讨论

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.

据我们所知，此前没有关于XXX用于亚洲人的精确报告。但关于其他填充剂（例如，透明质酸和胶原）用于白种人NLF和鼻颧沟填充的研究已众所周知。^1,5,14,18关于XXX用于亚洲人以及关于使用该填充剂隆鼻的文章数量非常有限。 本研究在此特别针对NLF和鼻颧沟填充的注射技术，合适、满意的XXX用量以及相关并发症进行讨论与分析。

Nasolabial fold

鼻唇沟纹

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.

使用填充剂对NLF区域进行美容年轻化在日本非常流行。我们的诊所中54％的患者因短期需要而申请使用这种方法（表1）。患者在该区域未经历过任何并发症，也未发现任何异常如硬结或与NLF相关的其他病变。很少听到患者回答“无变化”。但必须注意的是，这些患者，无论年龄和NLF深度如何，均仅注射少量XXX。据报告，聚丙烯酰胺在人体中的半衰期超过20年，可能在大剂量的情况下确实如此。然而，一项报告称¹⁹注射的0.1ml XXX似乎在9个月内就被人体皮肤吸收了。在面颊严重下垂的情况下，不能仅依赖于使用填充剂，建议补充面部除皱手术。这个区域的注射技术并不复杂，对于刚刚开始行医的内外科医生而言可能是最简单的。为避免发生线性硬结，严禁沿NLF进行线性的表面注射。^6,20 根据XXX的说明书，建议使用扇形注射技术。外科医生和患者能够在治疗后立即就看到结果，这样可以使索赔发生率最小化。表3显示了按照患者年龄分布列出的满意度和良好效果。一般来说，老年患者与年轻患者相比需注射更大剂量的XXX。

Nasojugal groove

鼻颧沟

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.

与其他填充剂包括脂肪移植物相比，XXX施用于鼻颧沟时需格外小心，且技术能力要求高。 这是因为XXX凝胶比其他填充剂更浓缩、更硬，导致术后皮肤不平整的风险更大。 必须预估负或正向量眼眶所需填充剂的合适剂量。^8,9,11-13通常根据我们诊所的研究，负向量眼眶比正向量眼眶需要的填充剂量大，此外前者的注射区域也有必要更宽。

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.

为了用XXX创建新的面中部外观，学习曲线很长，并且在实际使用XXX之前需强化训练透明质酸的使用。刚开始临床实践的医生为避免失败常使用少量的XXX，但使用不足量的XXX会导致失败和走入误区的风险升高，如皱纹增多和皮肤不平整。 解释下眼睑可能发生的颜色变化，以及在咨询期间指出患者下眼睑的现有色素沉着状况都很重要。 每年会遇到类似填充剂加重下眼睑色素沉着的投诉数量在2-3次。