Lower Blepharoplasty in Eyelids Previously Injected With Hyaluronic Acid Gel Filler

Abstract

As under-eye filler injection has become widespread, it is important to understand possible differences and outcome of lower blepharoplasty in these patients. Herein, we describe our experience to address under-eye fat prolapse (via lower blepharoplasty) in patients with “residual fullness” after previous eyelid hyaluronic acid gel injections. Retrospective analysis of patients undergoing (transconjunctival) lower blepharoplasty (with fat repositioning) by one surgeon in eyelids previously injected with hyaluronic acid gel (+/− hyaluronidase), with “residual fullness.” Minimum follow-up time was 6 months. Preoperative and postoperative photographs at longest follow-up visit were evaluated by blind observers. Patient satisfaction was recorded using questionnaire. Surgical anatomy was observed. Total of 15 patients (28 eyelids; 13 females, 2 males) underwent lower blepharoplasty in eyelids previously injected with hyaluronic acid gel (latter to treat under-eye hollowness [tear trough deformity] and/or to camouflage under-eye fat prolapse [“bags”]). All patients had at least one prior hyaluronic acid gel injection with “residual fullness.” Ten patients had also received at least 1 previous hyaluronidase injection. Mean age was 47 years (range, 28-68 years). The surgical anatomy was slightly to moderately distorted with soft tissues (orbital fat, sub-orbicularis oculi fat, orbicularis oculi muscle) being more “spongy” with less clear delineation of surgical landmarks, septa, and fat pads. All patients reported satisfaction with surgical outcome, with no complications or reoperations. Three patients received “touch-up” filler injections. “Revision” lower blepharoplasty can be done safely and effectively to address “residual fullness” in eyelid previously injected with hyaluronic acid gel (+/− hyaluronidase).