Purpose: We assessed the indications, efficacy, safety, and durability of hyaluronic acid gel filler injections in the periorbital region. Efficacy was evaluated through subjective patient satisfaction and objective symptom improvement. Methods: We conducted a retrospective analysis of the medical records of patients who underwent periorbital hyaluronic acid gel filler injections between February 2011 and June 2023. Patient demographics, indications for treatment, pre-injection symptoms, post-injection outcomes (including patient satisfaction), complications, and filler durability were collected and analyzed. Results: In total, 125 patients underwent 177 injection sessions. The mean age of patients was 49.0 years, with female predominance (71.2%). The most common indications were lid retraction (26.55%), enophthalmos (22.03%), and tear trough deformity (12.99%). Overall patient satisfaction was high (89.27%), and undercorrection was the primary reason for dissatisfaction (10/177); subsequent injections successfully addressed undercorrection in all patients. Symptom improvement was observed in 94.35% of injections, and 7 cases required surgery for persistent symptoms. Enophthalmos correction was 1.07 mm per injection and 1.15 mm per 1 cc of filler. Lid retraction improved by 1.41 ± 0.82 mm with an average of 0.51 ± 0.36 cc of filler per session. Common complications included pain, bruising, nausea, vomiting, and swelling. The mean filler durability was 46.3 weeks. Conclusions Lid retraction, enophthalmos, and tear trough deformity were common indications for periorbital hyaluronic acid gel filler injections. Most patients reported symptom improvement and high satisfaction. These findings suggest that periorbital filler injections can be a safe and effective outpatient treatment option for various periorbital conditions.

Purpose: We assessed the indications, efficacy, safety, and durability of hyaluronic acid gel filler injections in the periorbital region. Efficacy was evaluated through subjective patient satisfaction and objective symptom improvement. Methods: We conducted a retrospective analysis of the medical records of patients who underwent periorbital hyaluronic acid gel filler injections between February 2011 and June 2023. Patient demographics, indications for treatment, pre-injection symptoms, post-injection outcomes (including patient satisfaction), complications, and filler durability were collected and analyzed. Results: In total, 125 patients underwent 177 injection sessions. The mean age of patients was 49.0 years, with female predominance (71.2%). The most common indications were lid retraction (26.55%), enophthalmos (22.03%), and tear trough deformity (12.99%). Overall patient satisfaction was high (89.27%), and undercorrection was the primary reason for dissatisfaction (10/177); subsequent injections successfully addressed undercorrection in all patients. Symptom improvement was observed in 94.35% of injections, and 7 cases required surgery for persistent symptoms. Enophthalmos correction was 1.07 mm per injection and 1.15 mm per 1 cc of filler. Lid retraction improved by 1.41 ± 0.82 mm with an average of 0.51 ± 0.36 cc of filler per session. Common complications included pain, bruising, nausea, vomiting, and swelling. The mean filler durability was 46.3 weeks. Conclusions Lid retraction, enophthalmos, and tear trough deformity were common indications for periorbital hyaluronic acid gel filler injections. Most patients reported symptom improvement and high satisfaction. These findings suggest that periorbital filler injections can be a safe and effective outpatient treatment option for various periorbital conditions.

Purpose: We assessed the indications, efficacy, safety, and durability of hyaluronic acid gel filler injections in the periorbital region. Efficacy was evaluated through subjective patient satisfaction and objective symptom improvement. Methods: We conducted a retrospective analysis of the medical records of patients who underwent periorbital hyaluronic acid gel filler injections between February 2011 and June 2023. Patient demographics, indications for treatment, pre-injection symptoms, post-injection outcomes (including patient satisfaction), complications, and filler durability were collected and analyzed. Results: In total, 125 patients underwent 177 injection sessions. The mean age of patients was 49.0 years, with female predominance (71.2%). The most common indications were lid retraction (26.55%), enophthalmos (22.03%), and tear trough deformity (12.99%). Overall patient satisfaction was high (89.27%), and undercorrection was the primary reason for dissatisfaction (10/177); subsequent injections successfully addressed undercorrection in all patients. Symptom improvement was observed in 94.35% of injections, and 7 cases required surgery for persistent symptoms. Enophthalmos correction was 1.07 mm per injection and 1.15 mm per 1 cc of filler. Lid retraction improved by 1.41 ± 0.82 mm with an average of 0.51 ± 0.36 cc of filler per session. Common complications included pain, bruising, nausea, vomiting, and swelling. The mean filler durability was 46.3 weeks. Conclusions Lid retraction, enophthalmos, and tear trough deformity were common indications for periorbital hyaluronic acid gel filler injections. Most patients reported symptom improvement and high satisfaction. These findings suggest that periorbital filler injections can be a safe and effective outpatient treatment option for various periorbital conditions.

Purpose: Although previous studies have found an association between brain iron levels and brain function, few have explored this relationship in children with autism spectrum disorder (ASD). Thus, we aimed to determine the association between quantitative susceptibility mapping (QSM)-derived magnetic susceptibility values (MSVs) and brain function in children with ASD. Materials and Methods: The study included children with ASD who underwent both a brain magnetic resonance imaging with QSM and the Wechsler intelligence scale for children intelligence quotient (IQ) test. Select subcortical brain regions (caudate, putamen, globus pallidus, and thalamus; both right and left) were automatically segmented, and the MSVs were extracted from the QSM. The IQ score parameters (verbal comprehension, working memory, perceptual organization, and processing speed indices, and full-scale IQ) were measured. Correlation analysis was used to assess the association between age and IQ test parameters and between age and MSV. Linear regression analysis was performed to measure the relationship between the MSV and IQ test parameters. Results: A total of 23 children with ASD (median age [interquartile range]: 10 [8–14] years; 12 males) were included. Age was not correlated with any of the IQ test parameters (p > 0.05). There was a significant correlation between age and right-thalamus MSV (r = 0.443, p = 0.03); however, no such correlation was found with the MSVs of other regions (p > 0.05). Among the IQ test parameters, the verbal comprehension index significantly correlated with the left-caudate MSV (r = 0.420, p = 0.046) and the perceptual organization index significantly correlated with the right-globus-pallidus MSV (r = 0.414, p = 0.049). Conclusion Select subcortical MSVs were associated with IQ test parameters in children with ASD, suggesting that QSM is a potential neurodevelopmental marker.

INTRODUCTION: Since 2016, several therapies have been approved for treating atopic dermatitis (AD) in Singapore, including biologics, oral Janus kinase (JAK) inhibitors and topical crisaborole. This study supplements the 2016 Singapore treatment guidelines for AD, focusing on newer therapies for moderate-to-severe disease, while revisiting older treatment regimens to accommodate changes in knowledge and practice. METHOD: A modified Delphi panel was held, led by 2 co-chairs. The voting expert panel consisted of 12 dermatologists experienced in managing AD in Singapore. Delphi survey rounds were conducted between 24 July and 27 October 2023. Panellists indicated their agreement with drafted statements using a 5-point Likert scale. Consensus was defined as ≥80% agreement. An expert meeting was held to facilitate the consensus process between rounds 1 and 2 of voting. RESULTS: All expert panellists participated in both survey rounds, with a 100% response rate. Thirty-nine statements, classified into general principles, conventional treatments, biologics and JAK inhibitors, were proposed. Of these, 27 statements reached consensus at the end of round 1. After the expert meeting, 17 statements were included in round 2, of which 16 statements reached consensus. One statement did not reach consensus. Key updates are the inclusion of dupilumab and JAK inhibitors as potential first-line treatments for moderate-to-severe AD, in certain populations. CONCLUSION This modified Delphi study generated consensus among Singapore dermatology experts, to update treatment guidelines in moderate-to-severe atopic dermatitis. The consensus statements developed are intended to supplement the 2016 Singapore treatment guidelines for AD. Further revisions may be required when new evidence and/or treatments become available.
Dermatitis, Atopic/drug therapy* ; Humans ; Singapore ; Janus Kinase Inhibitors/therapeutic use* ; Biological Products/therapeutic use* ; Delphi Technique ; Consensus ; Antibodies, Monoclonal, Humanized/therapeutic use* ; Severity of Illness Index ; Bridged Bicyclo Compounds, Heterocyclic/therapeutic use* ; Dermatologic Agents/therapeutic use* ; Practice Guidelines as Topic ; Pyrimidines/therapeutic use* ; Boron Compounds