Eur J Plast Surg (2011) 34:313 DOI 10.1007/s00238-011-0554-5 LETTER TO THE EDITOR Saif Ramman & Morris Ritz & Will McMillan Received: 29 September 2010 /Accepted: 17 January 2011 /Published online: 23 February 2011 Springer-Verlag 2011 Sir, density hyaluronic acid is easily palpable and causes Hyaluronic acid fillers have had a well-documented use irregularities if placed too superficial. This has been a for restoring volume in facial aesthetic procedures [1–6]. well-tolerated technique for those affected postoperative There has also been an appreciable rate of dimpling patients. Typically only 0.5 ml is needed, and repeat or documented following facial surgery when suspension incremental treatment is possible. sutures are placed close to the dermis. This can be seen with MACS face-lifting and in some cases of SMAS face- lifting, and it will affect the appearance during a period of Conflict of interest None. time [7–9]. In most cases, patients are happy to wait for the spontaneous resolution of the dimple as this phenomenon References tends to be short-lived and resolves with time. However, there is a small group of patients who are severely 1. Carruthers JDA, Glogau RG, Blitzer A (2008) Advances in facial emotionally distressed by the presence of dimpling . rejuvenation: botulinum toxin type A, hyaluronic acid dermal We employ a previously undocumented technique which is fillers, and combination therapies—consensus recommendations. Plast Reconstr Surg 121(suppl 5):5S–30S indicated in this subgroup of patients and we found it to be 2. Klein AW, Fagien S (2007) Hyaluronic acid fillers and botulinum a useful tool in the hands of the plastic surgeon. It is toxin type A: rationale for their individual and combined use for advantageous to use medium-density hyaluronic acid fillers injectable facial rejuvenation. Plast Reconstr Surg 120(6 S (Restylane®) to temporarily fill the defect. Careful injection SUPPL):81S–88S 3. Verpaele A, Strand A (2006) Restylane SubQ, a non-animal of this filler using the fanning and tunnelling technique is stabilized hyaluronic acid gel for soft tissue augmentation of the necessary to prevent any irregularities or a palpable mass. It mid- and lower face. Aesth Surg 26(suppl1):S10–S17 is better. Inject without local anaesthetic as this can mask 4. Raspaldo H (2008) Volumizing effect of a new hyaluronic acid sub- the defect, and we found that these injections can leave a dermal facial filler: a retrospective analysis based on 102 cases. J Cosmet Laser Therapy 10(3):134–142 small transient bruise. 5. Buck DW II, Alam M, Kim JYS (2009) Injectable fillers for This filler has an expected longevity similar to that of the facial rejuvenation: a review. Plast Reconstr Aesthe Surg 62 resolving dimple, so this will solve a practical problem as (1):11–18 6. Lindqvist C, Tveten S, Bondevik BE, Fagrell D (2005) Random- the filler will be slowly reabsorbed while the defect is ized, evaluator-blind, multicenter comparison of the efficacy and subsiding. We advocate the use of medium-density hyalur- tolerability of Perlane versus Zyplast in the correction of nasolabial onic acid fillers for this technique; otherwise, the high- folds. Plast Reconstr Surg 115(1):282–289 7. Mendelson BC (1997) SMAS fixation to the facial skeleton: rationale and results. Plast Reconstr Surg 100(7):1834–1842 : : 8. Tyres AG (2006) Brow lift via the direct and trans-blepharoplasty S. Ramman M. Ritz (*) W. McMillan approaches. Orbit 25(4):261–265 Melbourne Institute of Plastic Surgery, 9. Guyron B (2006) Endoscopic forehead rejuvenation: I. Limitations, 253 Wattletree Road, Malvern, Victoria 3144, Australia flaws, and rewards. Plast Reconstr Surg 117(4):1121–1123 e-mail: email@example.com
European Journal of Plastic Surgery – Springer Journals
Published: Aug 1, 2011
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