title: Hyalurostructure treatment: superior clinical outcome through a new protocol-a 4-year comparative study of two methods for tear trough treatment.
abstract: BACKGROUND
  The tear trough represents a main aesthetic characteristic of the aging process, which leads many patients to the wish for a safe and efficient rejuvenation method to fill their eye rings. The authors analyzed results and complication rates of two methods for hollow eye ring treatment.
  
  
  METHODS
  The authors used two methods on two patient collectives. Group A was treated using hyaluronic acid gel (Restylane; Q-Med, Uppsala, Sweden) and a reinforced 25-gauge Pix'l+ micro cannula. The authors developed a modified method for group B that included a combination of cooling of the periorbital area, no local anesthesia, preincision displacement of malar fat 10 mm below the orbital border, and postintervention corticoid therapy for 48 hours.
  
  
  RESULTS
  Protocol B was associated with significantly lower complication rates. The authors also analyzed in how smoking, age, and skin properties might affect the clinical outcome. They found that choice of treatment and a history of blepharoplasty were significant predictive factors that correlated with complications.
  
  
  CONCLUSIONS
  Tear trough treatment by hyalurostructure shows satisfying and efficient results with few complications. The revised technique used in group B combines multiple peri-interventional procedures including preinjection cooling of the periorbital area, preincision with displacement of the malar fat 10 mm below the orbital border, applying gentle back-and-forth movements while injecting, and oral corticosteroid therapy 48 hours after intervention. This technique makes hyalurostructure a competent and promising treatment for tear trough management.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Monte Carlo, Monaco; and Heidelberg, Germany From the Department of Ophthalmology and Oculoplasty, Princess Grace Hospital, and Alcazar Eye Clinic.
authors.forename: Philippe
authors.initials: P
authors.lastname: Berros
authors.forename: Lilian
authors.initials: L
authors.lastname: Lax
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bétis
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D007267:Injections; D008297:Male; D008875:Middle Aged; D009915:Orbit; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control; D012060:Rejuvenation; D012189:Retrospective Studies; D015595:Skin Aging / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D006820:Hyaluronic Acid; C445361:Restylane