Novel treatment protocol for combined tear through ligament stretching and injection.

Abstract

Complex anatomical changes have been the main challenges for optimal treatment results of tear trough deformities through hyaluronic acid (HA) injections. This study presents a novel technique consisting of a pre-injection tear trough ligament stretching (TTLS-I) leading to its release, and compared its efficacy, safety and patient satisfaction to tear trough deformity injection (TTDI). This was 4-year retrospective single-center cohort study of 83 TTLS-I patients, with a follow-up period of one year. One hundred and thirty five TTDI patients served as a comparison group.Outcome analyses included the analysis of possible risk factors for adverse outcome, as well as comparative statistics between the complication and satisfaction rates among the two groups. TTLS-I patients received significantly less hyaluronic acid (HA) (0.3cc (0.2cc-0.3cc)) than TTDI patients (0.6cc (0.6cc-0.8cc), p<0.001). The injected HA amount was a significant predictive factor for complications (p<0.05).Complication rates assessed during the follow-up visit for hematomas, edema, as well as the need for corrective hyaluronidase injection were low in both groups, with no significant differences among both groups. TTDI patients had significantly higher rates (5.1%) of lump surface irregularities during follow-up compared to 0% in the TTLS-I group (p<0.05).After one year of follow-up, 98.8% of TTLS-I patients were satisfied whereas TTDI patients were satisfied in 95.6%, with no significant difference. TTLS-I is a novel, safe and effective treatment method, necessitating significantly less HA compared to TTDI. Moreover, it leads to very high satisfaction, as well as very low complication rates.