透明质酸钠凝胶多平面注射填充技术用于鼻唇沟纹矫正的临床观察

Clinical observation of modified multiplanar injection of sodium hyaluronate gel for improvement of the nasolabial fold

目的根据面部衰老的原理,结合透明质酸钠凝胶的流变学特性,探讨改进注射填充鼻唇沟纹的方法。方法采用27 G锐针于鼻唇沟起始部垂直进针,在骨膜表面注射填充高黏弹性、高内聚力的透明质酸钠凝胶,增加上颌骨体积,改善鼻基底凹陷;再于鼻唇沟内下方白唇皮下脂肪内,采用30 G锐针呈扇形均匀平铺注射中等黏弹性和内聚力的透明质酸钠凝胶,以增加该部位脂肪厚度,减轻与鼻唇沟外上侧脂肪厚度的差异。并根据鼻唇沟纹严重程度评定量表(WSRS)进行评分;注射前WSRS平均为3.46±0.69。结果本组共27例患者。注射后4周WSRS平均为1.93±0.41,有效率为100%;注射后12周WSRS平均为2.61±0.48,有效率为78.3%;注射后24周WSRS平均为3.17±0.37,有效率为29.6%。其中,注射部位出现疼痛23例(占85.2%)、肿胀21例(占77.8%)、红斑11例(占40.7%)、瘀青11例(占40.7%)、搔痒9例(占33.3%)、疱疹1例(占3.7%),均于注射后4周内缓解。结论联合使用不同流变学特性的透明质酸钠凝胶行多平面注射填充鼻唇沟安全有效,外观自然。

Objective To explore the modified method of filling the nasolabial fold by injection based on the principles of facial aging and the rheological properties of sodium hyaluronate gel. Methods A 27G sharp needle was inserted vertically at the beginning part of the nasolabial fold. Sodium hyaluronate gel with high viscoelasticity and cohesion was injected into the periosteal surface to increase maxilla volume and improve nasal basement depression. In the subcutaneous fat of the white lip within and below the nasolabial fold, sodium hyaluronate gel with medium viscoelasticity and cohesion was administered with a fan-shaped uniform injection with a 30 G sharp needle to increase the fat thickness in this area, and reduce the difference of the fat thickness compared with the lateral superior side of the nasolabial fold. The nasolabial fold wrinkles were scored according to the wrinkle severity rating scale （WSRS）. The average WSRS score before injection was （3.46 ± 0.69）. Results A total of 27 patients were involved in the study. Four weeks after injection, the average WSRS was （1.93 ± 0.41） and the rate of efficacy was 100%. Twelve weeks after injection, the average WSRS was （2.61 ± 0.48） and the rate of efficacy was 78.3 %. Twenty-four weeks after injection, the average WSRS was （3.17 ± 0.37） and the rate of efficacy was 29.6%. Adverse reactions at the injection site included 23 cases of pain （85.2%）, 21 cases of swelling （77.8%）, 11 cases of erythema （40.7%）, 11 cases of bruising （40.7%）, 9 cases of itching （33.3%）, and 1 case of herpes （3.7%）. All the above adverse reactions were relieved within 4 weeks after injection. Conclusion The combination procedure of sodium hyaluronate gel with different theological properties administered with a multiplanar injection to fill the nasolabial fold was safe and effective, and the appearance was natural.