๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Volume Replacement and Cautions
Volume Replacement and Cautions
Volume replacement to the upper or lower lid can be achieved using a range of different approaches. Minimally invasive techniques include autologous fat or three-dimensional fillers. Hyaluronic acidโbased fillers have become increasingly popular and are now the gold standard of dermal fillers because of their efficacy and safety. Unlike other types of fillers, their effects may be reversed through the use of hyaluronidase. Hyaluronidase is a hyaluronic acid degrading enzyme that comes in an animal and human recombinant form. It is used to correct the side effects of hyaluronic acidโbased fillers, including (1) over correction or superficial implantation of hyaluronic acid, (2) inflammatory or noninflammatory nodules, and (3) local or remote vascular occlusion.152 Any surgeon using hyaluronic acidโbased fillers should have hyaluronidase available if needed, as well as an understanding of appropriate injection
technique.
The most feared complication of filler injection is permanent vision loss from intravascular occlusion. In cases of possible embolism and vision loss, the filler must be reversed within 90 minutes to avoid permanent blindness.153 A strong understanding of periorbital vascular anatomy is necessary when performing filler injection to avoid inadvertent vascular cannulation. Additionally, during deeper injections where vessels with larger diameters are located, appropriate technique with aspiration before injection is essential to avoid intravascular injection, though even meticulous technique does not guarantee appropriate placement. Since the central retinal artery is an end artery, there are no vessels that can assist in reperfusion in the setting of a central retinal artery occlusion. Permanent vision loss is inevitable if a filler thrombus is not reversed. Most argue for either periorbital or retrobulbar hyaluronidase injection when confronted with this situation.153โ158 Interestingly, hyaluronidase does not have to be injected directly into the occluded vessel. Even when injected adjacent to an affected vessel, it has been shown to dissolve intravascular hyaluronic acid.155