The Rise and Fall of the Pale Puffy Lower Eyelid Pillow

Area of Science:

• Dermatology
• Aesthetic Medicine
• Cosmetic Procedures

Background:

• Delayed complications from hyaluronic acid (HA) fillers can cause significant patient distress.
• The "pale puffy pillow" is an exaggerated presentation of a known late complication of HA fillers.
• This condition is frequently misdiagnosed as festoons, leading to inappropriate management.

Purpose of the Study:

• To describe an exaggerated clinical presentation of a late complication of hyaluronic acid fillers.
• To highlight the misdiagnosis of this complication as festoons.
• To present a simple and effective treatment strategy.

Main Methods:

• A case series approach was used to document the clinical presentation.
• Treatment involved the administration of hyaluronidase.
• Ablative fractional carbon dioxide (CO2) laser resurfacing was employed for residual skin laxity.

Main Results:

• The study identified and described the "pale puffy pillow" presentation.
• Correction with hyaluronidase was found to be straightforward.
• Fractional CO2 laser resurfacing effectively addressed residual skin laxity post-hyaluronidase treatment.

Conclusions:

• The "pale puffy pillow" is a distinct, albeit exaggerated, complication of hyaluronic acid fillers.
• Prompt recognition and treatment with hyaluronidase are crucial.
• Fractional CO2 laser resurfacing offers a viable solution for persistent skin laxity.