Single-Session High-Dose Hyaluronidase for Managing Periorbital Hyaluronic Acid Filler Complications

Periorbital complications from hyaluronic acid (HA) fillers are common due to the region's unique anatomy. Hyaluronidase is widely used for management, but dosing remains empirical with no standardized protocol. This study aimed to assess the safety and efficacy of a high-dose, single-session hyaluronidase approach for treating such complications.

A retrospective study was conducted on 54 patients presenting with periorbital HA-related complications between August 2020 and May 2024. Four main types of complications were identified: persistent edema, tear trough bulging, under-correction, and subcutaneous nodules. The average interval from the first HA injection to presentation was 25.8 months (range 1.5-72 months). Injection points were determined through visual inspection and palpation, marked at the most prominent areas, and spaced approximately 7-10 mm apart. A vertical bolus injection technique was used to administer 30-90 IU (0.1-0.3 mL) of hyaluronidase per point, totaling 150-600 IU per lower eyelid.

The mean follow-up was 52.9 days (range 14-474 days). All patients responded successfully to one session of high-dose hyaluronidase. The mean dose per lower eyelid was 350.3 IU. No cases required retreatment. Nineteen patients (35.2%) achieved satisfactory outcomes without further intervention, while the remaining 35 (64.8%) underwent subsequent lower eyelid blepharoplasty.

High-dose, single-session hyaluronidase injection is a safe, effective, and efficient approach for treating a broad range of HA-related periorbital complications, even in complex cases involving multiple previous treatments or long filler retention time.

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