Migrated periocular filler masquerading as arteriovenous malformation: a diagnostic and therapeutic dilemma

Migration of dermal filler is a rare complication in the periocular area. We describe a case that highlights the diagnostic and therapeutic dilemmas posed. A patient presented with a bluish swelling involving the left brow, temple, and glabella. It was ill-defined, mobile, and nontender. An MRI suggested a vascular malformation, while an ultrasound suggested a dermoid. On further questioning, the patient revealed having a permanent polyalkylimide filler injected to the glabella 10 years ago. This raised the possibility of delayed migration. The eyebrow, temple, and glabella were explored through a skin-crease incision. Transparent gel was expressed and cicatrized granulomas were excised. The patient made an excellent recovery through an inconspicuous incision. This case emphasizes the importance of taking a detailed history and revisiting the diagnosis, if necessary. We describe a relatively scar-free approach to remove widely distributed migrated fillers. Clinical and radiologic features of migrated filler can mimic tumor.