Delayed Superficial Migration of Retained Hyaluronic Acid Years Following Periocular Injection

Abstract

Cosmetic injection of hyaluronic acid (HA) and other fillers is increasingly common, and the late complications of these relatively new procedures are now coming to medical attention. Three patients with delayed periocular swelling that began years after injection of HA are described, with CT, MRI, and histopathologic characterization. While HA fillers are marketed as having a temporary effect of several months, the authors demonstrate that they may persist in the body for up to 9 years. Unlike most previous reports, there was no inflammatory reaction or encapsulation, simply infiltration into more superficial subcutaneous layers. All cases improved after surgical biopsy and hyaluronidase injections. Delayed periocular swelling after filler injections from several years prior can mimic serious medical conditions. With a detailed history and high index of suspicion, one may avoid a costly and invasive workup.

An unexpected cause of bilateral periorbital oedema

“…While many complications of soft tissue augmentation appear immediately or occur shortly afterwards and are easily linked to the procedure, the occurrence of delayed filler migration poses a diagnostic challenge. There are several recent case reports of delayed filler migration presenting as discrete facial masses or periorbital oedema . Some of these patients undergo extensive evaluations prior to uncovering the underlying aetiology, as did ours …”

“…There are several recent case reports of delayed filler migration presenting as discrete facial masses or periorbital oedema . Some of these patients undergo extensive evaluations prior to uncovering the underlying aetiology, as did ours …”

“…Patients seeing a new provider may be reluctant to share a history of these procedures, and if separated by several years, will probably not connect these events. Therefore, ascertaining a history of filler injection may prevent both an extensive medical investigation and potentially unnecessary invasive procedures, as simple administration of hyaluronidase with or without adjunctive surgical debulking has been successfully used in instances of HA migration …”

“…There are several recent case reports of delayed filler migration presenting as discrete facial masses or periorbital oedema. [2][3][4][5] Some of these patients undergo extensive evaluations prior to uncovering the underlying aetiology, as did ours. [2][3][4] In a recent article, Jordan and Stoica proposed several mechanisms for the phenomenon of filler migration, as well as strategies to prevent them.…”

Chronic eyelid edema and xerophthalmia secondary to periorbital hyaluronic acid filler injection

“…Etiologies remain unclear; however, the rapid amelioration of symptoms upon administration of Hyaluronidase suggests that the edema is associated with the use of HA dermal fillers. Although the effects of HA should only persist for a duration between 6 and 18 months, these findings suggest that HA may persist in the body for several years and has the potential to migrate to other sites, causing infiltration into more superficial subcutaneous layers of the face …”