Restylane for facial dimpling following surgery

Abstract

Sir, Hyaluronic acid fillers have had a well-documented use for restoring volume in facial aesthetic procedures [1–6]. There has also been an appreciable rate of dimpling documented following facial surgery when suspension sutures are placed close to the dermis. This can be seen with MACS face-lifting and in some cases of SMAS facelifting, and it will affect the appearance during a period of time [7–9]. In most cases, patients are happy to wait for the spontaneous resolution of the dimple as this phenomenon tends to be short-lived and resolves with time. However, there is a small group of patients who are severely emotionally distressed by the presence of dimpling [7]. We employ a previously undocumented technique which is indicated in this subgroup of patients and we found it to be a useful tool in the hands of the plastic surgeon. It is advantageous to use medium-density hyaluronic acid fillers (Restylane®) to temporarily fill the defect. Careful injection of this filler using the fanning and tunnelling technique is necessary to prevent any irregularities or a palpable mass. It is better. Inject without local anaesthetic as this can mask the defect, and we found that these injections can leave a small transient bruise. This filler has an expected longevity similar to that of the resolving dimple, so this will solve a practical problem as the filler will be slowly reabsorbed while the defect is subsiding. We advocate the use of medium-density hyaluronic acid fillers for this technique; otherwise, the highdensity hyaluronic acid is easily palpable and causes irregularities if placed too superficial. This has been a well-tolerated technique for those affected postoperative patients. Typically only 0.5 ml is needed, and repeat or incremental treatment is possible.