Nonsurgical lower eyelid rejuvenation using injectable poly‐d,l‐lactic acid in Asian patients

Abstract

Background Filler injection for lower eyelid rejuvenation remains a difficult subject due to many complicated anatomic changes as the face ages. Objectives To propose an alternative, simple, and effective filler injection method in lower eyelids for Asian patients. Methods Any patient who has tear trough deformities, infra‐orbital hollows, nasojugal grooves, dark eye circles, as well as mild eyebags is a potential candidate for this method. Our filler choice is injectable poly‐d,l‐lactic acid (PDLLA; AestheFill; REGEN). PDLLA must be reconstituted with sterile water for injection (SWFI) before administration. When the patient's troughs, grooves, or volume deficit are classes II and III, 3–4 ml of SWFI and 1 ml of lidocaine are used. When the deficits are class I, 5–7 ml of SWFI and 1 ml of lidocaine are used. With the fanning injection technique, a wide region that covers all the deficits is evenly injected. The depth is under the dermis layer. The total amount of filler injection is not more than 2 ml on each side. Results Since 2019, we have injected more than 100 patients by following these steps in Taiwan. The level of patient satisfaction is high. Only some mild and transient post‐injection complications such as edema, erythema, and ecchymosis were found. Conclusions We propose an alternative, simple and effective method for non‐surgical lower eyelid rejuvenation for Asian patients. However, anyone who wants to perform this procedure should be well‐trained and knowledgeable about the anatomy, product, and procedure to prevent adverse events.

Multiple branch retinal artery occlusions following the new facial cosmetic filler (Poly-D, L-lactic Acid) injection a case report

“…Research performed by the manufacturer reported approximately 16,000 patients receiving facial injection of PDLLA filler from April 2014 to July 2018 with no serious adverse effects (i.e., death, blindness, and skin necrosis). Adverse side effects observed included mild swelling (50% of all patients), bruising (30%), and pain (20%) which were resolved or relieved with ice packing and medication [1]. Although previous studies showed safety of PDLLA as a subdermal filler, the present case had a major side effect of the multiple branch arterial occlusion after injection of PDLLA above the eyebrow.…”

“…Injectable poly-D, L-lactic acid (PDLLA) is a new cosmetic filler (AestheFill; REGEN Biotech, Inc., Seoul, South Korea). This subdermal stimulatory filler was first approved by the Korean Food and Drug Administration in 2014 and commercially marketed in Taiwan in 2020 [1]. Here, we presented the case of a 23-year-old female, who showed no previous ophthalmic medical history, complicated with sudden vision loss in the right eye after PDLLA injection at the glabella.…”

Laser‐assisted blepharoplasty: An innovative safe and effective technique

“…The eyelids and periorbital regions can be rejuvenated using a variety of medical and surgical procedures 23–25,30,31 . However, blepharoplasty is still the most popular 2,26–29 .…”

Fan‐Dotting injection technique: A simple method for infraorbital rejuvenation using injectable Poly‐D,L‐lactic acid

“…1 We proposed a simple and effective method using injectable poly-D,L-lactic acid (PDLLA; AestheFill; REGEN) recently in Journal of Cosmetic Dermatology. 2 The injection method is superficial, wide, and even distribution of PDLLA under eyes using fanning technique. 2 However, even distribution is difficult to achieve when performing traditional fanning technique especially for novice practitioners.…”

“…For patients who have moderate-to-severe undereye defects, 3-4 ml of SWFI and 1 ml of lidocaine are used. 2 We choose a 1-cc syringe connecting with a 23G cannula as the injector. During injection, the whole cannula is inserted under the dermis from an entry point 1 cm lateral and inferior to the lateral canthus.…”