Nestor Mark S, Ablon Glynis R, Stillman Mark A
J Clin Aesthet Dermatol. 2010 Mar;3(3):29-34.
Objectives. Consensus guidelines developed for the use of hyaluronic acid dermal fillers describe the use of cooling the skin to reduce patient discomfort during injection. The vasoconstrictive effects of cold may provide reduced ecchymosis and swelling at the site. However, the effect of applying ice or cooled air is unpredictable because these modalities do not deliver precise temperature, which may result in cold burn or insufficient effect to targeted areas. This open-label, randomized, single-blinded, split-face trial was conducted to measure the extent to which applying a spot cooling device reduces patient discomfort and ecchymoses in the clinical setting in patients undergoing a dermal filler procedure. Subjects. Twenty male and female subjects of any race, ages 35 to 65 years, with moderate and severe nasolabial folds were included in this study. Seven (35%) subjects had received previous small gel particle hyaluronic acid injections. Methods. Prior to injection, the topical cooling system was set at 35 degrees F and a cooled applicator was applied for 20 seconds on one nasolabial fold. A control using a noncooled applicator was applied for 20 seconds on the other nasolabial fold. Postprocedure ice packs were prohibited so as not to confound the subject's perception of procedure-related pain. Subjects (using visual analog pain scales) and blinded investigators rated pain and ecchymosis using predetermined scales and satisfaction surveys. Results. Use of the cooling system was associated with mean pain reduction of 61, 70, and 42 percent compared to control, as measured by visual analog pain scales, immediately following and one hour and three hours post small gel particle hyaluronic acid injection. Additionally, use of the cooling system was associated with mean ecchymosis reduction of 88, 89, 80, and 66 percent compared to control immediately following injection, one hour, three hours, and next-day postinjection. Conclusion. The cooling system provided adequate pain management (both subjectively and objectively through blinded evaluations) during and after small gel particle hyaluronic acid dermal filler injections for the correction of moderate nasolabial folds. Furthermore, results demonstrate that the cooling system is associated with decreased ecchymosis. Future studies are needed comparing the use of topical anesthetics to a cooling system for the reduction of pain and ecchymosis associated with the use of dermal filler injections.
目的。为透明质酸真皮填充剂的使用制定的共识指南描述了通过冷却皮肤来减轻注射过程中患者的不适感。寒冷的血管收缩作用可能会减少注射部位的瘀斑和肿胀。然而，冰敷或冷空气吹拂的效果难以预测，因为这些方式无法精确控制温度，这可能导致冷灼伤或对目标区域效果不佳。本开放性标签、随机、单盲、半脸对照试验旨在衡量在接受真皮填充手术的患者临床环境中，使用点冷却装置减轻患者不适和瘀斑的程度。
受试者。本研究纳入了20名年龄在35至65岁之间、有中度和重度鼻唇沟的男女受试者，种族不限。7名（35%）受试者曾接受过小颗粒凝胶透明质酸注射。
方法。注射前，将局部冷却系统设置为35华氏度，并在一侧鼻唇沟使用冷却敷贴20秒。在另一侧鼻唇沟使用未冷却的敷贴作为对照，持续20秒。术后禁止使用冰袋，以免混淆受试者对手术相关疼痛的感知。受试者（使用视觉模拟疼痛量表）和盲法研究者使用预定量表对疼痛、瘀斑和满意度进行评分。
结果。通过视觉模拟疼痛量表测量，在小颗粒凝胶透明质酸注射后即刻、1小时和3小时，与对照相比，冷却系统的使用分别使平均疼痛降低了61%、70%和42%。此外，与对照相比，在注射后即刻、1小时、3小时和注射后次日，冷却系统的使用分别使平均瘀斑减少了88%、89%、80%和66%。
结论。冷却系统在小颗粒凝胶透明质酸真皮填充剂注射过程中及注射后，通过盲法评估在主观和客观上均提供了充分的疼痛管理，用于矫正中度鼻唇沟。此外，结果表明冷却系统与瘀斑减少有关。未来需要开展研究，比较局部麻醉剂与冷却系统在减轻真皮填充剂注射相关疼痛和瘀斑方面的效果。
