Blog
About Time
As dermatologists we are all aware of the serious nature of psoriasis and its impact on the quality of life of patients. In the last decade we...
De Pasquale and colleagues (Aesthetic Plast Surg. 2013;37:587-591) published a review of the use of hyaluronic acid (HA) fillers for tear trough deformity. In this study, 22 patients were injected with HA filler and evaluated 7 days after injection; then after 1, 6, and 12 months; and then yearly up to 3 years (20/22 patients). High-frequency ultrasonography using a 15-MHz scanner with an axial resolution of 15 mm was utilized to evaluate the presence of filler at each follow-up visit. Injection technique with 3 punctures and filler deposit was used.
The amount of filler used in each area ranged from 0.1 to 0.3 mL (mean [standard deviation], 0.267±0.128 mL). At 1-week follow-up, 21 patients required another injection in the same area or adjacent to the injected area to improve the appearance. The filler was always identifiable by ultrasonography, and it was possible to measure the amount of filler in the tissue. Filler measurement during the first follow-up scan ranged from 4.31 to 1.81 mm (mean [standard deviation], 3.06±0.70 mm), whereas the last follow-up scan showed values ranging from 1 to 2.3 mm (mean [standard deviation], 1.40±0.29 mm).
What's the issue?
The study showed several interesting findings. The fact that ultrasonography can reliably show HA filler agent in this area is very interesting. Because the tear trough is one of the more sensitive areas we inject with HA, it may be useful to utilize this technology for follow-up patients. The ultrasound also showed that some HA filler was present for as long as 3 years, which confirms the clinical observation that patients require less agent at a greater duration in this area. The authors also stressed that the technique of 3 to 5 injections perpendicular to the skin below the orbital rim created filler deposits deep in the orbicularis oculi muscle and was safe and effective. Does this technique differ from the one you use? Do you use a different technique for different patients? Have you seen different results based on your technique?
