Navigating Lower Eyelid Blepharoplasty in Patients with Undereye Filler: Challenges, Complications, and Recommendations

The clinical course of patients with a history of hyaluronic acid (HA) filler injections undergoing lower eyelid blepharoplasty, including preoperative, intraoperative, and postoperative effects of HA filler is reported.

A retrospective case series was conducted involving patients with a history of HA filler injections to the lower eyelid/tear trough or cheek who subsequently underwent lower blepharoplasty surgery. Data collected included demographic information, aesthetic history, and preoperative features. Intraoperative findings and the postoperative course were documented, as was the requirement for additional treatments.

Fifty cases were assessed, of which 48 met inclusion criteria. Seventeen had a history of filler injection more than 3 years before presentation (35.4%), and 15 (31.3%) were unable to recall the timeframe of filler injection. The majority (83.3%) showed evidence of 1 or more filler-associated adverse effects. In preparation for lower blepharoplasty, additional perioperative treatments were often indicated, most commonly hyaluronidase for dissolution of filler. A subset of patients experienced prolonged postoperative edema (43.8%), requiring further intervention and follow-up.

Individuals receiving HA filler to the eyelids and cheeks may in time seek eyelid surgery many years later. Eyelid surgeons should therefore be prepared to recognize and deal with HA filler-related issues in all individuals seeking eyelid surgery. The presence of HA filler in this region can significantly influence outcomes of lower blepharoplasty surgery, both intraoperatively and postoperatively. Early identification and anticipation of these issues, with preoperative counseling to avoid unrealistic expectations, is required.