3:2 proportion eye‐opening technique using 2 mL of hyaluronic acid filler

This approach to enhancing the periorbital area accentuates the patient's natural beauty by employing minimal hyaluronic acid (HA), resulting in subtle and refined outcomes. We describe a proposed filler technique for eye-opening using 2 mL of HA in the proportion of 0.3 and 0.2 mL: 1 mL of high G-prime hyaluronic acid (HGHA) had a concentration of 25.0 mg/mL (Kirialys Volume, Pharmaesthetics, Brazil)


3:2 proportion eye-opening technique using 2 mL of hyaluronic acid filler
To the editor, This approach to enhancing the periorbital area accentuates the patient's natural beauty by employing minimal hyaluronic acid (HA), resulting in subtle and refined outcomes.We describe a proposed filler technique for eye-opening using 2 mL of HA in the proportion of 0.3 and 0.2 mL: 1 mL of high G-prime hyaluronic acid (HGHA) had a concentration of 25.0 mg/mL (Kirialys Volume, Pharmaesthetics, Brazil), and is characterized by the predominance of elasticity over fluidity and its ability to lift tissue; and 1 mL of intermediate G-prime hyaluronic acid (IGHA) had a concentration of 20.0 mg/mL (Kirialys Global, Pharmaesthetics, Brazil), it has easy modeling characteristics, with the ability to spread due to its balance between elasticity and fluidity.In addition, the patient had a substantial volume loss in the temporal region.In the right hemiface, the patient received injections of HGHA in the inferior lateral portion of the temporal crest: 0.3 mL supraperiostal (27G needle) and 0.2 mL supraorbital (22G cannula).IGHA was applied in the temporal region through an entry hole in the malar zygomatic transition: 0.2 mL submuscular orbicularis and 0.3 mL subcutaneously.In the left hemiface, the patient received the IGHA in the same doses and locations; however, 0.3 mL of HGHA was applied in the inferior portion of the left temporal crest (needle), and a further 0.2 mL of HGHA   subcutaneous fat, and skin. 1 With adequate revolumization of the temple, a naturally-appearing convexity to the area can be restored with the face and brow lifted upward to provide proper support for further treatment of the midface and lower face. 2

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patients who present a discrete loss of temporal volume, and ptosis in the lateral portions, with a tendency toward square facies (Figure 2A-pictures (c), (d), (g), and (h); Figure 2B-pictures (b) and (d)) we suggest an injection of 0.3 mL of HGHA in the lower portion of the temporal crest, just bone with a 27 G needle in bolus, even with this small amount of product (high-density HA) in this topography, there is a possibility of the elevation of ligamentary and muscular structures in the upper lateral quadrant of the orbital region.Two 0.1 mL doses of HGHA should be applied posteriorly to the lateral orbicular border, below the orbicularis muscle with a 22G cannula, as shown in Figure 1A,B where we can modulate muscle contraction, reducing the appearance of crow's feet lines.In addition, 0.3 mL of IGHA should be injected in retroinjection sub muscularly using a 22G cannula in the upper edge of the orbit in scattered microdoses to lift the corner of the eyebrow, with the insertion point in the upper edge of the zygomatic bone, where we can sculpt the elevation of the eyebrow corner.Also 0.2 mL of IGHA, in microdoses scattered in the temporal region, should be applied subcutaneously posterior to the lateral orbicular border.For patients who have a significant loss of volume in the temporal region (Figure 2A-pictures (a), (b), (e), and (f); Figure 2Bpictures (a) and (c)) we recommend supraperiostal injections of 0.2 mL of HGHA using a 27G needle in the lower portion of the temporal crest, and 0.3 mL, submuscular, in the lateral portion of the orbicularis muscle, occupying the entire temple region, with the insertion point in the malar zygomatic transition.Through another entry hole on the upper border of the zygomatic bone, a 22G cannula should be inserted for the submuscular administration of 0.2 mL of IGHA in the upper lateral border of the orbit, and 0.3 mL subcutaneously in the temporal region, posterior to the lateral border of the orbit, with the aim of augmenting volume through a meticulous application, using an intermediate G-prime HA.This 3:2 proportion 3:2 proportion eye-opening technique using 2 mL of HA filler also can be used for complaining of asymmetry.We describe an example with the right eye smaller than the left (Figure 2A-pictures (a) and (b); Figure 2B-pictures (a)).
submuscularly (cannula) posteriorly to the lateral border of the right orbit, in sparse microdoses.Facial aging is a multifactorial process that results in a range of physiological and morphological changes in both the skeletal and soft-tissue composites-the bones, ligaments, muscles, fasciae, This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.© 2024 The Authors.Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

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I G U R E 1 (A) Treatment with HA on the right hemiface of one case with discrete loss of temporal volume, and ptosis in the lateral portions, with a tendency toward square facies.It is possible to notice the eye-opening and lifting effect on the middle and lower third of the right side of the face.The left side is without treatment and with the application of markings, as shown in Figure 1B, for HGHA (green) and IGHA (blue in the subcutaneous plane and red in the supraperiostal plane).The black dots are the cannula entry holes.F I G U R E 2 Legend on next page.

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I G U R E 2 (A) Examples of the 3:2 proportion eye-opening technique using 2 mL of hyaluronic acid filler.(a, c, e, g) before the procedure, and (b, d, f, h) 1 month after the injections.(a, b) correction of the asymmetry.(c, d, g, h) treatment of square face patients with discrete loss of temporal region; note the improvement in the lateral portion of the eyes.(e,f) treatment of a patient with intense loss of temporal region, note how there is an improvement in the pattern of the upper eyelid.(B) The left pictures show the evaluation of movement vectors of facial structures after the application of 2 mL of HA.Warm colors indicate an increased lifting effect with the direction of the arrows showing the direction of pull on the skin.The right pictures demonstrate de increase in volume after the procedure, lighter blue colors suggest bigger amounts of volume.Note picture (c) with the numerical measure of HA in the temporal area.(Vectra 3D XT software, Canfield Scientific Inc, NJ, USA).