鍾經略醫生示範打透明質酸填充劑填平淚溝（術前及術後效果對比）
淚溝的位置
填平淚溝之前後對比
填平淚溝之前後對比
以透明質酸填充劑治療淚溝的挑戰
將透明質酸（HA）填充劑注射至淚溝能夠改善眼下凹陷，但這是美容醫學中技術要求最高的操作之一。其風險顯著，預防依賴精確的解剖知識與謹慎的技術。
⚠️ 風險與危險
- 血管阻塞： 眶下動脈與鼻翼動脈鄰近淚溝，若誤入血管可能導致缺血、皮膚壞死，甚至罕見的眼部併發症如失明。
- 廷德耳效應： 若填充劑置於過淺層，光線經凝膠散射，會在薄眼皮下呈現藍色變色。
- 水腫與浮腫： HA 親水性強，過量或錯位注射會吸水，造成腫脹或「泡泡眼」。
- 結節或不規則： 注射不均或過度填充會導致顆粒感、輪廓不平整或可觸及的填充物。
- 感染： 與任何注射相同，若未遵循無菌操作，存在局部感染風險。
🛡️ 預防策略
- 解剖知識： 熟悉眶下血管走向及該區皮膚薄弱特性。
- 產品選擇： 使用柔軟、低黏度的 HA 填充劑，適合精細區域。
- 注射層次： 建議深層注射，位於骨膜上方，而非淺層真皮。
- 小劑量： 微量分次注射，逐步建立效果，避免過度矯正。
- 技術： 考慮使用鈍針導管代替尖針，以降低血管損傷風險。
- 抽吸與緩慢注射： 注射前輕微抽吸，並以低壓緩慢推注，減少誤入血管的可能。
- 術後監測： 觀察早期血管受損徵象（疼痛、皮膚蒼白、視覺改變），並準備及時使用 透明質酸酶（hyaluronidase）處理。
✅ 總結： 淚溝填充能顯著改善眼下凹陷，但存在血管阻塞、廷德耳效應及水腫等風險。預防依賴深厚的解剖知識、正確的產品選擇、精準的技術，以及隨時準備處理併發症的能力。
The challenges of the treatment of tear trough with Hyaluronic Acid Filler
Injecting hyaluronic acid (HA) filler into the tear trough can rejuvenate the under‑eye area, but it is one of the most technically demanding procedures in aesthetics. The risks are significant, and prevention relies on anatomical precision and careful technique.
⚠️ Risks & Dangers
- Vascular occlusion:
- The infraorbital artery and angular vessels run close to the tear trough. Inadvertent intravascular injection can cause ischemia, skin necrosis, or—rarely—ocular complications such as blindness.
- Tyndall effect:
- If filler is placed too superficially, light scatters through the gel, creating a bluish discoloration under the thin eyelid skin.
- Edema & puffiness:
- HA is hydrophilic; excess or misplaced filler can attract water, leading to swelling or a “puffy” look.
- Nodules or irregularities:
- Uneven placement or overfilling can cause lumps, contour irregularities, or palpable filler.
- Infection:
- As with any injection, there is a risk of local infection if aseptic technique is not followed.
🛡️ Prevention Strategies
- Anatomical knowledge:
- Understand the course of the infraorbital vessels and the thinness of the skin in this region.
- Product choice:
- Use a soft, low‑viscosity HA filler designed for delicate areas.
- Injection plane:
- Place filler deep, just above the periosteum, rather than superficially in the dermis.
- Small volumes:
- Inject micro‑aliquots (tiny amounts) and build gradually to avoid overcorrection.
- Technique:
- Consider using a blunt cannula instead of a sharp needle to reduce vascular injury risk.
- Aspiration & slow injection:
- Gentle aspiration before injection and slow, low‑pressure delivery help minimize intravascular placement.
- Post‑care:
- Monitor for early signs of vascular compromise (pain, blanching, vision changes) and be prepared to use hyaluronidase promptly if needed.
✅ Summary: Tear trough filler can dramatically improve under‑eye hollows, but it carries risks such as vascular occlusion, Tyndall effect, and edema. Prevention depends on deep anatomical knowledge, careful product selection, precise technique, and readiness to manage complications.