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The Injection for the Lower Eyelid Retraction: A Mechanical Analysis of the Lifting Effect of the Hyaluronic Acid

  • Original Article
  • Non-Surgical Aesthetic
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Level of Evidence IV

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Funding

This study was funded by Clinical Research Program of 9th People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine (JYLJ027) and National Natural Science Foundation of China (81772098).

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Author notes

  1. Wenjing Xi, Sheng Han and Shaoqing Feng have contributed equally to this work.

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China

    Wenjing Xi, Shaoqing Feng & Yixin Zhang

  2. ZenrayShangmei Medical Aesthetics’ Clinic, Beijing, China

    Sheng Han

  3. School of Civil Engineering, Chongqing University, Chongqing, China

    Ke Li

  4. Plastic Reconstructive and Aesthetic Surgery Department, Campus Bio-Medico University, Rome, Italy

    Beniamino Brunetti

  5. Cosmetic Surgery Unit, Villa Salaria Clinic, Rome, Italy

    Davide Lazzeri

  6. Department of Plastic Surgery, Jinhua Central Hospital, Zhejiang University, Jinhua, China

    Yun Tong

Authors
  1. Wenjing Xi
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  2. Sheng Han
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  3. Shaoqing Feng
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  4. Ke Li
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  5. Beniamino Brunetti
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  6. Davide Lazzeri
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  7. Yun Tong
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  8. Yixin Zhang
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Corresponding authors

Correspondence to Yun Tong or Yixin Zhang.

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None of the authors has financial conflicts or interests to report in association with the contents of this paper.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Xi, W., Han, S., Feng, S. et al. The Injection for the Lower Eyelid Retraction: A Mechanical Analysis of the Lifting Effect of the Hyaluronic Acid. Aesth Plast Surg 43, 1310–1317 (2019). https://doi.org/10.1007/s00266-019-01440-3

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  • DOI: https://doi.org/10.1007/s00266-019-01440-3

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