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Quantitative Evaluation of Volume Augmentation in the Tear Trough with a Hyaluronic Acid-Based Filler: A Three-Dimensional Analysis

Donath, Alexander S. M.D.; Glasgold, Robert A. M.D.; Meier, Jason M.D.; Glasgold, Mark J. M.D.

Plastic & Reconstructive Surgery: May 2010 - Volume 125 - Issue 5 - pp 1515-1522
doi: 10.1097/PRS.0b013e3181d70317
Cosmetic: Original Articles
Discussion

Background: Despite the prevalent use of hyaluronic acid-based filling materials for facial soft-tissue augmentation and favorable reports of durability in the infraorbital region, no quantitative data exist on the long-term durability of these products following injection. This study represents the first attempt to use three-dimensional imaging to quantify augmentation achieved and duration of effect with one hyaluronic acid product in the tear trough.

Methods: The authors conducted a prospective, blinded case series in a clinical setting. One non-animal stabilized hyaluronic acid material was used to augment 20 tear troughs to address cosmetic deficiency in this region. Patients were followed long term with three-dimensional imaging. Posttreatment and pretreatment images were compared, volume change was calculated at each time point, and percentage change between immediate and long-term posttreatment was evaluated. All measurements and calculations were performed independent of the injector.

Results: Residual effect from the hyaluronic acid product was demonstrable on three-dimensional imaging in 100 percent of tear troughs augmented in this study at the final follow-up visit. Average follow-up was 14.4 months (range, 8.5 to 22.75 months). Average initial augmentation measured by three-dimensional imaging was 0.21 cc per site. Average maintenance of effect for patients at the final follow-up visit was 85 percent.

Conclusions: The long-term durability of a small gel particle-based hyaluronic acid in the tear trough is substantiated for the first time in an objective, quantitative fashion using three-dimensional imaging for evaluation of volumetric facial rejuvenation. Three-dimensional photographic imaging offers clinicians a precise and expeditious method for quantitatively evaluating volumetric changes in the face, and represents a significant advance in technology for studying the effects of facial aging.

Cincinnati, Ohio; Highland Park and Piscataway, N.J.; and Jacksonville, Fla.

From Cincinnati Facial Plastic Surgery; Glasgold Group Plastic Surgery; the Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; and Meier Plastic Surgery.

Received for publication May 26, 2009; accepted November 16, 2009.

Disclosures: The Vectra imaging system used in this study was supplied by Canfield Imaging Systems, Fairfield, New Jersey. No financial support was provided by any corporation, nor was any synthetic filler product provided on a discounted or complimentary basis for this study.

Alexander S. Donath, M.D., Cincinnati Facial Plastic Surgery, 7763 Montgomery Road, Suite A, Cincinnati, Ohio 45236, drdonath@cincyfacialplastics.com

©2010American Society of Plastic Surgeons