title: Hyaluronic Acid Gel Injection for Multiple Eyelid Folds in Asian Eyelids: A Novel Approach.
abstract: OBJECTIVE
  Upper eyelids of the Asian population have several unique anatomical characteristics that result in the characteristic absence of a native eyelid fold; however, 40% to 60% of the Asian population do exhibit a naturally occurring fold. Aging-associated soft tissue atrophy and loss of skin elasticity can lead to periorbital volume loss and subsequent development of multiple eyelid folds in patients previously with a native single-fold. The authors describe a nonsurgical technique for the management of multiple eyelid folds in Asian patients using hyaluronic acid gel (HAG) injection.
  
  
  METHODS
  In this retrospective review, 6 upper eyelids of 5 Asian patients who underwent HAG injection for multiple eyelid folds were identified. Patients were injected with HAG superior to the native eyelid fold in a superficial plane just deep to the orbicularis oculi muscle and in the suborbicularis oculi plane of the superior sulcus.
  
  
  RESULTS
  Five Asian patients with prior history of a single naturally occurring upper eyelid fold who developed age-related unilateral multiple eyelid folds underwent injection with HAG. All patients tolerated the procedure well and without complication. Restoration of a single-fold with bilateral upper eyelid symmetry was achieved successfully in all patients.
  
  
  CONCLUSIONS
  Multiple eyelid folds may occur in Asian patients with an established naturally occurring single eyelid fold as a result of periorbital volume loss. HAG injection in the periorbital region provides a nonsurgical solution to restore volume and reform a single eyelid fold.
authors.affiliation: Division of Oculoplastic and Reconstructive Surgery, Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, U.S.A.
authors.forename: Diana
authors.initials: D
authors.lastname: Tamboli
authors.forename: Ronald
authors.initials: R
authors.lastname: Mancini
mesh_terms: D000328:Adult; D000375:Aging; D005143:Eyelids / Q000187:drug effects*; D005152:Facial Muscles; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007273:Injections, Intramuscular; D012189:Retrospective Studies; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid