Safia Alaa, Abd Elhadi Uday, Merchavy Shlomo, Batheesh Ramzy, Bathish Naji
Department of Otolaryngology, Rebecca Ziv Medical Center, Safed 1311001, Israel.
Department of Dermatology, Rambam Health Care Campus, Haifa 3100000, Israel.
J Clin Med. 2025 Jun 27;14(13):4572. doi: 10.3390/jcm14134572.
Hyaluronic acid (HA) has emerged as a favored adjunct to restore volume after blepharoplasty and is very effective in the treatment of postoperative hollowness, sagging, and asymmetry. Its efficacy, rate of complications, and optimal injection technique are different in different clinical studies. Hyaluronidase has been studied by diverse methods in the treatment of HA complications, including chronic edema and surgical distortion. This study critically evaluated the efficacy, safety, and technical aspects of HA in the context of blepharoplasty outcomes. A systematic review was performed to evaluate the use of HA and hyaluronidase for post-blepharoplasty volume rejuvenation and the treatment of complications. Studies describing HA injection technique, time interval between blepharoplasty and injection, volumetric maintenance, complication rates, esthetic and functional results, and patient satisfaction scores were considered. Risk of bias was estimated with the ROBINS-I tool. Sample sizes across the five included studies ranged from 5 to 109 patients, and follow-up intervals ranged from 1 month to 7 years. The age of patients ranged from 31 to 76 years, and females accounted for 86% of the participants in some studies. Injection of HA successfully restored meaningful volume, with retention persisting for over 12 months in the majority of cases. HA preoperative injection caused significant patient satisfaction in a short duration and was not associated with severe complications; delayed injection caused slight distortions in some revision operations. Lipofilling showed a reduced rate of complications (12%) compared with isolated blepharoplasty (20%), suggesting its utility as an adjuvant procedure of volume restoration. Hyaluronidase successfully treated recalcitrant edema, with improvements ranging from 50% to 100%, while the application of adjuvant RF microneedling caused complete remission (100%) in subjects with multiple treatments. The application of ultrasound imaging made measurements more precise, although methods of clinical assessment were significantly heterogeneous among the studies. HA displayed efficacy in terms of efficient volume restoration after blepharoplasty, especially when technique, time, and filler selection are meticulously optimized. In comparison to lipofilling, HA is seen as somewhat safer because of its reversibility and lower likelihood of adverse vascular events. Nonetheless, considerable variability in filler type, amount, timing of administration, and result evaluation constrains conclusive clinical recommendations. The use of hyaluronidase is an effective remedial approach for overcorrection or ongoing edema.
透明质酸（HA）已成为睑成形术后恢复容积的一种常用辅助手段，在治疗术后凹陷、下垂和不对称方面非常有效。在不同的临床研究中，其疗效、并发症发生率和最佳注射技术各不相同。透明质酸酶已通过多种方法用于治疗HA相关并发症，包括慢性水肿和手术畸形。本研究在睑成形术效果的背景下，对HA的疗效、安全性和技术方面进行了严格评估。进行了一项系统评价，以评估HA和透明质酸酶在睑成形术后容积恢复和并发症治疗中的应用。考虑了描述HA注射技术、睑成形术与注射之间的时间间隔、容积维持、并发症发生率、美学和功能结果以及患者满意度评分的研究。使用ROBINS-I工具估计偏倚风险。纳入的五项研究样本量从5例到109例患者不等，随访间隔从1个月到7年不等。患者年龄从31岁到76岁不等，在一些研究中女性占参与者的86%。HA注射成功恢复了有意义的容积，大多数情况下维持时间超过12个月。术前注射HA在短时间内使患者满意度显著提高，且未发生严重并发症；延迟注射在一些修复手术中导致轻微畸形。与单纯睑成形术（20%）相比，脂肪填充的并发症发生率较低（12%），表明其作为容积恢复辅助手术的实用性。透明质酸酶成功治疗了顽固性水肿，改善率在50%至100%之间，而辅助射频微针治疗在多次治疗的受试者中导致完全缓解（100%）。超声成像的应用使测量更精确，尽管各研究中的临床评估方法存在显著异质性。HA在睑成形术后有效恢复容积方面显示出疗效，特别是在技术、时间和填充剂选择经过精心优化时。与脂肪填充相比，HA因其可逆性和较低的不良血管事件发生率而被认为更安全。尽管如此，填充剂类型、用量、给药时间和结果评估的显著差异限制了确定性的临床建议。透明质酸酶的使用是一种治疗过度矫正或持续性水肿的有效补救方法。
