title: Hyaluronic acid gel distribution pattern in periocular area with high-resolution ultrasound imaging.
abstract: BACKGROUND
  High-resolution ultrasound (HRUS) is a useful tool in defining anatomic and dynamic soft tissue relationships in the periocular area. It also allows visualization of hyaluronic acid (HA) gel within the soft tissue.
  
  
  OBJECTIVE
  The authors investigate the difference in the distribution pattern between 2 HA fillers in the periocular tissue using HRUS.
  
  
  METHODS
  The charts of 10 patients who underwent periocular injection using HA gel filler and were subsequently examined with HRUS were reviewed. Half of the patients (n = 5) were treated with Restylane-L (Medicis Aesthetics, Inc, Scottsdale, Arizona) and the remaining 5 with Belotero Balance (Merz Aesthetics, Inc, San Mateo, California). Ultrasonographic evaluation (Logiq p6; GE Healthcare, Waukesha, Washington) was performed before and immediately after HA filler injection.
  
  
  RESULTS
  The HA appears as a hypoechoic image within the soft tissue plane on HRUS. Restylane-L filler formed a localized hypoechoic image within the tissue, with some spread into bubbles or pearl-like configuration. Belotero Balance spread more widely into the tissue plane and diffused into an elongated or spindle-shaped hypoechoic image.
  
  
  CONCLUSIONS
  Our preliminary data suggest that HA gel fillers with differing production technologies show distinct spread and distribution patterns in the periocular tissues on HRUS examination.
authors.affiliation: Jules Stein Eye Institute, Division of Orbital, Ophthalmic Plastic & Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Goh
authors.forename: Jocelyne C
authors.initials: JC
authors.lastname: Kohn
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Rootman
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Lin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials; D003357:Cosmetic Techniques; D004058:Diffusion; D004487:Edema / Q000139:chemically induced / Q000000981:diagnostic imaging; D005123:Eye; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D012060:Rejuvenation; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D001672:Biocompatible Materials; C584568:belotero balance; D006820:Hyaluronic Acid; C445361:Restylane
keywords: Belotero Balance; Restylane-LT; cosmetic medicine; filler; high-resolution ultrasound; hyaluronic acid; oculoplastics; periocular hollow; ultrasound