title: Oculofacial contour asymmetries: Management of combined treatment with hyalurostructure and botulinum toxin injections.
abstract: OBJECTIVE
  To assess the long-term results of the treatment of oculofacial asymmetries using a combined injection schedule for injections of hyaluronic acid, with a specific micro cannula and botulinum toxin.
  
  
  METHODS
  A retrospective study was conducted from January 2009 to January 2010. Patients were treated in the Alcazar Eye Clinic and Oculoplastic Department in Princess Grace Hospital, Monaco. We selected patients complaining of asymmetrical periorbital features who received treatment with hyalurostructure and botulinum toxin injection in one or more sessions. Nine patients were selected and presented with the following symptoms: asymmetry of eyebrow position (2 patients), superior orbital hollow (2 patients), tear trough (2 patients) and orbital volume (ocular prosthesis) (3 patients). The objective was to evaluate the efficiency of combined treatment in one or more sessions on these oculofacial asymmetries. Hyaluronic acid injections were done using hyalurostructure. Hyaluronic acid gel (Restylane Lidocaine) was used with a 25 gauge reinforced micro-cannula (pix'l +, Thiebaud). This was combined with injections of botulinum toxin (azzalure*) to areas of muscular hyperaction. Follow-up was done at 1 year by clinical examination, photography and patient satisfaction. Complications of this combined treatment have been identified.
  
  
  RESULTS
  At 1-year follow-up, 88% of patients were satisfied or very satisfied with their results. There were no more complications secondary to both treatments in the same session. It was not noticed more hematomas and bruises than in classical injection method. The action of toxin is constant over time despite the association of hyaluronic acid injections.
  
  
  CONCLUSIONS
  Combined treatments with toxin and hyaluronic acid in oculofacial asymmetries are efficient and can be proposed in the same session. These treatments must be repeated to maintain and optimize muscle contraction and volume loss. Use of hyalurostructure and botulinum toxin treatment in the same session is effective and safe.
authors.affiliation: Princess Grace Hospital, Ophthalmology and Oculoplasty, avenue pasteur, Monte Carlo, Monaco. philberros@aol.com
authors.forename: Philippe
authors.initials: P
authors.lastname: Berros
authors.forename: Angelo
authors.initials: A
authors.lastname: Tsirbas
authors.forename: Philippe
authors.initials: P
authors.lastname: Garcia
authors.forename: David
authors.initials: D
authors.lastname: Farhi
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bétis
authors.forename: Olivier
authors.initials: O
authors.lastname: Galatoire
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003357:Cosmetic Techniques; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005123:Eye; D005146:Facial Asymmetry / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D017060:Patient Satisfaction; D012189:Retrospective Studies
chemical_list: D003879:Dermatologic Agents; D009465:Neuromuscular Agents; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA; C445361:Restylane