{"id":34665,"date":"2022-11-23T14:20:30","date_gmt":"2022-11-23T07:20:30","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=34665"},"modified":"2022-11-26T09:28:00","modified_gmt":"2022-11-26T02:28:00","slug":"ky-thuat-lam-day-hom-mat-duoi-ranh-nuoc-mat-va-ranh-mi-ma","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/ky-thuat-lam-day-hom-mat-duoi-ranh-nuoc-mat-va-ranh-mi-ma\/","title":{"rendered":"K\u1ef9 thu\u1eadt l\u00e0m \u0111\u1ea7y h\u00f5m m\u1eaft d\u01b0\u1edbi, r\u00e3nh n\u01b0\u1edbc m\u1eaft, v\u00e0 r\u00e3nh m\u00ed m\u00e1"},"content":{"rendered":"

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft K\u1ef9 thu\u1eadt l\u00e0m \u0111\u1ea7y h\u00f5m m\u1eaft d\u01b0\u1edbi, r\u00e3nh n\u01b0\u1edbc m\u1eaft, v\u00e0 r\u00e3nh m\u00ed m\u00e1<\/strong><\/a>, xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

M\u1ee9c \u0111\u1ed9 kh\u00f3: C, \u0110\u1ed9 hi\u1ec7u qu\u1ea3: A, Bi\u1ebfn ch\u1ee9ng: C<\/p>\n

K\u1ebft lu\u1eadn 1: H\u00f5m m\u1eaft d\u01b0\u1edbi g\u1ed3m 3 ph\u1ea7n:r\u00e3nh n\u01b0\u1edbc m\u1eaft \u1edf ph\u00eda trung t\u00e2m , h\u00f5m m\u1eaft d\u01b0\u1edbi \u1edf ph\u00eda gi\u1eefa, v\u00e0 r\u00e3nh m\u00ed m\u00e1 \u1edf ph\u00eda b\u00ean.<\/p>\n

K\u1ebft lu\u1eadn 2: \u0110\u1ec3 ch\u1ec9nh s\u1eeda th\u1ec3 t\u00edch n\u00f4ng, HA \u0111\u01b0\u1ee3c ti\u00eam v\u00e0o l\u1edbp d\u01b0\u1edbi b\u00ec v\u1edbi cannula a 30-G \u00d7 3-cm. \u0110\u1ec3 ch\u1ec9nh s\u1eeda th\u1ec3 t\u00edch s\u00e2u, th\u1ec3 t\u00edch \u0111\u01b0\u1ee3c \u0111\u1eb7t v\u00e0o l\u1edbp d\u01b0\u1edbi c\u01a1 v\u1edbi cannula 27-G ho\u1eb7c 30-G \u00d7 3-cm . S\u1eed d\u1ee5ng HA filler l\u01b0\u1ee1ng c\u1ef1c m\u1ec1m \u0111\u1ec3 ti\u00eam v\u00f9ng d\u01b0\u1edbi \u1ed5 m\u1eaft.<\/p>\n

V\u00f9ng d\u01b0\u1edbi m\u1eaft kh\u00f4ng \u0111\u1ec1u m\u00e0u, th\u01b0\u1eddng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201c qu\u1ea7ng th\u00e2m m\u1eaft\u201d l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111a y\u1ebfu t\u1ed1. 4 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u c\u1ee7a qu\u1ea7ng th\u00e2m m\u1eaft bao g\u1ed3m m\u00e0u da ( s\u1eafc t\u1ed1), s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c m\u1ea1ch m\u00e1u m\u00e0u xanh b\u00ean d\u01b0\u1edbi da, n\u1ebfp nh\u0103n da v\u00e0 s\u1ef1 t\u1ea1o b\u00f3ng tr\u00ean b\u1ec1 m\u1eb7t da. C\u1ee5 th\u1ec3, tu\u00fdp da Fitzpatrick III t\u1edbi IV c\u00f3 di truy\u1ec1n nhi\u1ec1u v\u1ec1 t\u0103ng s\u1eafc t\u1ed1 quanh \u1ed5 m\u1eaft, c\u00e1i m\u00e0 c\u00f3 xu h\u01b0\u1edbng tr\u1edf n\u00ean r\u00f5 h\u01a1n khi c\u00f3 tu\u1ed5i. C\u00f3 nhi\u1ec1u m\u1ea1ch m\u00e1u b\u1ea9m sinh v\u00f9ng d\u01b0\u1edbi m\u1eaft ho\u1eb7c s\u1ef1 gi\u00e3n c\u1ee7a m\u1ea1ch m\u00e1u do thi\u1ebfu ng\u1ee7 ho\u1eb7c kinh nguy\u1ec7t c\u0169ng c\u00f3 th\u1ec3 l\u00e0m th\u00e2m qu\u1ea7ng m\u1eaft. N\u1ebfp nh\u0103n \u1edf da d\u01b0\u1edbi \u1ed5 m\u1eaft do l\u00e3o h\u00f3a ho\u1eb7c vi\u00eam da m\u1ea1n t\u00ednh nh\u01b0 vi\u00eam da c\u01a1 \u0111\u1ecba ho\u1eb7c vi\u00eam da ti\u1ebfp x\u00fac c\u0169ng c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean Nh\u00e2n c\u1ee7a qu\u1ea7ng th\u00e2m m\u1eaft. S\u1ef1 kh\u00f4ng \u0111\u1ec1u m\u00e0u<\/p>\n

K\u1ebft lu\u1eadn 3: \u1ede b\u1ec7nh nh\u00e2n c\u00f3 ph\u00ec \u0111\u1ea1i d\u1ea3i trung t\u00e2m c\u1ee7a c\u01a1 v\u00f2ng m\u1eaft, khuy\u00ean s\u1eed d\u1ee5ng BoNT-A \u1edf 2-3 \u0111i\u1ec3m (1.5\u20132 U m\u1ed7i \u0111i\u1ec3m) d\u1ecdc theo d\u1ea3i trung t\u00e2m. \u1ede b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n thi\u1ebfu m\u00e1 tr\u01b0\u1edbc, ph\u1ee5c h\u1ed3i th\u1ec3 t\u00edch cho v\u00f9ng m\u00e1 tr\u01b0\u1edbc \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n

C\u0169ng c\u00f3 th\u1ec3 l\u00e0 do b\u1ea9m sinh ho\u1eb7c t\u1ea1o b\u00f3ng \u1edf b\u00ean d\u01b0\u1edbi m\u1eaft do h\u00f5m \u1edf khu v\u1ef1c d\u01b0\u1edbi \u1ed5 m\u1eaft ho\u1eb7c s\u1ef1 tho\u00e1t v\u1ecb c\u1ee7a m\u1ee1 d\u01b0\u1edbi \u1ed5 m\u1eaft (a.k.a. b\u1ecdng m\u1eaft) ho\u1eb7c s\u1ef1 ch\u1ea3y x\u1ec7 c\u1ee7a mi m\u1eaft d\u01b0\u1edbi. Trong c\u00e1c v\u1ea5n \u0111\u1ec1 \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean, vi\u1ec7c ch\u1ec9nh s\u1eeda b\u00f3ng d\u01b0\u1edbi m\u1eaft l\u00e0 gi\u1ea3i ph\u00e1p \u0111\u01a1n gi\u1ea3n v\u00e0 d\u1ec5 nh\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb qu\u1ea7ng th\u00e2m m\u1eaft. Trong khi ph\u1eabu thu\u1eadt l\u00e0 b\u1eaft bu\u1ed9c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ecdng m\u1eaft d\u01b0\u1edbi ho\u1eb7c ch\u1ea3y x\u1ec7 mi d\u01b0\u1edbi, th\u00ec thi\u1ebfu th\u1ec3 t\u00edch \u1edf v\u00f9ng d\u01b0\u1edbi \u1ed5 m\u1eaft c\u00f3 th\u1ec3 d\u00f9ng HA filler \u0111\u1ec3 tr\u1ebb h\u00f3a qu\u1ea7ng th\u00e2m m\u1eaft.<\/p>\n

H\u00f5m d\u01b0\u1edbi \u1ed5 m\u1eaft bao g\u1ed3m 3 th\u00e0nh ph\u1ea7n ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed, t\u00ean l\u00e0 r\u00e3nh n\u01b0\u1edbc m\u1eaft \u1edf ph\u00eda trung t\u00e2m, h\u00f5m d\u01b0\u1edbi \u1ed5 m\u1eaft \u1edf ph\u00eda gi\u1eefa, v\u00e0 r\u00e3nh m\u00ed m\u00e1 \u1edf ph\u00eda b\u00ean. (Fig. 4.32) [12]. R\u00e3nh n\u01b0\u1edbc m\u1eaft \u0111\u01b0\u1ee3c t\u1ea1o b\u1edfi \u00bd ph\u00eda trung t\u00e2m c\u1ee7a h\u00f5m \u1ed5 m\u1eaft d\u01b0\u1edbi, n\u01a1i ph\u1ea7n da m\u1ecfng c\u1ee7a khu v\u1ef1c xung quanh \u1ed5 m\u1eaft g\u1eb7p ph\u1ea7n da d\u1ea7y c\u1ee7a khu v\u1ef1c m\u00e1. R\u00e3nh m\u00ed m\u00e1 \u1edf \u00bd ph\u00eda b\u00ean c\u1ee7a h\u00f5m d\u01b0\u1edbi \u1ed5 m\u1eaft, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1ebft l\u00f5m \u0111\u1ec3 l\u1ea1i sau khi \u0111eo k\u00ednh b\u1ea3o h\u1ed9. Ph\u1ea7n gi\u1eefa h\u00f5m d\u01b0\u1edbi \u1ed5 m\u1eaft n\u1eb1m \u1edf ngo\u00e0i r\u00eca c\u1ee7a 2 khu v\u1ef1c n\u00e0y, inferior to the pretarsal roll or the inferior tarsus. R\u00e3nh n\u01b0\u1edbc m\u1eaft v\u00e0 ph\u1ea7n gi\u1eefa h\u00f5m d\u01b0\u1edbi \u1ed5 m\u1eaft th\u01b0\u1eddng do b\u1ea9m sinh v\u00e0 c\u00f3 th\u1ec3 th\u1ea5y \u1edf c\u1ea3 ng\u01b0\u1eddi tr\u1ebb, th\u00ec r\u00e3nh m\u00ed m\u00e1 th\u01b0\u1eddng th\u1ea5y \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i, v\u1edbi s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a g\u00f2 m\u00e1 v\u00e0 s\u1ef1 tho\u00e1t v\u1ecb kh\u1ed1i m\u1ee1 d\u01b0\u1edbi \u1ed5 m\u1eaft (Fig. 4.33).<\/p>\n

\"Fig.
Fig. 4.32 Infraorbital hollowness consists of three parts depending on the location, namely the tear trough on the medial aspect, the central infraorbital hollow on the central aspect, and the palpebromalar groove on the lateral aspect<\/figcaption><\/figure>\n

Gi\u1ea3i ph\u1eabu<\/h2>\n

R\u00e3nh n\u01b0\u1edbc m\u1eaft b\u1eaft \u0111\u1ea7u t\u1eeb kh\u00f3e m\u1eaft trong v\u00e0 k\u00e9o d\u00e0i ch\u00e9o xu\u1ed1ng d\u1ecdc theo v\u00e0nh m\u1eaft t\u1edbi h\u1ed9i t\u1ee5 v\u1edbi r\u00e3nh m\u00ed m\u00e1 \u1edf \u0111i\u1ec3m gi\u1eefa c\u1ee7a v\u00e0nh m\u1eaft. M\u1eb7t c\u1eaft d\u1ecdc c\u1ee7a khu v\u1ef1c d\u01b0\u1edbi \u1ed5 m\u1eaft cho th\u1ea5y c\u00e1c l\u1edbp t\u01b0\u01a1ng \u1ee9ng t\u1eeb n\u00f4ng t\u1edbi s\u00e2u bao g\u1ed3m da- l\u1edbp d\u01b0\u1edbi b\u00ec- c\u01a1 v\u00f2ng m\u1eaft- l\u1edbp m\u1ee1 tr\u01b0\u1edbc v\u00e1ch ng\u0103n- v\u00e1ch ng\u0103n \u1ed5 m\u1eaft- m\u1ee1 d\u01b0\u1edbi \u1ed5 m\u1eaft. (Fig. 4.34) [13]. V\u1ecb tr\u00ed c\u1ee7a r\u00e3nh n\u01b0\u1edbc m\u1eaft c\u0169ng nh\u1ea5t qu\u00e1n v\u1edbi d\u00e2y ch\u1eb1ng \u1ed5 m\u1eaft (ORL), n\u1ed1i v\u1edbi x\u01b0\u01a1ng \u1ed5 m\u1eaft v\u00e0 \u0111i qua c\u01a1 v\u00f2ng m\u1eaft. \u1ea2nh l\u00e2m s\u00e0ng \u1edf Fig. 4.35 well minh h\u1ecda t\u1ed1t cho v\u1ecb tr\u00ed c\u1ee7a ORL bi\u1ec3u hi\u1ec7n l\u00e0 m\u00e0u tr\u1eafng \u1edf trong \u1ea3nh do s\u1ef1 co m\u1ea1ch g\u00e2y ra b\u1edfi s\u1ef1 khu\u1ebfch t\u00e1n c\u1ee7a epinephrine tr\u1ed9n v\u1edbi lidocaine \u0111\u01b0\u1ee3c ti\u00eam \u1edf \u0111i\u1ec3m v\u00e0o c\u1ee7a cannula. (Fig. 4.35). ORL k\u00e9o c\u01a1 v\u00f2ng m\u1eaft xu\u1ed1ng t\u1edbi x\u01b0\u01a1ng, v\u00e0 s\u1ef1 g\u1eafn b\u00f3 ch\u1eafc ch\u1eafn n\u00e0y ng\u0103n ch\u1eb7n b\u1ea5t k\u00ec s\u1ef1 ch\u1ea3y x\u1ec7 n\u00e0o c\u1ee7a m\u1ee1 \u1ed5 m\u1eaft d\u01b0\u1edbi.<\/p>\n

Thay v\u00e0o \u0111\u00f3, tho\u00e1t v\u1ecb m\u1ee1 \u1ed5 m\u1eaft d\u01b0\u1edbi d\u1ecdc theo chu vi c\u1ee7a ORL. \u0110i\u1ec1u n\u00e0y v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng, tuy nhi\u00ean, cho d\u00f9 th\u1ebf n\u00e0o th\u00ec ORL c\u0169ng g\u1eafn v\u00e0o da ch\u1eb7t ch\u1ebd.<\/p>\n

C\u00f9ng v\u1edbi \u0111\u00f3, r\u00e3nh m\u00ed m\u00e1 ch\u1ea1y t\u1eeb kh\u00f3e m\u1eaft ngo\u00e0i song song v\u1edbi v\u00e0nh m\u1eaft v\u00e0 g\u1eb7p r\u00e3nh n\u01b0\u1edbc m\u1eaft \u1edf gi\u1eefa c\u1ee7a v\u00e0nh m\u1eaft d\u01b0\u1edbi. It also lies lateral to the arcus marginalis of the orbital rim. Trong khi r\u00e3nh m\u00ed m\u00e1 c\u00f3 th\u1ec3 l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ea9m sinh, n\u00f3 th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn l\u00e3o h\u00f3a v\u1edbi s\u1ef1 g\u1ed3 l\u00ean c\u1ee7a b\u1ecdng m\u1eaft d\u01b0\u1edbi v\u00e0 \u0111\u01b0\u1eddng r\u00e3nh \u1edf m\u00e1. S\u1eed d\u1ee5ng cannula ti\u00eam v\u00e0o khu v\u1ef1c quanh m\u1eaft c\u1ea7n tr\u00e1nh mi m\u1eaft d\u01b0\u1edbi v\u00e0 \u0111\u1ed9ng m\u1ea1ch g\u00f3c ch\u1ea1y trong khu v\u1ef1c n\u00e0y.<\/p>\n

\u0110\u00e1nh gi\u00e1 tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb<\/h2>\n

B\u1eaft \u0111\u1ea7u b\u1eb1ng \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng v\u00e0 v\u1ecb tr\u00ed c\u1ee7a h\u00f5m d\u01b0\u1edbi \u1ed5 m\u1eaft, \u0111\u00f3 l\u00e0 r\u00e3nh n\u01b0\u1edbc m\u1eaft, ph\u1ea7n gi\u1eefa h\u00f5m \u1ed5 m\u1eaft v\u00e0 r\u00e3nh m\u00ed m\u00e1. Trong khi h\u1ea7u h\u1ebft tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 h\u00f5m \u1edf r\u00e3nh n\u01b0\u1edbc m\u1eaft, n\u00ean ki\u1ec3m tra xem c\u00f3 h\u00f3p \u1edf 2 v\u00f9ng c\u00f2n l\u1ea1i kh\u00f4ng..<\/p>\n

\"

Fig. 4.33 (a) Before and (b) after tear trough volumization in a 28-year-old female. (c) Before and (d) after volumiza-tion of the tear trough, palpebromalar groove, and anterior malar depression in a 48-year-old female<\/figcaption><\/figure>\n

C\u0169ng c\u1ea7n ki\u1ec3m tra xem c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a tho\u00e1t v\u1ecb m\u1ee1 \u1ed5 m\u1eaft d\u01b0\u1edbi ho\u1eb7c ch\u1ea3y x\u1ec7 mi m\u1eaft d\u01b0\u1edbi. Ch\u00fa \u00fd khi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n c\u00f3 mi m\u1eaft l\u1ecfng l\u1ebbo v\u00e0 k\u00e9m \u0111\u00e0n h\u1ed3i, v\u00ec khi ti\u00eam l\u01b0\u1ee3ng nh\u1ecf kh\u00f3 n\u00e2ng l\u00ean, trong khi ti\u00eam l\u01b0\u1ee3ng l\u1edbn c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nh\u00ecn th\u1ea5y u c\u1ee5c. Trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u0169ng c\u00f3 v\u00f9ng m\u00e1 tr\u01b0\u1edbc ph\u1eb3ng, ph\u1ee5c h\u1ed3i th\u1ec3 t\u00edch \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho v\u00f9ng m\u00e1 tr\u01b0\u1edbc trung t\u00e2m. Khi ti\u00eam HA filler, \u0111\u1eb7c bi\u1ec7t khi \u0111\u1eb7t v\u00e0o m\u00f4 m\u1ecfng \u1edf v\u00f9ng r\u00e3nh n\u01b0\u1edbc m\u1eaft, c\u00f3 xu h\u01b0\u1edbng h\u1ea5p thu n\u01b0\u1edbc t\u1eeb m\u00f4 xung quanh v\u00e0 n\u1edf r\u1ed9ng. \u1ede tr\u01b0\u1eddng h\u1ee3p n\u00e0y, b\u1ec7nh nh\u00e2n u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc h\u1eb1ng ng\u00e0y d\u1ec5 b\u1ecb u c\u1ee5c do s\u1ef1 n\u1edf ra c\u1ee7a HA.<\/p>\n

Cu\u1ed1i c\u00f9ng, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a ph\u00ec \u0111\u1ea1i d\u1ea3i trung t\u00e2m c\u01a1 v\u00f2ng m\u1eaft ( n\u1eb1m \u1edf ngay b\u00ean d\u01b0\u1edbi r\u00e3nh n\u01b0\u1edbc m\u1eaft), c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, v\u00ec n\u00f3 co khi c\u01b0\u1eddi, c\u00f3 th\u1ec3 l\u00e0m HA filler \u0111\u1eb7t \u1edf r\u00e3nh n\u01b0\u1edbc m\u1eaft co c\u1ee5m l\u1ea1i v\u00e0 nh\u00f4 ra tr\u01b0\u1edbc. (Fig. 1.12).<\/p>\n

K\u0129 thu\u1eadt ti\u00eam (Table 4.6)<\/h2>\n

S\u1eed d\u1ee5ng HA filler l\u01b0\u1ee1ng c\u1ef1c v\u1edbi k\u00edch th\u01b0\u1edbc nh\u1ecf th\u00edch h\u1ee3p \u0111\u1ec3 ti\u00eam v\u00f9ng d\u01b0\u1edbi m\u1eaft. HA filler \u0111\u01a1n c\u1ef1c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o b\u1edfi v\u00ec ch\u00fang c\u00f3 xu h\u01b0\u1edbng h\u1ea5p thu n\u01b0\u1edbc v\u00e0 n\u1edf ra. cannula 30G x3cm th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u00f9ng d\u01b0\u1edbi \u1ed5 m\u1eaft, trong khi cannula 27G \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ti\u00eam s\u00e2u.<\/p>\n

\"Fig.
Fig. 4.34 A sagittal section of the infraorbital region<\/figcaption><\/figure>\n
\"Fig.
Fig. 4.35 This clinical photo well illustrates the circum-ference location of the orbital retaining ligament repre-sented in white due to the vasoconstriction induced by diffusion ofthe epinephrine mixed with lidocaine injected in the cannula entry point<\/figcaption><\/figure>\n

C\u00f3 1 m\u1ea1ng l\u01b0\u1edbi phong ph\u00fa c\u00e1c m\u1ea1ch m\u00e1u nh\u1ecf b\u00ean d\u01b0\u1edbi v\u00f9ng quanh m\u1eaft, v\u00e0 cannula c\u00f3 th\u1ec3 l\u00e0m t\u1ed5n th\u01b0\u01a1ng b\u1ea5t k\u00ec th\u00e0nh m\u1ea1ch n\u00e0o y\u1ebfu, d\u1eabn \u0111\u1ebfn b\u1ea7m t\u00edm, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi s\u1eed d\u1ee5ng 30G microcannula.<\/p>\n

Table 4.6 Summary of infraorbital hollow injection technique<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Item<\/td>\nContents<\/td>\n<\/tr>\n
Needle vs. Cannula<\/td>\n30-G 3-cm cannula cho l\u1edbp d\u01b0\u1edbi b\u00ec<\/p>\n

27-G or 30-G 3-cm cannula cho l\u1edbp d\u01b0\u1edbi c\u01a1 (preseptal layer)<\/td>\n<\/tr>\n

HA Filler<\/td>\nFiller l\u01b0\u1ee1ng c\u1ef1c v\u1edbi c\u00e1c m\u1ea3nh nh\u1ecf<\/td>\n<\/tr>\n
L\u01b0\u1ee3ng HA filler<\/td>\n\n
    \n
  • 0.1\u20130.3 mL m\u1ed7i b\u00ean cho r\u00e3nh n\u01b0\u1edbc m\u1eaft<\/li>\n
  • 0.1\u20130.5 mL m\u1ed7i b\u00ean cho ph\u1ea7n gi\u1eefa h\u00f5m \u1ed5 m\u1eaft d\u01b0\u1edbi<\/li>\n
  • 0.3\u20130.6 mL m\u1ed7i b\u00ean cho r\u00e3nh m\u00ed m\u00e1<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
\u0111\u1ed9 s\u00e2u khi ti\u00eam<\/td>\nL\u1edbp d\u01b0\u1edbi b\u00ec cho ch\u1ec9nh s\u1eeda n\u00f4ng<\/p>\n

L\u1edbp d\u01b0\u1edbi c\u01a1 cho ti\u00eam s\u00e2u<\/td>\n<\/tr>\n

\u0110i\u1ec3m v\u00e0o c\u1ee7a cannula<\/td>\n0.5\u20131 cm t\u1eeb ch\u1ed7 k\u1ebft th\u00fac c\u1ee7a r\u00e3nh n\u01b0\u1edbc m\u1eaft v\u1edbi r\u00e3nh n\u01b0\u1edbc m\u1eaft<\/p>\n

1 cm d\u01b0\u1edbi b\u00ean t\u1eeb kh\u00f3e m\u1eaft b\u00ean cho ph\u00eda gi\u1eefa c\u1ee7a h\u00f5m \u1ed5 m\u1eaft d\u01b0\u1edbi<\/p>\n

1 cm b\u00ean t\u1eeb kh\u00f3e m\u1eaft b\u00ean cho r\u00e3nh m\u00ed m\u00e1<\/td>\n<\/tr>\n

V\u00f9ng m\u1ee5c ti\u00eau<\/td>\nr\u00e3nh n\u01b0\u1edbc m\u1eaft<\/p>\n

Ph\u00eda gi\u1eefa h\u00f5m \u1ed5 m\u1eaft d\u01b0\u1edbi\/ R\u00e3nh m\u00ed m\u00e1<\/td>\n<\/tr>\n

V\u00f4 c\u1ea3m<\/td>\nB\u00f4i t\u00ea<\/td>\n<\/tr>\n
Tay r\u1ea3nh<\/td>\nGi\u1eef da \u0111\u1ed1i di\u1ec7n v\u1edbi h\u01b0\u1edbng ti\u1ebfn l\u00ean c\u1ee7a cannula \u0111\u1ec3 duy tr\u00ec \u0111\u1ed9 c\u0103ng c\u1ee7a da<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u0110i\u1ec3m v\u00e0o c\u1ee7a cannula \u0111\u01b0\u1ee3c t\u1ea3o b\u1edfi kim 26G. \u0110\u1ec3 gi\u1ea3m b\u1ea7m t\u00edm v\u00e0 tr\u00e1nh t\u1ed5n th\u01b0\u01a1ng qu\u00e1 m\u1ee9c m\u1ea1ch m\u00e1u trong khu v\u1ef1c quanh m\u1eaft, r\u1ea5t quan tr\u1ecdng khi \u0111\u00e2m kim ch\u1eadm v\u1edbi g\u00f3c xi\u00ean xu\u1ed1ng d\u01b0\u1edbi. Trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u, \u1ea5n v\u00e0o khu v\u1ef1c trong \u00edt nh\u1ea5t 3 ph\u00fat \u0111\u1ec3 ng\u1eebng ch\u1ea3y m\u00e1u.<\/p>\n

R\u00e3nh n\u01b0\u1edbc m\u1eaft<\/h3>\n

\u0110\u1ed9 s\u00e2u li\u00ean quan khi ti\u00eam ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 n\u1eb7ng c\u1ee7a r\u00e3nh n\u01b0\u1edbc m\u1eaft. \u0110\u1ed1i v\u1edbi r\u00e3nh n\u01b0\u1edbc m\u1eaft nh\u1eb9, s\u1eeda ch\u1eefa \u1edf l\u1edbp d\u01b0\u1edbi b\u00ec, n\u00f4ng t\u1edbi c\u01a1 v\u00f2ng m\u1eaft v\u1edbi cannula 30G. \u0110\u1ed1i v\u1edbi r\u00e3nh n\u01b0\u1edbc m\u1eaft s\u00e2u, s\u1eed d\u1ee5ng k\u0129 thu\u1eadt 2 l\u1edbp \u0111\u1ec3 tr\u00e1nh hi\u1ec7u \u1ee9ng Tyndall do \u0111\u1eb7t qu\u00e1 nhi\u1ec1u filler HA n\u00f4ng \u1edf l\u1edbp d\u01b0\u1edbi b\u00ec. \u1edf \u0111\u00e2y, HA filler \u0111\u01b0\u1ee3c \u0111\u1eb7t s\u00e2u t\u1edbi c\u01a1 v\u00f2ng m\u1eaft, v\u00e0o l\u1edbp m\u1ee1 tr\u01b0\u1edbc v\u00e1ch ng\u0103n, s\u1eed d\u1ee5ng cannula 27G x 3cm, tr\u01b0\u1edbc khi c\u00e1c \u0111i\u1ec1u ch\u1ec9nh t\u1ec9 m\u1ec9 h\u01a1n \u1edf d\u01b0\u1edbi b\u00ec s\u1eed d\u1ee5ng cannula 30G x 3m. (Fig. 4.36). \u0110i\u1ec3m v\u00e0o cannula c\u00e1ch \u0111i\u1ec3m k\u1ebft th\u00fac r\u00e3nh n\u01b0\u1edbc m\u1eaft 0.5-1cm d\u1ecdc theo \u0111\u01b0\u1eddng th\u1eb3ng k\u00e9o d\u00e0i t\u1eeb \u0111i\u1ec3m k\u1ebft th\u00fac. (Fig. 4.36). Trong tr\u01b0\u1eddng h\u1ee3p r\u00e3nh n\u01b0\u1edbc m\u1eaft ti\u1ebfp t\u1ee5c v\u01b0\u1ee3t ra 1\/3 gi\u1eefa h\u00f5m \u1ed5 m\u1eaft d\u01b0\u1edbi t\u1edbi khu v\u1ef1c d\u01b0\u1edbi \u0111\u1ed3ng t\u1eed, ch\u1ea1y song song v\u00e0nh m\u1eaft, \u0111i\u1ec3m v\u00e0o th\u1ee9 2 b\u1eaft bu\u1ed9c ph\u1ea3i \u0111\u1eb7t \u1edf ph\u1ea7n ngang c\u1ee7a r\u00e3nh nuwocs m\u1eaft. (Fig. 4.37). V\u1ec1 th\u1ec3 t\u00edch ti\u00eam, 0.1-0.3ml HA \u1edf d\u01b0\u1edbi b\u00ec v\u00e0 0.1-0.3ml HA \u1edf l\u1edbp m\u1ee1 tr\u01b0\u1edbc v\u00e1ch ng\u0103n \u0111\u1ec3 ch\u1ec9nh s\u1eeda \u0111\u1ee7 ph\u1ea7n thi\u1ebfu.<\/p>\n

V\u00f9ng da m\u1ecfng c\u1ee7a r\u00e3nh n\u01b0\u1edbc m\u1eaft c\u00f3 kh\u1ea3 n\u0103ng \u0111\u1ec3 l\u1ed9 ra b\u1ea5t k\u00ec s\u1ef1 gi\u00e3n n\u1edf kh\u00f4ng mong mu\u1ed1n n\u00e0o c\u1ee7a HA do s\u1ef1 h\u1ea5p th\u1ee5 n\u01b0\u1edbc qu\u00e1 m\u1ee9c. Do \u0111\u00f3, m\u1ee5c \u0111\u00edch l\u00e0 ch\u1ec9nh s\u1eeda nh\u1eb9 nh\u00e0ng h\u01a1n l\u00e0 c\u1ed1 g\u1eafng ch\u1ec9nh s\u1eeda to\u00e0n b\u1ed9 trong 1 l\u1ea7n. S\u1eed d\u1ee5ng kem t\u00ea l\u00e0 \u0111\u1ee7 cho g\u00e2y t\u00ea t\u1ea1i ch\u1ed7. Tuy nhi\u00ean, ch\u00fa \u00fd r\u1eb1ng, kem g\u00e2y t\u00ea khi b\u00f4i trong th\u1eddi gian d\u00e0i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn da s\u01b0ng l\u00ean v\u00e0 l\u00e0m m\u1edd \u0111i v\u00f9ng r\u00e3nh nuwocs m\u1eaft c\u1ea7n s\u1eeda ch\u1eefa. V\u00ec v\u1eady, kem t\u00ea ch\u1ec9 n\u00ean b\u00f4i \u1edf v\u1ecb tr\u00ed cannula \u0111i v\u00e0o h\u01a1n l\u00e0 b\u00f4i to\u00e0n b\u1ed9 v\u00f9ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

V\u00f9ng gi\u1eefa h\u00f5m d\u01b0\u1edbi \u1ed5 m\u1eaft<\/h3>\n

Ph\u1ea7n gi\u1eefa h\u00f5m \u1ed5 m\u1eaft d\u01b0\u1edbi, c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u00f5m d\u01b0\u1edbi m\u1eaft n\u1eb1m d\u01b0\u1edbi cu\u1ed9n mi m\u1eaft tr\u01b0\u1edbc ho\u1eb7c mi m\u1eaft d\u01b0\u1edbi. \u1ede \u0111\u00e2y, cannula 27G x 3m \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o l\u1edbp m\u1ee1 tr\u01b0\u1edbc v\u00e1ch \u0111\u1ec3 l\u00e0m \u0111\u1ea7y c\u01a1 b\u1ea3n ph\u1ea7n l\u00f5m t\u1eeb mi m\u1eaft d\u01b0\u1edbi t\u1edbi r\u00e3nh n\u01b0\u1edbc m\u1eaft, tr\u01b0\u1edbc khi tinh ch\u1ec9nh k\u1ebft qu\u1ea3 v\u1edbi cannula 30G 1 c\u00e1ch kh\u00e9o l\u00e9o d\u01b0\u1edbi b\u00ec. \u0110i\u1ec3m v\u00e0o cannula l\u00e0 1cm b\u00ean v\u00e0 1 cm d\u01b0\u1edbi t\u1eeb kh\u00f3e m\u1eaft b\u00ean (Fig. 4.37). Th\u1ec3 t\u00edch nh\u1ecf 0.1-0.5ml m\u1ed7i b\u00ean,ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1ed9 n\u1eb7ng.<\/p>\n

R\u00e3nh m\u00ed m\u00e1<\/h3>\n

S\u1eed d\u1ee5ng c\u00e1ch ti\u1ebfp c\u1eadn 2 l\u1edbp, cannula 27G x 3cm \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o l\u1edbp tr\u00ean m\u00e0ng x\u01b0\u01a1ng, s\u00e2u t\u1edbi c\u01a1 v\u00f2ng m\u1eaft \u0111\u1ec3 l\u00e0m \u0111\u1ea7y th\u1ec3 t\u00edch , sau \u0111\u00f3 cannula 30G \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ec9nh s\u1eeda chi ti\u1ebft \u1edf l\u1edbp d\u01b0\u1edbi b\u00ec.<\/p>\n

\"

Fig. 4.36 (a) Depth of injection for the tear trough, (b) sonographic findings of HA filler injected into the tear trough<\/figcaption><\/figure>\n
\"Fig.
Fig. 4.37 (a) tear trough (b) central infraorbital hollow (c) palpebromalar groove, and (d)total infraorbital hollow<\/figcaption><\/figure>\n

(Fig. 4.37). \u0111i\u1ec3m v\u00e0o c\u1ee7a cannula l\u00e0 1cm c\u1ea1nh kh\u00f3e m\u1eaft b\u00ean. (Fig. 4.37). L\u01b0\u1ee3ng HA filler \u0111\u01b0\u1ee3c ti\u00eam l\u00e0 0.1-0.3ml m\u1ed7i b\u00ean, m\u1eb7c d\u00f9 c\u1ea7n l\u01b0\u1ee3ng th\u1ec3 t\u00edch l\u1edbn \u0111\u1ec3 l\u00e0m \u0111\u1ea7y r\u00e3nh m\u00ed m\u00e1 s\u00e2u do s\u1ef1 tho\u00e1t v\u1ecb n\u1eb7ng c\u1ee7a kh\u1ed1i m\u1ee1 theo s\u1ef1 t\u0103ng l\u00ean c\u1ee7a tu\u1ed5i t\u00e1c.<\/p>\n

Ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb<\/h3>\n

\u1ede b\u1ec7nh nh\u00e2n c\u00f3 ph\u00ec \u0111\u1ea1i d\u1ea3i gi\u1eefa c\u01a1 v\u00f2ng m\u1eaft \u1edf d\u01b0\u1edbi m\u1eaft, s\u1eed d\u1ee5ng botox \u1edf 2-3 \u0111i\u1ec3m d\u1ecdc theo d\u1ea3i c\u01a1 ( 1.5-2 U m\u1ed7i \u0111i\u1ec3m) c\u00f3 th\u1ec3 \u0111em l\u1ea1i k\u1ebft qu\u1ea3 mong \u0111\u1ee3i. (Fig. 4.38).tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebfu h\u1ee5t \u1edf v\u00f9ng m\u00e1 tr\u01b0\u1edbc, h\u00e3y \u0111\u1ea3m b\u1ea3o c\u0169ng phuc h\u1ed3i th\u1ec3 t\u00edch \u1edf v\u00f9ng m\u00e1 tr\u01b0\u1edbc \u0111\u1ec3 l\u00e0m m\u01b0\u1ee3t m\u00e0 ph\u1ea7n chuy\u1ec3n ti\u1ebfp c\u1ee7a mi m\u00e1<\/p>\n

Bi\u1ebfn ch\u1ee9ng<\/h2>\n

C\u00e1c b\u1ea5t th\u01b0\u1eddng: Da m\u1ecfng \u1edf v\u00f9ng quanh m\u1eaft khi\u1ebfn cho v\u00f9ng n\u00e0y \u0111\u1eb7c bi\u1ec7t d\u1ec5 b\u1ecb nh\u1eefng t\u00ecnh tr\u1ea1ng b\u1ea5t th\u01b0\u1eddng. D\u00f9 s\u1ef1 l\u00e0m \u0111\u1ea7y qu\u00e1 m\u1ee9c nh\u1eb9 ho\u1eb7c s\u1ef1 n\u1edf ra c\u1ee7a HA filler \u0111\u1ec1u c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y l\u1ed3i l\u00f5m \u1edf v\u00f9ng n\u00e0y. (Fig. 4.39). Nguy c\u01a1 n\u00e0y cao h\u01a1n v\u1edbi HA filler \u0111\u01a1n c\u1ef1c, v\u00ec ch\u00fang c\u00f3 t\u00ednh \u01b0a n\u01b0\u1edbc cao h\u01a1n filler l\u01b0\u1ee1ng c\u1ef1c. (Fig. 2.23).<\/p>\n

B\u1ea7m t\u00edm: \u0110\u1ec3 ng\u0103n ch\u1eb7n s\u1ef1 t\u1ed5n th\u01b0\u01a1ng t\u1edbi m\u1ea1ng l\u01b0\u1edbi m\u1ea1ch m\u00e1u b\u00ean d\u01b0\u1edbi khu v\u1ef1c n\u00e0y trong khi ti\u00eam, \u0111\u00e2m kim \u1edf \u0111i\u1ec3m v\u00e0o kim 26G ch\u1eadm r\u00e3i v\u00e0 h\u01b0\u1edbng \u0111i xu\u1ed1ng, tr\u00e1nh c\u00e1c t\u0129nh m\u1ea1ch nh\u00ecn th\u1ea5y.<\/p>\n

Hi\u1ec7u \u1ee9ng Tyndall: Tr\u00e1nh \u0111\u1eb7t qu\u00e1 nhi\u1ec1u HA filler n\u00f4ng \u1edf l\u1edbp d\u01b0\u1edbi b\u00ec \u0111\u1ec3 tr\u00e1nh hi\u1ec7u \u1ee9ng Tyndall.<\/p>\n

\"

Fig. 4.38 S\u1eed d\u1ee5ng botox \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ph\u00ec \u0111\u1ea1i gi\u1ea3i trung t\u00e2m c\u01a1 v\u00f2ng m\u1eaft (a) Before, (b) afterand (c). \u0111i\u1ec3m ti\u00eam cho ph\u00ec \u0111\u1ea1i gi\u1ea3i trung t\u00e2m c\u01a1 v\u00f2ng m\u1eaft<\/figcaption><\/figure>\n
\"Fig
Fig 4.39 (a) Before and (b) after tear trough volumization. Ch\u00fa \u00fd t\u1edbi s\u1ef1 l\u1ed3i l\u00f5m c\u1ee7a v\u00f9ng \u0111i\u1ec1u tr\u1ecb<\/figcaption><\/figure>\n

Nasojugal Groove<\/h2>\n

Difficulty Level: A, Effectiveness: A, Complications: B<\/p>\n

Summary 1: A23-G \u00d7 5-cm cannula is used for deep injections into the SOOF. Both biphasic HA fillers with large particle size and monophasic HA fillers with high visco- elasticity are acceptable for use.<\/p>\n

Summary 2: The adjunctive use of BoNT-A can optimize results in patients presenting with a hypertrophic medial band of the orbicularis oculi m. under the eyes. Injection of BoNT-A is advised at two spots (1.5\u20132 U per spot) along the medial band. In patients manifesting concurrent depression in the tear trough, volume replacement should be performed in the tear trough in conjunction with the nasojugal groove.<\/p>\n","protected":false},"excerpt":{"rendered":"

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