title: Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic Acid gel.
abstract: OBJECTIVE
  To report our preliminary experience utilizing a nonsurgical alternative in the treatment of lower eyelid retraction: expansion and reinforcement of the lower eyelid with hyaluronic acid gel.
  
  
  METHODS
  Retrospective review of patients with lower eyelid retraction treated with hyaluronic acid gel. Pretreatment, post-treatment, and follow-up photographs were digitized and overall outcomes assessed. Measurements of inferior scleral show were standardized and compared.
  
  
  RESULTS
  Sixty-five procedures (31 patients; 14 male; mean age 58 years, range, 33-78 years) with lower eyelid retraction of various etiologies were treated with hyaluronic acid gel. A mean change in scleral show of 1.04 mm was found when pre- and post-treatment measurements were compared. The overall mean follow-up period was 6.2 months (range, 1-12 months). During the interval from initial treatment to follow-up visit (mean 4.6 months, range, 1-12 months), the effect of the hyaluronic acid gel diminished, with a mean increase in inferior scleral show of 0.52 mm. Twelve patients underwent a second, and 6 patients underwent a third, maintenance treatment with an improvement in scleral show of 0.87 mm and 1.13 mm, respectively. Complications were minor and included swelling, redness, bruising, and tenderness at the sites of injection.
  
  
  CONCLUSIONS
  Based on our preliminary results, hyaluronic acid gel shows promise as a treatment modality for the management of lower eyelid retraction. Long-term follow-up will better clarify the required frequency of maintenance injections, the degree of hyaluronic acid gel retention, and the position of the lower eyelid over time.
authors: Division of Orbital and Ophthalmic Plastic and Reconstructive Surgery and the Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. goldberg@jsei.ucla.edu
authors: Robert A
authors: RA
authors: Goldberg
authors: Seongmu
authors: S
authors: Lee
authors: Thiran
authors: T
authors: Jayasundera
authors: Angelo
authors: A
authors: Tsirbas
authors: Raymond S
authors: RS
authors: Douglas
authors: John D
authors: JD
authors: McCann
mesh_terms: D000328:Adult; D000368:Aged; D005141:Eyelid Diseases / Q000188:drug therapy*; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D015626:Tissue Expansion / Q000379:methods*
chemical_list: D005782:Gels; D006820:Hyaluronic Acid