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討論

To the best of our knowledge, there is no precise report concerning the use of XXX in relation to the Orientals. Studies on the use of other fillers (e.g., hyaluronic acid and collagen) for NLF and nasojugal groove in Caucasians are well known.^1,5,14,18 Only a limited number of reports about XXX for Orientals and rhinoplasty using this filler have been published. Our study here in discusses the injection technique, analysis for determination of the appropriate and satisfactory dose of XXX and related complications encountered especially for NLF and nasojugal groove augmentation.

據(jù)我們所知，此前沒有關(guān)于XXX用于亞洲人的精確報告。但關(guān)于其他填充劑（例如，透明質(zhì)酸和膠原）用于白種人NLF和鼻顴溝填充的研究已眾所周知。^1,5,14,18關(guān)于XXX用于亞洲人以及關(guān)于使用該填充劑隆鼻的文章數(shù)量非常有限。 本研究在此特別針對NLF和鼻顴溝填充的注射技術(shù)，合適、滿意的XXX用量以及相關(guān)并發(fā)癥進行討論與分析。

Nasolabial fold

鼻唇溝紋

Aesthetic rejuvenation to the NLF region with fillers is most popular in Japan. In our clinic, 54% of the patients requested for this method because of the short-time requirement (Table 1). We have not experienced any complications in this area nor were we able to identify any abnormalities, such as indurations or other lesions concerned with the NLF. A ‘‘No change’’ response from the patients was seldom heard, but one must note that these patients were injected with only a small amount of XXX, regardless of their age and the depth of the NLF. It has been reported that the half-life of polyacrylamide in the human body is greater than 20 years. This may be true for large quantities; however, according to a report,19 the injection of 0.1 ml of XXX appears to be absorbed by the human skin within 9 months. In cases with severe drooping of the cheeks, we should not depend on the use of fillers only, but recommend the supplementation of the face lift surgery. The injection technique in this area is not complicated and may be easiest for physicians and surgeons just beginning their practice. It is contraindicated to inject linearly and superficially along the NLF avoiding a  linear  induration.^6,20   We  recommend  the  fan-shaped injection technique according to the XXX instruction manual. The surgeon and the patient are able to visualise the results immediately after treatment, thus minimising the incidence of claims. Table 3 reveals the satisfaction and favourable results attained in terms of patient age distribution. In general, the older patients require more XXX in comparison to the younger patients.

使用填充劑對NLF區(qū)域進行美容年輕化在日本非常流行。我們的診所中54％的患者因短期需要而申請使用這種方法（表1）?；颊咴谠搮^(qū)域未經(jīng)歷過任何并發(fā)癥，也未發(fā)現(xiàn)任何異常如硬結(jié)或與NLF相關(guān)的其他病變。很少聽到患者回答“無變化”。但必須注意的是，這些患者，無論年齡和NLF深度如何，均僅注射少量XXX。據(jù)報告，聚丙烯酰胺在人體中的半衰期超過20年，可能在大劑量的情況下確實如此。然而，一項報告稱¹⁹注射的0.1ml XXX似乎在9個月內(nèi)就被人體皮膚吸收了。在面頰嚴重下垂的情況下，不能僅依賴于使用填充劑，建議補充面部除皺手術(shù)。這個區(qū)域的注射技術(shù)并不復(fù)雜，對于剛剛開始行醫(yī)的內(nèi)外科醫(yī)生而言可能是最簡單的。為避免發(fā)生線性硬結(jié)，嚴禁沿NLF進行線性的表面注射。^6,20 根據(jù)XXX的說明書，建議使用扇形注射技術(shù)。外科醫(yī)生和患者能夠在治療后立即就看到結(jié)果，這樣可以使索賠發(fā)生率最小化。表3顯示了按照患者年齡分布列出的滿意度和良好效果。一般來說，老年患者與年輕患者相比需注射更大劑量的XXX。

Nasojugal groove

鼻顴溝

Extreme precaution and high technical skills are required for XXX administration to the nasojugal groove in comparison to other fillers, including fat transplantation. This is due to the fact that the XXX gel is more condensed and harder than the others, thus greater risks in postprocedural skin irregularity exists. We have to estimate the appropriate amount of filler required by a negative or positive vector orbit.^8,9,11-13  In general, and according to our clinical studies, negative vector orbit needs more filler amount than positive one, and wider area injection is also more essential for negative vector orbit than positive.

與其他填充劑包括脂肪移植物相比，XXX施用于鼻顴溝時需格外小心，且技術(shù)能力要求高。 這是因為XXX凝膠比其他填充劑更濃縮、更硬，導(dǎo)致術(shù)后皮膚不平整的風(fēng)險更大。 必須預(yù)估負或正向量眼眶所需填充劑的合適劑量。^8,9,11-13通常根據(jù)我們診所的研究，負向量眼眶比正向量眼眶需要的填充劑量大，此外前者的注射區(qū)域也有必要更寬。

In order to create a new midfacial appearance with XXX, the learning curve is long and requires intensive training in using hyaluronic acid prior to the actual use of XXX. Physicians starting clinical practice tend to use small amounts of XXX to avoid failure, but there are higher risks of failure and pitfalls with the use of insufficient amounts of XXX, such as increase in more wrinkles and irregularities. It is important to explain the colour changes that may occur to the lower eyelid and to point out the present pigmentation condition of the patient’s lower eyelid during consultation. We have encountered this complaint, two or three times in a year, that the filler worsened the pigmentation in the lower eyelid.

為了用XXX創(chuàng)建新的面中部外觀，學(xué)習(xí)曲線很長，并且在實際使用XXX之前需強化訓(xùn)練透明質(zhì)酸的使用。剛開始臨床實踐的醫(yī)生為避免失敗常使用少量的XXX，但使用不足量的XXX會導(dǎo)致失敗和走入誤區(qū)的風(fēng)險升高，如皺紋增多和皮膚不平整。 解釋下眼瞼可能發(fā)生的顏色變化，以及在咨詢期間指出患者下眼瞼的現(xiàn)有色素沉著狀況都很重要。 每年會遇到類似填充劑加重下眼瞼色素沉著的投訴數(shù)量在2-3次。