Late-Onset Upper Eyelid and Brow Edema as a Long-Term Complication of Hyaluronic Acid Filler Injection

Abstract

Background Late-onset upper eyelid edema is an uncommonly recognized complication of hyaluronic acid (HA)-based filler injection to the supraorbital area. Objectives The authors sought to report their experience in diagnosing and managing late-onset upper eyelid edema. Methods This was a noncomparative, retrospective study of a series of 17 consecutive patients who presented with upper eyelid edema 6 to 24 months after uneventful HA filler injection in the supraorbital area. Results The study group included 17 female patients. The average time of presentation was 13.9 months. Thirteen patients (76.4%) were satisfied after hyaluronidase and requested no further treatment (observation only); 4 patients (23.5%) elected to receive HA filler re-treatment, with satisfactory results. All patients were followed-up for at least 6 months after the re-treatment. Conclusions The incidence of late-onset upper eyelid edema is likely to increase as the number of patients undergoing HA filler injection to the supraorbital area increases. Our study emphasizes the importance of recognizing this condition and suggests a suitable noninvasive treatment with satisfying results for both the patient and the physician. Level of Evidence: 4

Comparing Water Absorption of Food and Drug Administration–Approved Hyaluronic Acid Fillers

“…Blepharoplasty surgeons should be aware that chronic edema can occur because of long-term filler retention along the periocular area and should be evaluated. 1,[4][5][6][7][8][9] In some cases, costly work-ups with CT, MRI, and biopsy for pathology have been prompted by the sequelae from this long-term retention of filler 9 years after injection. 6 Hyaluronic acid filler in the eyelids and midface has been successfully dissolved with hyaluronidase up to 9 years after the original injection.…”

“…6 Hyaluronic acid filler in the eyelids and midface has been successfully dissolved with hyaluronidase up to 9 years after the original injection. 1,[4][5][6][7][8][9] Understanding which HA fillers are more prone to volume expansion, and which are more prone to delayed edema over time, is important for injectors to recognize.…”

“…It is important to recognize that choosing fillers that have less absorption of water is not a guarantee that the area will not have edema, which requires dissolution with hyaluronidase in the future. 1,[4][5][6][7][8][9] Even fillers shown here with low water absorption can swell over time in some patients, especially along orbital rims when given a substantial volume and enough time (illustrated in Figures 3 and 4). In Europe, the short chain (SPHAL) NASHA is used for dermal enhancement over the cheeks with micro boluses termed skin boosters.…”

“…Delayed edema with Tyndall effect is a specific event limited exclusively to the periorbital area, indicated by that lined by the orbicularis oculi muscle, including the upper lid/ brow region as recently demonstrated. 9 It is all the more difficult to reproduce the in vitro results with the specific anatomy of this unique zone of risk. However, trying to elucidate the different rheologic features of fillers in rapport to this potential long-term complication should be strongly encouraged, as given the exponential increase of HA injections in the periocular region and the long-time presentation of the dysmorphism to the eyelid, negatively affecting their safety and in turn patients demand.…”

A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions

“…Similarly, no evidence was found, in a form of RCTs, clinical trials, and retrospective case-control studies, on the management of over-corrections, inflammatory nodules, or tissue ischemia/necrosis associated with aesthetic HA filler injections; the available evidence was mainly retrospective case reports or case series. We have also listed the summary of 11 excluded studies [10,14,16,[56][57][58][59][60][61][62][63] in table 5. They were retrospective case series, with 5 cases or more, reporting on the use of hyaluronidase for managing aesthetic complications associated with aesthetic HA filler injection.…”