Use Of Hyaluronic Acid Gel Research Articles

Prevention of intrauterine adhesions.

Intrauterine adhesions are a serious complication that occurs after intrauterine procedures, most often in connection with pregnancy. Manifestations such as amenorrhea, pelvic pain, and infertility for a woman, especially in reproductive age, are serious and together with intrauterine adhesions we call them Asherman's syndrome. Primary prevention after intrauterine procedures is important. Published studies show that the use of hyaluronic acid gel, especially after abortions, leads to the prevention of moderate and severe intrauterine adhesions and also increases the pregnancy rate.

Polycarbophil vaginal moisturizing gel versus hyaluronic acid gel in women affected by vaginal dryness in late menopausal transition: A prospective randomized trial

ObjectivesDuring menopausal transition, women are frequently affected by vulvovaginal atrophy (VVA), due to the decline of estrogen levels. Resulting symptoms are itching, burning, dyspareunia, and vaginal dryness (reported in up to 85%). The aim of this trial was to verify if medical device polycarbophil vaginal (PCV) moisturizer gel is not less effective than hyaluronic acid (HA) gel in treating vaginal dryness. Material and methodsThis was a multicenter, open label, randomized, parallel group, comparative study with non-inferiority design. Female included were ≥45 to ≤55 years in the menopausal transition, with subjective dryness, any objective sign of VVA, pH > 5, and body mass index of ≥18.5 to ≤36 kg/m2. Subjects were randomized to 1 g of PCV gel twice a week for 30 days or 3 g of HA vaginal gel every 3 days for 30 days. Results53 subjects (mean age 49.45 ± 2.96 years) were analyzed. Vaginal health index showed an improvement (p < 0.001) in both groups (from 12.54 ± 1.37 to 16.36 ± 2.66 for PCV, from 12.00 ± 1.91 to 16.60 ± 2.50 for HA), but the difference between final means (95%CI: −1.66 to 1.18) evidenced that PCV is non-inferior to HA treatment. Similarly, an improvement was evidenced in vaginal maturation index (p = 0.005 for PCV, ns. for HA), female sexual function index (p < 0.001 for PCV, p < 0.001 for HA), and SF-12 (p < 0.001 for PCV, p < 0.001 for HA), with no difference between groups. Safety was optimal and no adverse events were reported. ConclusionsThe use of HA gel does not give additional benefits to those that are already provided by the moisturizing PCV.

Cannula versus needle in medical rhinoplasty: the nose knows.

The use of hyaluronic acid (HA) fillers has become a popular alternative for nose remodeling, although poor understanding of the nasal anatomy has resulted in adverse events and generated some controversy. Among them, is the question of where and when to use cannulas vs needles. Through multiple cadaver dissections, clinical experience and the review of medical literature the authors conclude the use of needle over cannula is preferred, assuring a correct injection plane lying fully against the bone or cartilage. Although blunt in nature, cannulas may lead to difficulty in determining with precision the exact depth of product placement and contribute to more dissection of adjacent structures. Thorough knowledge of the highly variable nasal anatomy, including vessel depth location is of outmost importance in avoiding adverse events. Good patient selection is critical where most noses for augmentation rhinoplasty and some reduction rhinoplasty candidates where the goal is to camouflage the dorsal hump are amenable to medical rhinoplasty, unless there is reduced skin elasticity of nasal soft tissues or distortion of anatomy from surgery or trauma. Appropriate product selection is important for effective results. The authors suggest fillers with low cohesivity and high lifting capacity. Finally, we suggest a technique referred as Rhinosculpting base in the use the use of three conceptual elements: facial analysis, light reflection, and use of HA gel as a cartilage graft, in combination with the detailed injection technique presented in this article, which ensures a safer and satisfying treatment outcome.

Meta-analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations.

Intrauterine adhesion (IUA) is a severe complication that occurs following abortion, and hyaluronic acid gel has been used to prevent IUA following intrauterine operation. The present study aimed to systematically evaluate the efficacy of hyaluronic acid gel in preventing IUA following intrauterine operation. In the current study, a literature search was performed using PubMed, Cochrane Library and EMbase databases for randomized controlled clinical trials that used hyaluronic acid gel as an adjuvant therapy following intrauterine operation. The terms ‘hyaluronic acid’, ‘intrauterine adhesions’, ‘Asherman's syndrome’, ‘IUA’, ‘dilatation and curettage’, ‘abortion’ and ‘hysteroscopic’ were used to search for articles published online before July 31, 2018. RevMan 5.3 software was used to analyze the indicators of uterine cavity adhesion formation and pregnancy rates following intrauterine operation. A total of seven randomized controlled clinical studies were included, consisting of 952 patients who underwent intrauterine operation. The meta-analysis indicated that the use of hyaluronic acid gel reduced the incidence of IUA [relative risk (RR)=0.42; 95% confidence interval (CI)=0.30-0.57; P<0.001] and the score for IUA after an intrauterine operation (mean difference=-1.29; 95%=-1.73 to -0.84; P<0.001). A subgroup analysis revealed that the preventive effect of hyaluronic acid gel on IUA was not affected by the type of intrauterine operation, namely abortion (RR=0.40; 95% CI=0.26-0.62; P<0.001) and hysteroscopy (RR=0.44; 95% CI=0.28-0.68; P<0.001). The preventive effect of hyaluronic acid gel on IUA was also not affected by primary disorders/diseases including the following: Abortion (RR=0.48; 95% CI=0.29-0.78; P=0.003); IUA (RR=0.38; 95% CI=0.21-0.67; P<0.001) and submucosal myoma of the uterus, endometrial polyps or mediastinum uterus (RR=0.40; 95% CI=0.18-0.90; P=0.03). Hyaluronic acid gel improved pregnancy rates after intrauterine operations (RR=1.94; 95% CI=1.46-2.60; P<0.001). In conclusion, hyaluronic acid gel was indicated to significantly reduce the incidence of IUA following intrauterine operation, regardless of the type of intrauterine operation or the presence of primary diseases. Treatment with hyaluronic acid gel was also revealed to increase pregnancy rates following intrauterine operation.

Ultrasound-guided repeat intrauterine balloon dilatation for prevention of adhesions.

Intrauterine adhesions (IUAs) can occur following an invasive intrauterine procedure as a result of the normal healing process of the damaged endometrium/myometrium1. Although several interventions have been proposed for preventing the occurrence of IUAs, such as use of hyaluronic acid gel or polyethylene oxide-sodium carboxymethylcellulose gel, estrogen therapy and use of an intrauterine balloon or intrauterine device, their effectiveness is still uncertain2. The idea of using intrauterine pressure, through injection of saline solution into the uterine cavity, under ultrasound guidance for treating IUAs was first introduced in 20013. Subsequently, the potential therapeutic effect on mild adhesions of intrauterine insertion of a balloon and infusion of a distending medium was reported in 20144. More recently, ultrasound-guided balloon therapy for the treatment of mild IUAs in the outpatient setting was described5, 6. Here, we present a technique for adhesion prophylaxis following intrauterine surgery, based on the hypothesis that use of a balloon for dilatation of the uterine cavity and/or adhesiolysis might be effective using short repeated sequences in the most pivotal period. Before introducing the intrauterine balloon approach, we used hyaluronic acid gel routinely for prevention of IUAs. In our experience, repeat intrauterine balloon therapy can achieve better anatomic results and reduce the need for repeat intervention compared with use of hyaluronic acid gel (Figure 3 and Figure S2). The main disadvantages of the technique are the need for additional appointments and the pain associated with uterine-cavity distension. Although we are optimistic about the value of the method, well-designed studies are needed to evaluate its effectiveness and safety. A randomized controlled trial (RCT) completed recently found that intermittent intrauterine balloon therapy can prevent reformation of IUAs after hysteroscopic adhesiolysis8. Another RCT from the same group, evaluating the efficacy of intrauterine balloon dilatation therapy in adhesion prevention following hysteroscopic myomectomy, is ongoing9. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Assessment of Hyaluronic Acid Gel Injection in the Reconstruction of Interdental Papilla: A Randomized Clinical Trial.

BACKGROUND:Various techniques have been implemented to reconstruct the deficient interdental papilla.AIM:The present trial was conducted to assess the effect of injection of hyaluronic acid gel for the reconstruction of deficient interdental papilla.MATERIAL AND METHODS:Thirty-six deficient interdental papilla sites in ten patients were randomly allocated into two equal groups; intervention group who received the injection of hyaluronic acid (HA) gel and control group who received the injection of saline solution as a placebo. Each deficient papilla received three injections. The first injection was given one week following the re-evaluation period (four weeks after performing full mouth supra-gingival scaling and sub-gingival debridement). The second and third injections were given after three and six weeks, respectively. The height and surface area of black triangles were recorded at baseline before the injection procedures. The participants were recalled after three and six months from the first injection for re-measuring the recorded parameters. At 6 months, patients’ satisfaction was also assessed.RESULTS:After three and six months from baseline, the results revealed a statistically significant higher mean decrease in height and surface area of black triangles in favour of the HA group. From three to six months, there was no statistically significant difference between the two groups in both parameters. At 6 months, the HA group showed a statistically significant higher mean satisfaction score than the saline group.CONCLUSION:The use of hyaluronic acid gel for the reconstruction of interdental papillary deficiency was effective with promising levels of patients’ satisfaction.

Hyaluronic acid gel after ressectoscopy for uterine synechiae in perimenopause - case report

Introduction: Uterine synechiae are a possible complication of every intrauterine procedure, namely dilation and uterine curettage, but also hysteroscopy. Their prevalence is difficult to estimate given the wide range of symptoms or even the absence of them. Hysteroscopy is the gold standard for synechiae diagnosis and it's also the main treatment option. Nevertheless, their recurrence represents a major concern and some strategies have been proposed including, intra-uterine devices, oestroprogestative pill, and hyaluronic acid products. The remaining, in gel formulation, revealed good results in some of the studies performed, which include young women, most of them with pregnancy desire. As far as we know, the use of hyaluronic acid gel (HAG) for prevention of recurrence of uterine synechiae in perimenopause women has never been described.

Tear Trough Deformity: Study of Filling Procedures for Its Correction.

The aim of this work is to discuss the anatomy of the tear trough region with relative danger areas, and to describe 2 different options to correct this deformity.The tear trough is a concave deformity of the orbital fat that is noticeable as a result of inherited anatomic differences and aging. However, the periorbital region is a complex area with its own septa and ligaments, fat compartments, muscles, vascularization, and lymphatic drainage and presents anatomic characteristics that must be taken into account in order to achieve good results and avoid complications.The use of hyaluronic acid gel or autologous fat for soft tissue correction is a good option.A total of 96 patients with periorbital hollowing were divided into 2 groups; each group received a different treatment, from December of 2013 to December of 2015, with hyaluronic- or lipo-filling.

Focal or whole gland salvage prostate brachytherapy with iodine seeds with or without a rectal spacer for a post EBRT local failure: How best to spare the rectum?

e636 Background: Salvage prostate permanent implant (sPPI) for post radiation local failures provides high rates of biochemical control. The cumulative dose delivered to the prostate and the rectum when taking into account the dose from the primary irradiation is still unknown. Besides cancer control, the primary goal of sPPI should be to protect the rectum in order to avoid any rectal fistula in the long term. Methods: We reviewed the post implant CT-based dosimetry of 18 selected patients who underwent sPPI with 125I seeds for an isolated biopsy-proven local failure several years after external beam radiation therapy (EBRT). Ten patients had a whole prostate sPPI and 8 patients had a multi-parametric MRI-based focal sPPI. Eight patients had an injection of hyaluronic acid (HA) gel in the prostate-rectum space. The BED of the primary EBRT and the BED of the sPPI were calculated using several a/b ratios (1.5, 2, 3, 5 and 10) and t1/2 (1h for the prostate and 0.3h for the rectum). Comparisons of BED parameters and doses delivered to the rectum according to the use of HA gel, prostate irradiation (whole gland versus focal) were performed using Wilcoxon exact test. Results: The median dose received by 90% of the prostate (D90) was 65.0 Gy [12.0 - 107.2] and the median prostate volume receiving 100% of the prescribed dose (V100) was 45.3% [14.4 - 98.3]. The median D90 and the median V100 for the index lesion were 162.0 Gy [139.4 - 199.1] and 96.1% [88.4 – 100.0], respectively. The median cumulative Biological Equivalent Dose (BED) after EBRT+sPPI for the prostate and the rectum were higher for patients treated on whole gland versus patients treated with focal sPPI (313.5 Gy2 vs 174.4 Gy2, p = 0.06 and 258.1 Gy3 vs 172.6 Gy3, p &lt; 0.01, respectively). The median D0.1 cc for the rectum was significantly lower for patients who had HA gel: 63.3 Gy [29.0 - 78.3] compared to patients with no gel: 83.9 Gy [34.9 – 180.0] (p = 0.04). Conclusions: Focal sPPI provided lower cumulative prostate and rectum BED when compared to whole gland plans. D0.1cc delivered to the rectum was significantly lower after sPPI with HA gel while it was not different between focal or whole gland plans.

Tear trough deformity: different types of anatomy and treatment options.

AimTo explore the efficacy of tear trough deformity treatment with the use of hyaluronic acid gel or autologous fat for soft tissue augmentation and fat repositioning via arcus marginalis release.Material and methodsSeventy-eight patients with the tear trough were divided into three groups. Class I has tear trough without bulging orbital fat or excess of the lower eyelid skin. Class II is associated with mild to moderate orbital fat bulging, without excess of the lower eyelid skin. Class III is associated with severe orbital fat bulging and excess of the lower eyelid skin. Class I or II was treated using hyaluronic acid gel or autologous fat injections. Class III was treated with fat repositioning via arcus marginalis release. The patients with a deep nasojugal groove of class III were treated with injecting autologous fat into the tear trough during fat repositioning lower blepharoplasty as a way of supplementing the volume added by the repositioned fat.ResultsSeventy-eight patients with tear trough deformity were confirmed from photographs taken before and after surgery. There were some complications, but all had complete resolution.ConclusionsPatients with mild to moderate peri-orbital volume loss without severe orbital fat bulging may be good candidates for hyaluronic acid filler or fat grafting alone. However, patients with more pronounced deformities, severe orbital fat bulging and excess of the lower eyelid skin are often better served by fat repositioning via arcus marginalis release and fat grafting.

Use of Hyaluronic Acid Gel in the Treatment of Lagophthalmos in Sunken Superior Sulcus Syndrome

To evaluate the use of hyaluronic acid gel in the management of lagophthalmos in sunken superior sulcus syndrome. Lagophthalmos associated with orbital fat atrophy and deep superior sulcus is a known entity described previously. Orbital fat atrophy results in deep superior sulcus where skin, orbicularis muscle, and orbital septum retract posteriorly in the deep superior sulcus, leading to lagophthalmos from suboptimal orbicularis function and effective skin shortening. The authors define this condition as sunken superior sulcus syndrome (SSSS) when the deep superior sulcus leads to exposure keratopathy. Thus, the syndrome consists of deep superior sulcus, lagophthalmos, and exposure keratopathy. Although the use of hyaluronic acid gel has been proposed as a management option for paralytic lagophthalmos, its application in the treatment of lagophthalmos in SSSS has not been reported. In this study, 5 patients (10 eyelids) with SSSS were injected with hyaluronic acid gel in the superior sulcus of the upper eyelid. Injected amount was titrated until the desired point was reached: complete or nearly complete eyelid closure. After an average follow up of 9.5 months, lagoph thalmos improved by 2 mm or 69% (p = 0.02) on the right side and by 1 mm or 71% (p = 0.01) on the left side. Most patients also reported significantly improved ocular comfort and appearance of the superior sulcus. The only complications noted were bruising and temporary uneven contour of the upper eyelid sulcus. Management of lagophthalmos in SSSS with hyaluronic acid gel is an effective and safe alternative to surgery.

Use of Hyaluronic Acid Gel in the Management of Cicatricial Ectropion: Results and Complications

Aims: To report our experience using hyaluronic acid gel injection in the lower eyelid to treat cicatricial ectropion.Methods: Clinical records and literature review.Results: Between November 2009 and June 2011, 12 lower eyelids of 11 patients with cicatricial ectropion were treated with hyaluronic acid gel. All 11 patients demonstrated improvement in the eyelid position after treatment but only 3 patients (27.3%) experimented total correction after injection. Although the correction was partial in the majority of the patients, the signs and symptoms associated with conjunctival and corneal exposure improved in all patients. Seven patients (63.7%) developed irregular fullness which resolved over time, but in 4 patients (36.3%) fullness persisted for one year.Conclusions: In our experience, hyaluronic acid gel is a nonsurgical, minimally invasive and safe technique that improves cicatricial ectropion, but with a poor cosmetic result that limits its use. This treatment could be considered only in patients who decline surgery or are poor surgical candidates, as the aesthetic result would not be acceptable to many.

A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

ObjectiveTo compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome. Study designRetrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system. ResultsBoth the intrauterine balloon group and the IUD group achieved significantly (P<0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P<0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups. ConclusionThe insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.

Friction Force Measurement During Cochlear Implant Insertion

The aim of the study was to evaluate force profiles during array insertion in human cochlea specimens and to evaluate a mechatronic inserter using a 1-axis force sensor. Today, the surgical challenge in cochlear implantation is the preservation of the anatomic structures and the residual hearing. In routine practice, the electrode array is inserted manually with a limited sensitive feedback. Hifocus 1J electrode arrays were studied. The bench test comprised a mechatronic inserter combined to a 1-axis force sensor between the inserter and the base of the array and a 6-axis force sensor beneath the cochlea model. Influence of insertion tube material, speed (0.15, 0.5, and 1.5 mm/s) and lubricant on frictions forces were studied (no-load). Different models were subsequently evaluated: epoxy scala tympani model and temporal bones. Frictions forces were lower in the plastic tube compared with those in the metal tube (0.09 ± 0.028 versus 0.14 ± 0.034 at 0.5 mm/s, p < 0.001) and with the use of hyaluronic acid gel. Speed did not influence frictions forces in our study. Insertion force profiles provided by the 1- and 6-axis force sensors were similar when friction forces inside the insertion tool (no-load measurements) were subtracted from the 1-axis sensor data in the epoxy and temporal bone models (mean error, 0.01 ± 0.001 N). Using a sensor included in the inserter, we were able to measure array insertion forces. This tool can be potentially used to provide real-time information to the surgeon during the procedure.

Nonsurgical Management of Silent Sinus Syndrome With Hyaluronic Acid Gel

A 44-year-old woman was referred with 3 mm of left enophthalmos and a deep superior sulcus. She was diagnosed 6 months earlier with silent sinus syndrome and had undergone a left middle-meatal antrostomy with improvement of her hypoglobus but not of her enophthalmos and superior sulcus deformity. Two milliliters of Restylane SubQ (Q-Med AB, Uppsala, Sweden) was injected as a single bolus in the intraconal and extraconal posterior orbit via a standard transcutaneous inferotemporal approach using a primed green 21-gauge needle. Immediate reduction of enophthalmos by approximately 2 mm and superior sulcus improvement were noted. This remained stable at 6 months. The symptoms and signs of silent sinus syndrome can be effectively corrected with this minimally invasive nonsurgical option. To our knowledge, the use of hyaluronic acid gel for the treatment of enophthalmos in silent sinus syndrome has not been previously reported.

Use of Hyaluronic Acid Filler for Tear-Trough Rejuvenation as an Alternative to Lower Eyelid Surgery

To describe one surgeon's experience with the use of hyaluronic acid gel (Perlane) as a tear-trough filler over an 18-month period and to assess patient satisfaction with the procedure. Consecutive, interventional case series involving case note review, masked grading of clinical photographs, and patient satisfaction survey. A total of 198 eyes of 100 patients were treated, with a mean follow-up of 5.1 months. Patients were principally female (87%), white (89%), and middle-aged (mean age = 47.8 years). Eight percent had previous lower eyelid blepharoplasty, and one had thyroid orbitopathy. The gel was placed preperiosteally, deep to orbicularis, anterior to the inferior orbital rim, with a mean volume of 0.59 ml per eye. The injection procedure was tolerable in 95% of patients without local anesthetic. Side effects described by patients included bruising (75%), swelling (26%), blue discoloration (4%), and lumpiness (33%). However, only 7% required dissolution with hyaluronidase. Eight percent requested additional hyaluronic acid gel within 3 months. Mean downtime was 1 day. Most patients (85%) described marked or moderate satisfaction with the treatment, 5% were ambivalent, and 10% were dissatisfied. This series confirms the effective use of hyaluronic acid gel (Perlane) in tear-trough rejuvenation. It has high patient tolerability, minimal complications, and high patient satisfaction. However, bruising, persistent lumpiness, or lack of perceived effect can lead to dissatisfaction in approximately 10% of cases.

Use of Hyaluronic Acid Gel for Upper Eyelid Filling and Contouring

To describe the use of hyaluronic acid gel for upper eyelid filling, contouring, and rejuvenation. In this consecutive, retrospective, interventional case series, standard serial puncture injections with preperiosteal placement of filler were administered at the superior orbital rim. Outcome measures included classification of upper eyelid volume deficiency as I) medial A-shaped hollow, II) generalized hollow, III) postblepharoplasty volume loss, and IV) upper eyelid hooding with subbrow volume deflation; volume of filler used; masked, independent assessment of pretreatment and posttreatment photographs; patient satisfaction; and complications. Twenty-seven patients were included with a mean follow-up of 13 months. More than 85% were white women with a mean age of 51 years (range, 24-65 years). Five patients were classified as type I, 8 as type II, 11 as type III, and 3 as type IV. The mean volume of filler used was 0.4 ml/eyelid (range, 0.1-1 ml). Photographic assessment showed improved static upper eyelid contour in 23 patients (85%), little change in 3 patients (11%), and deterioration in 1 patient (4%). Twenty-six patients (96%) were satisfied with the treatment, although 5 (19%) requested additional filler and 1 patient underwent dissolution within 3 months. Two of the 3 type IV patients still required blepharoplasty/ptosis surgery. All patients developed mild bruising and swelling but no discoloration or lumpiness. Hyaluronic acid filler is an effective means of rejuvenating the upper eyelid and is particularly successful in patients with medial/generalized upper eyelid hollowing, or significant postblepharoplasty upper eyelid show. A blepharoplasty/brow lift/ptosis procedure is still frequently required for hooding due to subbrow deflation (type IV).

Functional Use of Hyaluronic Acid Gel in Lower Eyelid Retraction

Functional Use of Hyaluronic Acid Gel in Lower Eyelid Retraction

The use of hyaluronic acid gel to treat uncommom areas of the face

The use of hyaluronic acid gel to treat uncommom areas of the face

Laparoscopic Myomectomy

Dr. Hurst is Director of Assisted Reproduction, Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232. E-mail: [email protected]. The author has disclosed that he receives grant/research support from Ferry Pharmaceuticals and is a member of the speakers bureau for Wyeth. He also has disclosed that the use of hyaluronic acid gel and Spray Gel for the treatment of adhesions as discussed in this article has not been approved by the U.S. Food and Drug Administration. The continuing education activity in Postgraduate Obstetrics & Gynecology is intended for obstetricians, gynecologists, and other health care professionals with an interest in the diagnosis and treatment of obstetric and gynecological conditions.