Journal List > J Korean Ophthalmol Soc > v.53(3) > 1009302

Chung, Shin, and Lew: Nonsurgical Treatment of Abnormal Eyelid Position Using Hyaluronic Acid Gel

Abstract

Purpose

The present study investigated the outcomes of nonsurgical treatment of abnormal eyelid position using hyaluronic acid gel.

Methods

Abnormal eyelid position including 18 eyes with lid retraction, 10 eyes with lagophthalmos, and 18 eyes with ectropion were treated with hyaluronic acid gel. The mean age was 50 ± 17.8 years and the mean observation period was 11 ± 2.4 months. The photographs of patients were taken before injection, 1 month, 4 months, and at the last follow-up after injection. The marginal reflex distance 1 (MRD1) and marginal reflex distance 2 (MRD2) of patients were measured and analyzed by the Image J Program. The severity of ectropion was graded by a scoring system.

Results

Ten eyes with lagopthalmos improved 1.9 ± 1.2 mm after injection. The 16 eyes with lid retraction improved 1.3 ± 0.9 mm. Twenty-three eyes with ectropion improved and 17 eyes (81%) were completely corrected. The average frequency of injection was 1.1 and the average dose of injection was 0.4 ± 0.12 cc. No significant complications were observed in any patient.

Conclusions

Hyaluronic acid gel injections can be used safely and effectively as a nonsurgical treatment for patients with abnormal eyelid position without any significant complications.

Figures and Tables

Figure 1
Schematic image of locations of hyaluronic acid gel injection. (A) Image of upper lid. (B) Image of lower lid.
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Figure 2
Examples of patients with lagopthalmos, before and after treatment with hyaluronic acid. Case 2, 81 year-old female with left lagopthalmos. (A) Before injection, (B) 4 months after injection. Case 3, 50 year-old female, with left paralytic lagopthalmos (C, D). Case 4, 39 year-old female, with right lagopthalmos. (E) Before injection, (F) 6 months after injection.
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Figure 3
Examples of patients with lid retraction, before and after treatment with hyaluronic acid gel injection. Case 2, 15 year-old female, after primary closure of lowerlid laceration. (A) Before injection, (B) 5 months after injection. Case 7, 58 year-old female, after Lower lid blepharoplasty who has injury of facial laceration. (C) Before injection, (D) 6 months after injection. Case 8, 11 year-old female, with lid retraction. (E) Before injection, (F) 6 months after injection.
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Figure 4
Examples of patients with ectropion, before and after treatment with hyaluronic acid. Case 3, 45 year-old male, with left paralytic ectropion. (A) Before injection, (B) 5 months after injection. Case 5, 72 year-old female, with left facial palsy. (C) Before injection, (D) 3 months after injection. Case 12, 70 year-old male, after lower blepharoplasty. (E) Before injection, (F) 8 months after injection.
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Table 1
Demography of the patients with lagophthalmos
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Table 2
Demography of patients with lid retraction
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IPF = interpalpebral fissure; ULLL = upperlid lowerlid; LL = lowerlid; UL = upperlid; s/p = post operative status.

Table 3
Demography of patients with ectropion
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ULLL = upperlid lowerlid; LL = lowerlid; UL = upperlid.

*Surgeon's grading system- Excellent: improvement of whole eyelid, Good: correction with improvement more than half of eyelid, Poor: correction with improvement less than half of eyelid; Patient's grading system- Execllent: satisfaction of both cosmesis and symptoms, Good: satisfaction of comesis or symptoms, Poor: satisfaction of cosmesis nor symptoms.

References

1. Morley AM, Taban M, Malhotra R, Goldberg RA. Use of hyaluronic acid gel for upper eyelid filling and contouring. Ophthal Plast Reconstr Surg. 2009. 25:440–444.
2. Donath AS, Glasgold RA, Glasgold MJ. Volme loss versus gravity: new concepts in facial aging. Curr Opin Otolaryngol Head Neck Surg. 2007. 15:238–243.
3. Colemans SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006. 26:1S. S4–S9.
4. Zimbler MS, Kokoska MS, Thomas JR. Anatomy and pathophysiology of facial aging. Facial Plast Surg Clin North Am. 2001. 9:179–187.
5. Lambros V. Volumizing the brow with hyaluronic acid fillers. Aesthet Surg J. 2009. 29:174–179.
6. John HE, Price RD. Perspectives in the selection of hyaluronic acid fillers for facial wrinkles and aging skin. Patient Prefer Adherence. 2009. 3:225–230.
7. Goldberg RA, Fiaschetti D. Filling the periorbital hollows with hyaluronic acid gel: initial experience with 244 injections. Ophthal Plast Reconstr Surg. 2006. 22:335–341.
8. Seiff SR. The fat pearl graft in ophthalmic plastic surgery: everyone wants to be a donor. Orbit. 2002. 21:105–109.
9. Ciuci PM, Obagi S. Rejuvenation of the periorbital complex with autologous fat transfer: current therapy. J Oral Maxillofac Surg. 2008. 66:1686–1693.
10. Flowers RS. Tear trough implants for correction of tear trough deformity. Clin Plast Surg. 1993. 20:403–415.
11. Gold MH. Use of hyaluronic acid fillers for the treatment of the aging face. Clin Interv Aging. 2007. 2:369–376.
12. DeLorenzi C, Weinberg M, Solish N, Swift A. A multicenter study of the efficacy and safety of subcutaneous nonanimal stabilized hyaluronic acid in aesthetic facial contouring: interim report. Dermatol Surg. 2006. 32:205–211.
13. Fezza JP. Nonsurgical treatment of cicatricial ectropion with hyaluronic acid filler. Plast Reconstr Surg. 2008. 121:1009–1014.
14. Kane MA. Treatment of tear trough deformity and lower lid bowing with injectable hyaluronic acid. Aesthetic Plast Surg. 2005. 29:363–367.
15. Steinsapir KD, Steinsapir SM. Deep-fill hyaluronic acid for the temporary treatment of the naso-jugal groove: a report of 303 consecutive treatments. Ophthal Plast Reconstr Surg. 2006. 22:344–348.
16. Ross JJ, Mahlotra R. Orbitofacial rejuvenation of temporal hollowing with perlane injectable filler. Aesthet Surg J. 2010. 30:428–433.
17. Goldberg RA, Lee S, Jayasundera T, et al. Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic acid gel. Ophthal Plast Reconstr Surg. 2007. 23:343–348.
18. Zamani M, Thyagarajan S, Olver JM. Functional use of hyaluronic acid gel in lower eyelid retraction. Arch Ophthalmol. 2008. 126:1157–1159.
19. Taban M, Mancini R, Nakra T, et al. Nonsurgical management of congenital eyelid malpositions using hyaluronic acid gel. Ophthal Plast Reconstr Surg. 2009. 25:259–263.
20. Kornstein AN. Soft-tissue reconstruction of the brow with restylane. Plast Reconstr Surg. 2005. 116:2017–2020.
21. Airan LE, Born TM. Nonsurgical lower eyelid lift. Plast Reconstr Surg. 2005. 116:1785–1792.
22. Biesman B. Soft tissue augmentation using restylane. Facial Plast Surg. 2004. 20:171–177.
23. Lowe NJ, Maxwell CA, Patnaik R. Adverse reactions to dermal fillers: review. Dermatol Surg. 2005. 31:1616–1625.
24. Friedman PM, Mafong EA, Kauvar AN, Geronemus RG. Safety data of injectable non animal stabilized hyaluronic acid gel for soft tissue Dugmentation. Dermatol Surg. 2002. 28:491–494.
25. Lowe NJ, Maxwell CA, Lowe P, et al. Hyaluronic acid skin fillers: adverse reactions and skin testing. J Am Acad Dermatol. 2001. 45:930–933.
26. Schanz S, Schippert W, Ulmer A, et al. Arterial embolization caused by injection of hyaluronic acid (Restylane). Br J Dermatol. 2002. 146:928–929.
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