Hyaluronic acid is a substance that is naturally present in our skin and other tissues, and it is commercialized so that it can be injected and used as a medicine. It’s a very effective way to increase the volume of nasolabial folds, marionette lines or cheeks and lips.
However, on the other hand,
great care must be taken when injecting into the part called the T zone, that is, between the eyebrows and the base of the nose. This part is characterized in part by the running of blood vessels, which are especially prone to blockage of blood vessels that go to the center of the forehead, sometimes progressing from embolism to tissue necrosis. In rare cases, it may regurgitate into the blood vessels in the orbit and clog the artery of the eyeball. It has also been reported that vision and vision are impaired and sometimes blindness.
To prevent these serious complications, there are precautions such as not pushing the syringe hard and not piercing the tissue deeply, but caution and experience may be important.
For the above reasons, when injecting hyaluronic acid near the T zone, we give careful consent to the effects on eyesight and visual field with informed consent before performing the procedure carefully.
The director at our clinic about 12 years ago when he just returned to Japan he had a lecture for a Japanese doctor.
At that time he already mentioned that it may lead to blindness rarely as a US report with hyaluronic acid or other subcutaneous infusions. In particular, special care is required for injection into the areas near eyes, between the eyebrows and the nose root. It is better not to inject such sites as much as possible, and when it is absolutely necessary to avoid excessive injection depth and speed (pressure).
The filler injection might appear an easy procedure but because of rare yet serious complication that my occur, a board-certified plastic surgeon or dermatologist should be doing the procedures.
Hyaluronic acid and Botox are rejuvenation methods that can be treated easily without reservation, but there are some conditions.
Those who are regularly using vitamin E, fish oil (EPA, DHA, omega 3, etc.), aspirin and other pain medication called NSAIDs have thin blood, so it is easy to get bruised by stabbing the needle, especially hyaluron near the lower eyelid. It is safer to treat it without taking medication for more than a week when considering such an injection.
Regarding Botox, it is said that it is not recommended if you are currently pregnant, or breastfeeding, but it is also said that it is better not to use it even if there is a possibility of pregnancy within the next 3 months from now. In addition, this is for both sexes.
Botulinum toxin such as Botox, and dermal fillers such as Restylane and Juvederm have been used for many years to treat facial wrinkles. Botox is usually used to treat lines between the eyebrows, wrinkles on the forehead, wrinkles in the corner of the eye. The most frequently used filler is the same substance as hyaluronic acid which is also present in healthy skin and its deeper layers, and these hyaluronic acid fillers are usually used in combination with legal and marinet wires and longitudinal wrinkles of the upper lip It is used to correct.
Recently, in the United States, long-lasting hyaluronic acid is used to make the upper part of the cheek plump, and by doing so, the wrinkles of all parts of the face pull to the apex of the bulge It is aiming at the effect of being decreased. This method is called Liquid Facelift in English and is also called a liquid face lift in Japanese, is now a very popular treatment.
“Fiblast” (Fibroblast) is a human bFGF material developed in Japan and it is approved by the Ministry of Health, Labor and Welfare for use in the treatment of decubitus ulcers (burn ulcers, lower leg ulcers) in the plastic surgery field.
Recently medical institutions of beauty medical care have used this material out of approval. Even in our clinic, patients receiving a subcutaneous injection of this substance at another clinics come and complain “lumps” of the injected sites. It is difficult to remove a lump caused by subcutaneous injection of fibroblasts and removal is difficult even with invasive treatment. I think whether it is better to pay attention to subcutaneous injection of the fibroblast material that is used for non-approval use.
Regarding PRP, the substances derived from your own blood, it is necessary to submit a third category registration on regenerative medicine by the Ministry of Health, Labor and Welfare, and I think that some approved medical institutions can still do such treatment. However, it is recent general opinion that the sustained effect by subcutaneous infusion as said earlier can not be expected.
We are using only Swedish Restylane and Juvederm made in France, which is approved as a subcutaneous infusion in the Ministry of Health, Labor and Welfare. Even if problems arise, there are degradative enzymes, and it is rare to cause permanent lumps and the like.
The director of our clinic came to Japan from the United States back in 2005. Just ten years ago I gave a lecture on safe hyaluronic acid therapy etc. to the doctors as a lecturer at a seminar on beauty care procedures such as hyaluronic acid. At that time, there was a report that there was already high risk of injection of hyaluronic acid-containing injections into the surroundings of the eyebrows in the United States.
There are few small arteries that are dominant in the vicinity of the eyebrows, and there is no supply of blood flow from the other side with side chains to each other (the end- artery). When injected material enters such a blood vessel, surrounding tissues die (necrosis). Also, since the artery around the eyebrows is located close to the arteriovenous of the orbit (in the dent of the eye), multiple examples in which the injected substance enters the eye artery for reflux to cause blindness It has been reported.
In the case of hyaluronic acid, there is still an enzyme agent that dissolves it, but there are cases where it can not be saved with other injectables, especially those of semi-permanent type.
The same problem may actually occur not only in the glabellar region but also anywhere in the center of the face. There are several technical key points when injecting subcutaneous infusions such as hyaluronic acid, and for those who do not master it, these risks are even higher.
In general terms, I think that treatment of these subcutaneous infusions should be done by specialists (board-certified dermatologists or plastic surgeons) who are familiar with cosmetic medicine (also attending academic societies) doctors. At our clinic, we explain the possible dangers to patients when treating that part, and we are doing the treatment.
Dr. Kure is the only US board-certified plastic surgeon in Japan.
About 10 years ago when we began preparing the clinic in Japan, we inofrmed on the safety of subcutaneous infusions such as hyaluronic acid in the US at a lecture meeting for doctors, but at that time I have mentioned the serious complications of blindness and skin necrosis many times.
In the United States some of these complications had already been announced.
Although hyaluronic acid itself is generally a safe dermal filler, it is rarely happened that there are events in which facial blood vessels become clogged due to treatment to the vicinity of the eyebrows and nose.
Although highly skilled technique is required for such injections, hyaluronic acid still has some medicines to dissolve it, but in many cases it can be reduced somehow, because there are no such drugs for permanent type of infusions , It will be a serious consequence when a problem occurs.
In our hospital, we do not use it as injectable material except for hyaluronic acid made from USA or France or autologous fat.
Hyaluronic acid is a type of polysaccharide and its basic chemical structure is the same as that originally found in human skin.
Because the force to attract moisture is strong, even a small amount of treatment may cause expansion effect beyond injection volume.
However, since the nasolabial lines formed after many years are deep subcutaneously deeply contained like a scar, it may be difficult to completely eliminate this with subcutaneous injectables.
Although I look at the situation with injection of about 1 cc usually, it can be said that the nasolabial lines should improve according to the injection volume.
It is extremely rare that unexpected swelling occurs by injecting hyaluronic acid. In that case there is a possibility of allergic reaction (which is said to be very difficult in theory).
In some cases it may be necessary to inject an enzyme agent that degrades hyaluronic acid.
More commonly seen are “lumps” and “bruises”, but the lump is more common when hard filler is used or the skin is thin at the injection site.
Regarding bruises, if you are taking medications or supplements that have blood-thinning action (Vitamin E, fish oil, aspirin, etc.), those who came to treatment after stopping them for more than one week It is safe.
If that is not the case, We think that big bruises will not happen often.
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Before applying hyaluronic acid injection, we apply local anesthetic cream to the area to be treated and wait for a while before treatment.
This will relieve pain considerably, but if you prefer treatment that is more painless, block anesthesia may be given.
The fillers that we use in our clinic usually contain local anesthesia as well. If you are very sensitive to slight pain, you may take oral pain killer ahead of time as an option.
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