RU2626588C1 - Method for treatment of hypercorrection arising in case of contour plastics by gels based on hyaluronic acid - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: defect is localized by ultrasound. Correction is carried out in 2 stages. First, phonophoresis with 1% hydrocortisone ointment is applied to the corresponding corrected zone, daily for 4 minutes and for 6-10 sessions. After 3 weeks, ultrasound monitoring is performed. After that, also under the ultrasound control, "Longidaza" at a dose of 75-150 MU is injected into the areas of undissolved gel exceeding 3 mm in size, bypassing the adjacent vessels and nerves. After 2 weeks, a repeated control ultrasound is performed to confirm the absence of undissolved gel patches.

EFFECT: method allows to obtain the desired aesthetic result, to shorten the period of medical and social rehabilitation.

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Description

The present invention relates to cosmetology and can be used to treat the negative effects of facial contouring with gels based on hyaluronic acid.

The urgency of the problem is due to the popularization of cosmetology, the increased number of injections of contour plastics, the use of gels based on hyaluronic acid in the forbidden areas of the face, which, in turn, led to a sharp increase in cases of contour plasty complications, undesirable effects and hypercorrection. The presence on the market of a large number of low-quality goods contributes to the formation of foci of acute and chronic inflammation in the zones of gel administration, requiring both surgical and other methods of gel removal. Current methods of treating such conditions do not give clinically significant results and are associated with a large number of side effects. The lack of standards, schemes, clear instructions and recommendations for the treatment of conditions such as aesthetic dissatisfaction of patients with the results of treatment, hypercorrection served as the basis for the search for effective and safe methods of treating the negative effects of contouring with hyaluronic acid gels.

An analogue of the present invention is a method of treating hypertrophic scars by phonophoresis with 1% hydrocortisone ointment, when the mechanical energy of the ultrasonic wave and the injected drug substance into the lesion is simultaneously present [Ozerskaya O.S. Monograph Skin scars and their dermatocosmetological correction. SPb .: OJSC "Art of Russia", 2007, p. 143]. As a result of the influence of the mechanical energy of the ultrasonic wave, thermal effects are realized, biochemical reactions are accelerated, and redox processes are stimulated. In addition, the injected drug is delivered to the deep layers of the tissues and deposited there, thus, there is a combined effect on the problem area of ultrasound and the injected drug. Such an introduction is painless for the patient and allows you to act on various links of pathogenesis in the pathological focus, activating the body's own resources, as well as due to the therapeutic effects of the administered drug. This method is taken as a prototype. The disadvantage of using phonophoresis for the treatment of pathological conditions is the duration of therapy, the likelihood of a repeat of the course of procedures, which is often not convenient for patients.

The closest analogue to the treatment of undesirable effects of contour plastics with gels based on hyaluronic acid is the introduction into the zone of the defect obtained after contour plastics, preparations of which the active substance is hyaluronidase [Ilsheva T.V. Complications of injection methods of correction in aesthetic medicine // Journal of Metamorphoses No. 2, March, 2013, p. 48-52]. The mechanism of action is associated with direct cleavage by the enzyme hyaluronidase of the substrate of the polymer of hyaluronic acid to a monomer. For correction, it is proposed to use various drugs with hyaluronidase activity, such as Lidaza, Desinfiltra, and others. Moreover, the preparations existing on the market today, the active substance of which is hyaluronidase, are not specified in the instructions for use in cosmetology. At the same time, there are no recommendations in aesthetic medicine for each of the drugs according to the doses, frequency of administration, volume of the drug administered. Also, there are no clear schemes for administering the drug: to what depth, in which way. The disadvantages of treating the undesirable effects of contouring with hyaluronic acid gels by introducing hyaluronidase preparations into the correction zone are the lack of a pronounced clinical effect and a large number of side effects from the therapy: acute edema in the injection zone, long-lasting pasty of surrounding tissues, risk of allergic reactions, pain with the introduction. The very introduction of drugs is technically carried out uncontrollably, almost blindly into the thickness of the facial tissues where the gel is supposedly located, without taking into account the patient's anatomical features and clearly determining the gel's location, its shape, size, topography relative to other face structures. With this introduction of drugs there is a high risk of damage to the vessels, nerves and other structures of the zone of interest located in the tissues, as well as the risk of introducing hyaluronidase into the lumen of the vessel or into the nerve, bypassing the gel itself. In the intervention zone, an inflammatory reaction of the surrounding tissues is formed, accompanied by swelling and pain.

Tasks:

1. Improve the accuracy of the administration of the drug directly to the problem area.

2. To minimize the risks of allergic, inflammatory reactions in the treatment of undesirable consequences of contouring.

3. Reduce the treatment time for patients.

4. To ensure the painlessness of the procedure for the correction of unwanted contour plasty results.

5. Provide the desired aesthetic effect.

The essence of the invention is that the localization of the defect is detected by ultrasound (ultrasound) and the subsequent correction in 2 stages: they act on the corresponding corrected area once, daily for 4 minutes by phonophoresis with 1% hydrocortisone ointment in a course of 6-10 sessions, and then after 3 weeks carry out ultrasonic (ultrasound) control, then also under ultrasound control in areas of insoluble gel larger than 3 mm, bypassing the adjacent vessels and nerves, inject the drug "Langidase" with subsequent repeated m ultrasound control after 2 weeks to confirm the absence of areas of insoluble gel.

The proposed method is tested on 20 patients for 2 years. The group included women aged 25 to 44 years, the average age of 31 years. Dissatisfaction with the aesthetic result of 100%, hypercorrection - 75%, asymmetry - 60%, swelling in the injection zone - 50% appeared in the complaints structure. The most common areas to be corrected were nasolacrimal grooves - 50%, lips - 30%, cheekbones - 10%, chin - 10%. After treatment, 100% of patients were satisfied with the aesthetic result.

The proposed method of treatment is as follows. First, they mark the face into zones according to the “watch dial” scheme, followed by a diagnostic ultrasound of the drug administration zones. They also collect an anamnesis, conduct an examination of the affected area, palpation. During ultrasound, a search for subcutaneous fragments of the gel is carried out, a clear determination of their localization, depth, measurement of longitudinal and transverse dimensions is noted, adjacent anatomical structures are noted relative to the gel (vessels, facial muscles, fibrous formations). The structures of the surrounding tissues are also determined (pastiness, fibrosis, other features, if any, for example, the presence of non-hyaluronic implants). After that, they begin treatment, which is carried out in two stages. At the first stage, depending on the clinical picture, a phonophoresis course with 1% hydrocortisone ointment is prescribed in an amount of 6-10 procedures once, daily for 4 minutes, followed by a follow-up ultrasound of the exposure zones, and an assessment of the dynamics of gel size reduction after 3 weeks. After the first stage of treatment is completed, the edema of the surrounding tissues usually decreases, the gel biodegrades: from distinct an-, hypoechoic loci, it takes on the form of heterogeneous fragmented structures replaced by connective tissue before treatment. Then, the second stage of treatment is carried out on the remaining fragmented gel with a diameter of more than 3 mm. Under ultrasound control, the drug “Langidaza” is injected directly into the gel, bypassing adjacent vessels and nerves, followed by repeated ultrasound control 2 weeks after administration. For this, the skin of the injection site is treated with an antiseptic, sterile echogel is applied. Ultrasonic navigation is performed by an apparatus with a 15-18 MHz sensor. Choose the optimal route for holding the needle into the gel, taking into account the position of blood vessels, nerves and other anatomical structures, in order to bypass them. In this case, both the standard mode and the Doppler and energy mapping modes are used, which allows for a clearer image and increases the accuracy of drug administration. The injection of the drug “Langidase” is carried out with an insulin syringe with a fixed needle, a dose of 75-150 international units (ME) per gel fragment (bolus) larger than 3 mm. Such a precise administration of the “Langidase” preparation in the described way under ultrasound control allows minimizing the risks of damage to surrounding tissues, delivering the target drug bypassing adjacent vessels and nerves, reducing its dose and volume, and consequently, the degree of inflammatory reaction and the risk of allergies.

The described method of treatment was applied to patients with localization of the gel in different areas of the face, while there was not a single case of complications or worsening of the patient's condition. As a result of the treatment, in 100% of cases, patients were satisfied with the aesthetic result.

Example 1. A female patient, 25 years old, with complaints of hypercorrection and asymmetry after the introduction of gels based on hyaluronic acid into the region of nasolacrimal grooves, cheekbones on the left. The patient was repeatedly injected with gels of various manufacturers in these zones. After the penultimate correction, Restylane Perlane gel was introduced into the area of nasolacrimal grooves, which the patient tried to remove by repeated injections of preparations based on the hyaluronidase enzyme, receiving a clinic of local edema in the injection zone of the hyaluronidase preparation, which lasts from several days to several weeks. After the third attempt to dissolve the gel with hyaluronidase preparations in the area of nasolacrimal grooves, Juvederm Volbella gel was introduced to correct the remaining asymmetry. The patient was not satisfied with the aesthetic result, asymmetry was maintained with the joined edema in the injection zone. Attempts to dissolve the gel with hyaluronidase preparations were continued, there were a total of 8. According to the patient, it was found out that various hyaluronidase preparations were administered to treat hypercorrection. To establish the name of hyaluronidase preparations, a single dose dose was not possible. The patient received an initial appointment with a clinic of pronounced edema in the eye area. On palpation in the area of the left cheekbone, compaction is determined. The patient underwent a diagnostic ultrasound of the soft tissues of the paraorbital and zygomatic areas. A hypoechoic filler in the initial reduction phase, up to 1.3 mm thick, up to 2.1 in length, with edema of the surrounding tissue in the form of a sleeve up to 6 mm in diameter, is indistinctly traced paraorbitally on the left. In the area of “palpable” formation above the zygomatic bone, focal edema with anechogenic inclusions with a total size of up to 9.2 × 4.1 × 6.1 mm is located on the left in the SC tissue.

In connection with the introduction of hyaluronidase into the hypercorrection zones on the eve of the drug, the patient was asked to wait 3-4 weeks with subsequent ultrasound control to assess the dynamics after the introduction of hyaluronidase into the hypercorrection zones. Repeated ultrasound after 6 weeks showed a positive trend relative to edema and a lack of dynamics relative to the gel. In the left nasolacrimal groove, the hypoechoic gel bolus is clearly visualized, 24.9 mm long, 4.0 mm thick. In the region of the left cheekbone, 2 hypoechoic boluses of 6.3 × 3.2 mm and 5.1 × 2.1 mm are located. Ultrasound control clearly demonstrated the absence of the desired clinical effect from the treatment of hypercorrection with hyaluronidase preparations. The patient was prescribed treatment: phonophoresis with 1% hydrocortisone ointment for 4 minutes once, daily for 10 sessions. On the control ultrasound 3 weeks after the end of the course of treatment revealed a positive trend. The gel in the area of the left nasolacrimal groove from a whole strip before treatment was fragmented into several sections with a maximum thickness of 1.2 mm, 0.9 mm and 1.1 mm (before treatment, the thickness was 4 mm). The size of the boluses in the region of the left cheekbone was 3.3 × 1.6 mm and 2.9 × 1.4 mm, respectively, against 6.3 × 3.2 mm and 5.1 × 2.1 mm before treatment, with obvious signs biodegradation, manifested by ultrasound in the form of an inhomogeneous bolus structure (presumably fibrous tissue). The size of the gel boluses after the first stage of treatment was reduced by 2-3 times. At the second stage of treatment directly into the gel bolus in the left cheekbone area of 3.3 × 1.6 mm under ultrasound control, bypassing the adjacent vessels and nerves, 75 ME of the drug “Langidaza” was administered. Ultrasound control was performed after 2 weeks, signs of reduction, biodegradation and fragmentation of the gel into separate isoechogenic areas with sizes less than 1 mm were performed in the injection zone. Palpation tissue homogeneous.

Example 2. A female patient, 25 years old, with complaints of hypercorrection and asymmetry after the introduction of gels based on hyaluronic acid in the lips. The patient was worried about the hypercorrection of the right lateral part of the upper lip and the asymmetry relative to the left, and there was also aesthetic dissatisfaction with the shape of the lips, the patient expressed a desire to get rid of the asymmetry and restore the previous shape of the lips. Before applying for help, an attempt was made to remove the gel by administering 2 bottles of the hyaluronidase preparation at the same time, the patient does not remember the name, after which, according to the patient, the clinic developed Quincke edema with edema of the entire face and neck. After stopping the edema, the asymmetry of the lips remained, and a seal was palpated in the right lateral part of the upper lip. When examining the patient, the lips are asymmetric, palpation in the area of the right lateral part of the upper lip is densified. During initial treatment, a diagnostic ultrasound of the lips was performed, a gel was found that is unevenly located in the tissues of the upper lip in the form of individual boluses ranging in size from 2.9 mm to 3.9 mm, with a maximum of 17.3 mm long in the area of the right lateral part of the upper lip, 4 , 6 mm, while the structure of the lip tissue is heterogeneous, with signs of severe fibrosis. The patient was prescribed treatment: phonophoresis with 1% hydrocortisone ointment for 4 minutes once, daily for 10 sessions. Ultrasound control 3 weeks after the end of the first stage of treatment showed a positive trend; there was a decrease in the size of boluses and changes in their structure from clearly visualized hypoechoic, anechogenic formations before treatment into heterogeneous structures replaced by echopositive tissue, presumably fibrous. The largest bolus - in the right lateral part of the upper lip decreased from 17.3 × 4.6 mm to 10.6 × 2.3 mm, however, slight asymmetry remained and the seal was palpated in this area. The patient underwent the second stage of correction, namely: the introduction of the drug "Langidase" 75 ME under ultrasound control, directly into the gel. After 2 weeks, ultrasound monitoring was performed, in the injection zone there were signs of reduction, biodegradation and fragmentation of the gel into individual isoechogenic areas less than 1-2 mm in size, heterogeneous in structure. On examination, the lips are symmetrical; on palpation, the structure of the lip tissue is uniform.

Thus, the technical result of the method is:

1. Improving the accuracy of the introduction of the drug directly into the problem area, bypassing blood vessels, nerves and other anatomical structures.

2. Minimizing the risk of allergic, inflammatory reactions in the treatment of undesirable consequences of contouring by reducing the dose and volume of the drug injected directly into the gel.

3. Reducing the treatment time for patients through the combined effects of various factors (physiotherapeutic, the effects of drugs).

4. Improving the comfort and painlessness of the procedure for the correction of undesirable results of contouring, the ability to stay in society during treatment.

5. Providing medical and social rehabilitation in 100% of cases.

Claims (1)

A method of treating hypercorrection that occurs during contour plasty with gels based on hyaluronic acid, characterized in that the localization of the defect using ultrasound, carry out correction in 2 stages, first act by phonophoresis with 1% hydrocortisone ointment on the corresponding corrected area, 4 minutes daily , course of 6-10 sessions, then after 3 weeks carry out ultrasonic (ultrasound) control, after which also under ultrasound control in areas of insoluble gel larger than 3 mm, bypassing adj -containing vessels and nerves injected "Longidaza" in 75-150 ME dose after 2 weeks is repeatedly executed control ultrasound study to confirm the absence of insoluble gel sections.