title: Modifying the upper eyelid crease in Asian patients with hyaluronic acid fillers.
abstract: BACKGROUND
  Preliminary experience with the use of hyaluronic acid fillers as a nonsurgical alternative in the management of upper eyelid crease asymmetry and superior sulcus hollowing in Asian patients has proven promising.
  
  
  METHODS
  This retrospective, interventional case series included seven patients (11 eyes) of various Asian ancestries. All patients had eyelid crease asymmetry or undesirably elevated eyelid creases along with hollowing of the upper eyelids. Upper eyelid crease asymmetry and hollowing of the superior sulcus were assessed before and after treatment. For all patients, hyaluronic acid fillers (Restylane, Medicis, Scottsdale, Ariz., or Juvéderm, Allergan, Irvine, Calif.) were injected into the retro-septal superior sulcus for eyelid hollowing and into the preseptal eyelid fold for crease asymmetry. Pretreatment and posttreatment photographs were taken. Outcomes were assessed by the total volume injected; masked, independent assessment using preoperative and postoperative photographs; and the subjective assessment of results by the patient.
  
  
  RESULTS
  The average age was 43.1 years. The average volume of hyaluronic acid filler injected was 0.61 cc per eye. All seven patients were satisfied with the cosmetic improvement after hyaluronic acid filler injections. No adverse effects were noted. To date, the treatment has remained effective for as long as 18 months.
  
  
  CONCLUSIONS
  Hyaluronic acid filler injections into the upper eyelid and superior sulcus are effective in providing volume to recreate the fullness natively present in the Asian upper eyelid. Furthermore, this fullness lowers the surgically created eyelid crease in those patients with eyelid asymmetry following cosmetic blepharoplasty. It should be considered in Asian patients presenting with upper eyelid hollowing or asymmetric eyelid creases.
authors.affiliation: La Jolla, Calif.; Seoul, Korea; and Singapore From the Division of Ophthalmic Plastic and Reconstructive Surgery, University of California, San Diego Department of Ophthalmology, Shiley Eye Center; the Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Kim's Eye Hospital; and the Singapore National Eye Center.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Choi
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Whipple
authors.forename: Sang-Rog
authors.initials: SR
authors.lastname: Oh
authors.forename: Ayelet
authors.initials: A
authors.lastname: Priel
authors.forename: Audrey
authors.initials: A
authors.lastname: Looi
authors.forename: Bobby S
authors.initials: BS
authors.lastname: Korn
authors.forename: Don O
authors.initials: DO
authors.lastname: Kikkawa
mesh_terms: D000328:Adult; D044466:Asian People; D003357:Cosmetic Techniques; D005143:Eyelids / Q000033:anatomy & histology*; D005260:Female; D005782:Gels / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D005782:Gels; C526061:Juvederm Ultra; D006820:Hyaluronic Acid; C445361:Restylane