{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:06:24Z","timestamp":1779080784927,"version":"3.51.4"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Botulinum toxin type A (BoNT-A) injections for glabellar rhytides can rarely lead to persistent blepharoptosis. Current management, including observation and \u03b1-adrenergic agonists, is often temporary, highlighting a need for definitive minimally invasive interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This article presents a novel, systematic protocol for ultrasound-guided preseptal hydrodissection. The technique utilizes high-frequency ultrasound with color Doppler to access the sub-orbicularis plane superficial to the orbital septum, where 20 mL of 5% dextrose in water (D5W) is delivered as low-pressure irrigational hydrodissection to establish a confined fluid layer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Application of this protocol in two patients with persistent BoNT-A ptosis refractory to conventional care resulted in progressive improvement. The Marginal Reflex Distance 1 (MRD1) increased from 0 to 4\u00a0mm in one patient and normalized in the other, with gains maintained at 3\u20136 months without additional treatment and no adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This work standardizes a technical protocol for a potential adjunctive intervention in persistent BoNT-A-associated ptosis. The findings are descriptive and hypothesis-generating, positioning the technique for consideration only after standard measures fail. Prospective controlled trials are required to establish efficacy and safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fopht.2026.1792644","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T04:17:58Z","timestamp":1779077878000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-guided preseptal hydrodissection with 5% dextrose in water for persistent botulinum toxin-associated ptosis: a technical protocol"],"prefix":"10.3389","volume":"6","author":[{"given":"King Hei Stanley","family":"Lam","sequence":"first","affiliation":[{"name":"Faculty of Medicine, The University of Hong Kong","place":["Hong Kong, Hong Kong SAR, China"]},{"name":"Faculty of Medicine, The Chinese University of Hong Kong","place":["Hong Kong, New Territories, Hong Kong SAR, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonghyun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Incheon Terminal Orthopedic Surgery Clinic","place":["Incheon, Republic of Korea"]},{"name":"The Board of Clinical Research, International Academy of Regenerative Medicine","place":["Incheon, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihyo","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyemi","family":"Yu","sequence":"additional","affiliation":[{"name":"Bio Plastic Surgery Clinic","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seungbeom","family":"Kim","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, International Academy of Regenerative Medicine","place":["Incheon, Republic of Korea"]},{"name":"Department of Pain Management, Miso Pain Clinic","place":["Suwon, Gyeonggi, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Chiung-Jui","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Pain Management and Rehabilitation, Chi Mei Medical Center","place":["Tainan, Taiwan"]},{"name":"A Tempo Regeneration Centerfor Musicians","place":["Tainan, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1159\/000083259","article-title":"Botulinum toxin: mechanisms of action","volume":"53","author":"Dressler","year":"2005","journal-title":"Eur Neurol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2002.121356","article-title":"A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines","volume":"46","author":"Carruthers","year":"2002","journal-title":"J Am Acad Dermatol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.13266","article-title":"Complications of botulinum toxin and fillers: a narrative review","volume":"19","author":"Kassir","year":"2020","journal-title":"J Cosmet Dermatol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.5114\/ada.2019.82795","article-title":"The whole truth about botulinum toxin - 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