Intradermal Injection of HA filler = Intradermal Injection of HA filler
저자
발행기관
학술지명
권호사항
발행연도
2016
작성언어
Korean
주제어
자료형태
학술저널
수록면
230-233(4쪽)
제공처
Background: Stabilized hyaluronic acid (S-HA) used for soft-tissue augmentation1 but S-HA can also be used for dermal hydration<sup>2</sup>. Based on various papers which deal with the dermal hydration or ‘Skin-Booster’, the injection amount per one injection site into dermis was more than 0.02cc using particle type S-HA (Restylane Vital<sup>TM</sup>)<sup>2</sup>. However that amount which is more than 0.02cc per injection site, could cause lumps on dermis of face because diameter of 0.02cc is more than 1mm and thickness of facial dermis is less than 1mm. Some doctors believe the deep injection into sub-dermis could prevent the lumps but that deep injections does not improve skin texture efficiently<sup>2</sup>. Volumizing filler injection can treat some wrinkles but it is defferent from improving skin texture. In this regard, I developed my own injection method using S-HA for improvement of skin texture in 2009. I injected 1cc of particle type S-HA dividing 1000 shots into facial dermis using injector. Key point of my method is reducing amount of injection per one injection site and that method would prevent lumps on dermis. When using injector, it also provides easier and faster injection than manual injection. Some non-particle type (mono-phasic or poly-phasic) S-HA do not make lump after injection into dermis because mono-phasic S-HA with lower cohesivity such as Belotero soft<sup>TM</sup> or Neuramis soft<sup>TM</sup> and Ivoire soft<sup>TM</sup> can easily spread out from the injection points as study of some papers<sup>3,4</sup>. But their longevity using mono-phasic S-HA is too shorter than particle type S-HA. For patients who have thin skins to improve skin texture, I prefer to inject with mono-phasic HA(Belotero basicTM, Berotero Soft<sup>TM</sup>, Ivoire soft<sup>TM</sup>, Neuramis soft<sup>TM</sup>) to prevent making lumps on the dermis than particle type S-HA. Methods: Most patients had been injected with 1cc of S-HA (Restylane Vital<sup>TM</sup>) into 1000 injection sites by injector. I did 200 stroke using injector and there are 5 needles on the part of needle head, therefore technically I injected into 1000 injection sites. Some women who have thin skin had been injected with 1cc of mono-phasic HA by injector to prevent making lump. The changes of skin texture were studied by skin roughness and morphology, dermal hydration by electric resistance, dermal thickness by ultrasonic image and biopsy study. Results: Skin roughness was significantly improved after 1000 shots of intradermal injection using 1cc of particle type S-HA. The amount of each shots was 0.001cc. Skin texture was surprisingly improved after 4 weeks intradermal injection of particle type S-HA. (Fig. 1) The changes or improvement about skin roughness could be found more easily and early by microscope than by naked eye. The depth that I injected by injector was exactly dermis in my biopsy. Conclusions: The skin texture improved after the intra-dermal injection of S-HA. Deep injection could make only replacing volume and could not make improvement of skin texture. It is recommended to use injector for dermal injection, since it would be much easier to inject than manual method for performing 1000 shots of 0.001cc. It will be faster and easy with automatic injector that can control injection amount and injection depth into dermis. This injection method that I developed with the injector will be helpful for many doctors and could make reproducibility even for beginners. In the microscopic view, even only 0.001cc of S-HA was not a small amount for dermal layer though many papers of Galderma describe the proper amount for dermal injection was about 0.02cc. Monophasic filler like Berotero Soft<sup>TM</sup>, Ivoire soft<sup>TM</sup>, Neuramis soft<sup>TM</sup> and Juvederm<sup>TM</sup> can be used with variable amount without risk of making lumps because that S-HA can spread out well as biopsy study of many paper5. But Restylane Vital<sup>TM</sup> is hard to spread because the particle size is composed with 200 to 400 micron particles, therfore that lumps can last longer more 6 months in dermis. I found out each 0.001cc amount of Restylane Vital<sup>TM</sup> that was made by injector last more than 13 months in my biopsy. The injection amount into each injection sites during ‘Skin-Booster’ procedure should be changed to prevent making lumps on the dermis in manual of Galderma company and papers. When using particle type S-HA, small amount about 0.001cc per one injection site can be useful for skin hydration and ‘Skin-Booster’ without making visible lumps.
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