25 mL to 1.8 mL). Mean follow-up was 5.1 months. Patients underwent telephone interviews at a mean 5.3 months after treatment.
Study results showed that 85% of patients were very or moderately satisfied with the treatment, 10% were dissatisfied and 5% were ambivalent.
Data showed 95% of patients tolerated the treatment; 18% reported no pain; 40% reported minimal discomfort; and 37% reported the procedure as painful but tolerable.
Side effects included bruising, swelling, blue discoloration and lumpiness. Eight percent of patients required an additional injection within 3 months of primary treatment, the authors reported.
What better procedure for an oculofacial surgeon to add to his or her armamentarium for tear-trough rejuvenation than the use of hyaluronic gel injectable fillers? There are currently a variety of successful surgical techniques for volume and contour enhancement in this area but each has its own potential surgical complications and degree of morbidity. Eighty-five percent of patients in this study were satisfied with the results. Ninety-five percent of patients tolerated the injections without anesthesia. Eighty-six percent of patients would recommend the procedure to a friend and 86% would consider repeating the injections again. The most common adverse effect, lumpiness, can be dealt with using massage or reversed with hyaluronidase. Satisfaction, tolerability, reversibility, patient referrals and repeat customers — what more could an oculofacial surgeon want from a single cosmetic procedure?
– Charles B. Slonim, MD, FACS
OSN
Oculoplastic and Reconstructive Surgery Board Member
Disclosure: Dr. Slonim
has no financial relationships related to the study.