Post-Hyaluronic Acid Recurrent Eyelid Edema: Pathophysiologic Mechanisms and a Proposed Treatment Protocol
Aesthetic Surgery Journal. Open Forum
|June 3, 2024
Summary
Serial hyaluronidase and microneedling effectively treated post-hyaluronic acid recurrent eyelid edema (PHAREE). This combination therapy offers a promising solution for PHAREE, with most patients experiencing symptom resolution without recurrence.
Area of Science:
- Dermatology
- Aesthetic Medicine
- Ophthalmology
Background:
- Facial augmentation with hyaluronic acid (HA) fillers is common.
- Post-hyaluronic acid recurrent eyelid edema (PHAREE) is a potential complication.
- The underlying pathophysiology of PHAREE remains unclear.
Observation:
- A novel treatment protocol involving serial hyaluronidase injections and fractionated radiofrequency microneedling was implemented.
- Carbon dioxide laser skin resurfacing was used in select cases.
- Five patients diagnosed with PHAREE were included in the study, with a minimum follow-up of 24 months.
Findings:
- All five patients achieved resolution of PHAREE symptoms.
- No adverse effects or recurrence of PHAREE were reported.
- One patient experienced complete resolution after a single treatment session, while four patients required a series of treatments.
Implications:
- This combined treatment approach may offer superior outcomes compared to hyaluronidase monotherapy for PHAREE.
- Factors such as the malar septum, eyelid lymphatic vulnerability, and HA fragment immunogenicity are hypothesized to contribute to PHAREE.
- Further investigation into the pathophysiologic mechanisms of PHAREE is recommended.
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