Managing Periocular Filler-Related Syndrome Prior to Lower Blepharoplasty

Area of Science:

• Ophthalmology
• Plastic Surgery
• Dermatology

Background:

• Hyaluronic acid (HA) fillers are widely used for periocular rejuvenation.
• Potential HA filler complications include visibility, contour abnormalities, malar edema, and blue-gray dyschromia.
• Effective management of these issues is crucial before further aesthetic procedures.

Purpose of the Study:

• To describe the clinical course of patients with periocular HA filler complications.
• To evaluate the outcomes of managing these complications with hyaluronidase and lower eyelid blepharoplasty.

Main Methods:

• HA fillers were dissolved using hyaluronidase (15-30 U/cm²).
• Visible lower eyelid fat prolapse post-filler removal was addressed with transconjunctival blepharoplasty, including fat repositioning and skin resurfacing.
• Complications and outcomes were systematically assessed.

Main Results:

• Twenty-three patients (46 eyelids) were treated for issues including contour abnormalities, malar edema, and blue-gray dyschromia.
• One or two sessions of hyaluronidase were effective in dissolving HA filler, though mild persistent edema occurred in some cases.
• Post-blepharoplasty, 82.6% of patients had acceptable outcomes with no complications; prolonged edema resolved in most cases over time.

Conclusions:

• Periocular HA filler complications necessitate identification and management before subsequent interventions.
• Hyaluronidase effectively dissolves HA fillers, but persistent mild malar edema is possible.
• Subsequent blepharoplasty yields acceptable outcomes, emphasizing the need for thorough patient counseling regarding expectations and limitations.