Restylane persisting in lower eyelids for 5 years

Abstract

The authors report the case of a 58-year-old woman presenting with "puffiness" in her lower eyelids persisting for approximately 5 years. While dark, puffy eyelid circles following hyaluronic acid placement periorbitally are not uncommon, what is so unusual in our case is that it was noted 5 years after treatment with Restylane. It has been our experience that hyaluronic acid within periorbital tissues can result in a negative cosmetic outcome that can persist for years after the treatment.

Filling the periorbital hollows with hyaluronic acid gel: Long‐term review of outcomes and complications

“…It is unclear why contour irregularities would only occur later as opposed to immediately following the injection. One possible explanation is late capsular contraction which occurs with HAG with a higher resistance of deformation such as Restylane-L. 3,10 HAG has been shown to support microbial growth, and another possible cause for contour irregularities is possible biofilm development with a resultant chronic granulomatous type reaction. 11,12 An identified risk factor for biofilm development is multiple passes through the skin and where possible this should be avoided.…”

“…The phenomenon of retained HAG several years after injection has been previously reported. 10 The prolonged retention beyond the manufacturer claim has been attributed to the high deformation characteristic of the cross-linked HAG fillers. 10 Several patients in this study were noted to have retained effect of filler more than 5 years postinjection, with one case even noted at the 10-year follow-up, while others had lost effect at the 6-month visit.…”

“…10 The prolonged retention beyond the manufacturer claim has been attributed to the high deformation characteristic of the cross-linked HAG fillers. 10 Several patients in this study were noted to have retained effect of filler more than 5 years postinjection, with one case even noted at the 10-year follow-up, while others had lost effect at the 6-month visit. Many different combinations of HAG filler exist, and the effect profile may be related to the degree of cross-linkage as well as the molecular weight of the HAG filler used.…”

Hyaluronidase Caveats in Treating Filler Complications

“…1,6,42,43 If active infection is suspected, hyaluronidase should be injected after initiating appropriate antibiotic treatment; otherwise, the enzyme can facilitate spreading of the infection to surrounding areas. 7,20 In case of unintentional intravascular injection or vascular compression by HA, the product has to be dissolved quickly.…”

Histopathological study of experimental intrapalpebral injection of hyaluronic acid gel

“…Это позволило предположить наличие некоторых морфологических особенностей при интрапальпебральном его введении. В литературе были описаны случаи длительного сохранения препарата ГГК в периорбитальной области, однако в них отсутствовали данные гистологического исследования [12][13][14]. На основе анализа литературных данных и результатов проведенных нами морфологических исследований можно констатировать значительное сходство структур век кролика и человека, в связи с чем проведение данного исследования на модели кролика представляется обоснованным [15][16][17].…”