Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
ZenrayShangmei Medical Aesthetics' Clinic, Beijing, China.
Aesthetic Plast Surg. 2019 Oct;43(5):1310-1317. doi: 10.1007/s00266-019-01440-3. Epub 2019 Aug 9.
It has been reported that the injection of the hyaluronic acid (HA) into the lower lid area could improve lower eyelid retraction. However, the published studies offered few insights into the mechanism of this treatment. When the underlying mechanism is not clear, many surgeons will not trust the method enough to apply it in their clinical practice. The purpose of this article was to propose a possible explanation for the underlying mechanism of the treatment and further verify the method by a series of cases.
The authors performed a mechanical analysis on the physical impact of HA on the lower eyelid. In the clinical cases, we injected the fillers under the orbicularis muscle to correct lower lid retraction. The results were evaluated by the standardized marginal reflex distance 2 (MRD2) immediately and 9 months later.
From October 2013 to October 2015, the injections were carried out in 27 cases (14 post-blepharoplasty and 13 involuntary). In 26 cases (96.3%), the retraction was completely corrected and did not recur through the last follow-up. The average improvement of the standardized MRD2 was 0.84 mm immediately after the injection and 1.19 mm 9 months later. Complications were not reported.
Lower eyelid retraction could be treated by the injection of HA under the orbicularis muscle. The filler in this situation acted as a lifter because the filler changed the balance of force of the lower lid, forcing it to shift upward to gain the new balance. The 'lifter' mechanism could be applicable to other facial injections that generate elevating effects.
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据报道，在下眼睑区域注射透明质酸（HA）可改善下眼睑退缩。然而，已发表的研究对这种治疗方法的机制提供的见解甚少。当潜在机制不明确时，许多外科医生不会充分信任该方法，以至于不会将其应用于临床实践。本文旨在为该治疗方法的潜在机制提供一种可能的解释，并通过一系列病例进一步验证该方法。
作者对 HA 对下眼睑的物理影响进行了力学分析。在临床病例中，我们在下眼轮匝肌下注射填充物以矫正下眼睑退缩。通过标准化的边缘反射距离 2（MRD2）即刻和 9 个月后评估结果。
从 2013 年 10 月至 2015 年 10 月，共对 27 例（14 例为术后眼睑成形术，13 例为非自愿性）进行了注射。在 26 例（96.3%）中，退缩完全矫正，且在最后一次随访中未复发。注射后即刻标准化 MRD2 的平均改善为 0.84mm，9 个月后为 1.19mm。未报告并发症。
下眼睑退缩可以通过在下眼轮匝肌下注射 HA 来治疗。在这种情况下，填充物充当了提升器，因为填充物改变了下眼睑的力平衡，迫使它向上移动以获得新的平衡。这种“提升器”机制可能适用于产生提升效果的其他面部注射。
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