The Efficacy and Safety of Hyaluronic Acid Injection in Tear Trough Deformity: A Systematic Review and Meta-analysis

Liu, Xuanchen; Gao, Yuan; Ma, Jiguang; Li, Jie

doi:10.1007/s00266-023-03613-7

Cited by 4 publications

(6 citation statements)

References 73 publications

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“…Such attributes may be finely tuned to closely mimic the biological tissues surrounding the administration site, enabling positive post-injection physiological outcomes [9][10][11]. Despite the invasive nature of dermal filler administration via localized injection, reported complication rates are low in the hands of medical professionals [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Among the important biophysical attributes of HA-based dermal fillers, system viscoelasticity, cohesivity, water uptake, and injectability are often cited [6][7][8]14,15]. Dynamic effects pertaining to product stability and biodistribution are also important from a product development standpoint [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…Therein, under minimal stress, homogeneous dermal fillers tend to approach the behavior of purely gel-like substances. As the shear stress intensifies, the system exhibits fluid-like behaviors and starts to flow, enabling extrusion through the needle [14]. Of note, the flow resistance is then influenced by external parameters, namely the cutaneous layer in which the gel is implanted, which generates counterpressure.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments

Micheels,

Porcello,

Bezzola

et al. 2024

Gels

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The injectability of cross-linked hyaluronic acid (HA) dermal fillers is influenced by polymer concentration, polymer cross-linking type and degree, the presence of lidocaine or other functional excipients, types of syringes, and injection techniques. Finished product injectability constitutes a critical quality attribute for clinical injectors, as it strongly influences product applicability and ease of use in aesthetic medicine. While injectable product extrusion force specifications are provided by the respective device manufacturers, the qualitative informative value of such datasets is low for injectors wishing to compare product brands and technologies from an injectability standpoint. Therefore, the present study comparatively assessed 28 cross-linked HA dermal fillers (JUVÉDERM®, Restylane®, BELOTERO®, TEOSYAL RHA®, and STYLAGE® brands) using various injectability benchmarking setups for enhanced clinical-oriented relevance. Manual product injections were performed by three specialized and experienced clinicians, whereas automatic product extrusion was performed using a Texture Analyzer instrument. The various hydrogel products were injected into ex vivo human skin and into SimSkin® cutaneous equivalents to appropriately account for injection-related counterpressure. The injectability results revealed important variability between and within product brands, with a strong influence of the local anesthetic lidocaine, HA contents, and needle gauge size. Critical appraisals of the investigated products were performed, notably from manufacturing process-based and clinical ease of application-based standpoints, centered on respective experimental injectability quality levels. Generally, it was confirmed that each HA-based dermal filler product requires specific expertise for optimal injection, mainly due to differing viscoelastic characteristics and injectability attributes. Overall, the present study set forth evidence-based and clinical-oriented rationale elements confirming the importance for injectors to work with injectable products with which they are experienced and comfortable to optimize clinical results.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments

Micheels,

Porcello,

Bezzola

et al. 2024

Gels

View full text Add to dashboard Cite

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“… 30 , 31 Despite having been available for many years, injecting HA fillers in the tear trough and the lower eyelid is technically challenging and associated with a high incidence of posttreatment complications. 6 , 7 , 16 , 32 , 33 Why are we still seeing these problems and what can be done to minimize or avoid them?…”

Section: Discussionmentioning

confidence: 99%

Lower Eyelid Dark Circles (Tear Trough and Lid-Cheek Junction): A Stepwise Assessment Framework

Liew,

Doreian,

Kunathathorn

et al. 2024

Aesthetic Surgery Journal

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Background Despite increasing popularity, the use of hyaluronic acid (HA) fillers for the correction of dark under eye shadows remains challenging. Specific guidance on patient assessment is limited. Objectives To develop a stepwise assessment framework for lower eyelid dark shadows to help practitioners to classify patients based on their underlying problems and facilitate a more strategic approach to treatment. Methods Literature review and peer collaboration informed the current availability of educational material for use by experienced injectors when assessing patients presenting with dark circles. A practitioner survey provided insight into current practices. A focus group convened to review the survey results and discuss best practice approaches to patient assessment. Results Surveyed practitioners (n = 39) reported patient concern about under eye hollows (91%), dark eye circles (80%) and looking tired (60%). All (100%) agreed that mid-cheek volume was critical when treating tear trough depression, only 26% reported use of a tear-trough classification system. The focus group developed a framework for assessing tear trough depression and the lid-cheek junction in patients presenting with dark circles. Key factors within this framework include the importance of appropriate lighting when conducing a visual inspection, regional inspection of the cheek and tear trough, palpation of the orbital rim and soft tissues, determination of the orbital vector and assessment of lower eyelid pigmentation/skin quality. Conclusions Careful step-by-step assessment can reduce the challenges of treating dark circles by identifying patients in whom dark eye circles may be improved without the need to directly inject filler into the tear trough.

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“…Therein, the level of control over the filler injection process is critical to ensure that the correct and desired amount of hydrogel is placed at the appropriate anatomical site and depth [1,3,4]. Importantly, the use of inhomogeneous dermal filler products (i.e., in terms of injectability attributes) may therefore result in excess in vivo product dispensing or in inappropriately shallow gel placement, potentially leading to adverse effects and clinical failure [5][6][7][8][9]. Of note, close consideration of dermal filler product injectability is of central importance for widely used cross-linked hyaluronic acid (HA)-based hydrogel systems.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive Evaluation of Injectability Attributes in OxiFree™ Dermal Fillers: MaiLi® Product Variants and Clinical Case Reports

Micheels,

Porcello,

Bezzola

et al. 2024

Gels

View full text Add to dashboard Cite

Dermal filler injectability is a critical factor for commercial product adoption by medical aesthetic professionals and for successful clinical administration. We have previously reported (in vitro and ex vivo) cross-linked hyaluronic acid (HA)-based dermal filler benchmarking in terms of manual and automated injectability requirements. To further enhance the function-oriented product characterization workflows and the clinical relevance of dermal filler injectability assessments, the aim of this study was to perform in vivo evaluations. Therefore, several variants of the MaiLi® product range (OxiFree™ technology) were characterized in vitro and in vivo in terms of injectability attributes, with a focus on hydrogel system homogeneity and ease of injection. Firstly, standardized in vitro assays were performed in SimSkin® cutaneous equivalents, with variations of the clinical injector, injection site, and injection technique. Then, automated injections in SimSkin® cutaneous equivalents were comparatively performed in a texture analysis setup to obtain fine-granulometry injection force profile results. Finally, five female participants were recruited for the in vivo arm of the study (case reports), with variations of the clinical injector, injection site, and injection technique. Generally, the obtained quantitative force values and injection force profiles were critically appraised from a translational viewpoint, based on discussions around the OxiFree™ manufacturing technology and on in-use specialized clinician feedback. Overall, the present study outlined a notable level of homogeneity across the MaiLi® product range in terms of injectability attributes, as well as consistently high ease of administration by medical aesthetic clinicians.

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The Efficacy and Safety of Hyaluronic Acid Injection in Tear Trough Deformity: A Systematic Review and Meta-analysis

Cited by 4 publications

References 73 publications

Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments

Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments

Lower Eyelid Dark Circles (Tear Trough and Lid-Cheek Junction): A Stepwise Assessment Framework

Comprehensive Evaluation of Injectability Attributes in OxiFree™ Dermal Fillers: MaiLi® Product Variants and Clinical Case Reports

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