Unilateral facial edema after filler injection of the lower eyelid

Tom S Decates,Frank M Niessen,Peter J Velthuis,Renu Saini,Elmer C Kruijt Spanjer

doi:10.1111/dth.13539

Abstract

The use of hyaluronic acid (HA) gel fillers for rejuvenation of the face has been increasing in popularity over the years. This nonsurgical, temporary technique is commonly used in the periocular region to restore volume. The aim of this study was creating awareness in the potential causes of edema after hyaluronic acid gel filler injections under the eyes. A 32‐year‐old woman presented for a cosmetic consultation to address unilateral swelling of the left check. She states she had an HA filler injected in the tear trough on both sides. Extensive evaluation and ultrasound were performed by physicians of different specialties. Intra‐oral and radiological examination revealed a tooth‐related cause known as apical periodontitis. Removal of this tooth resulted in complete resolution of the patient's presenting symptoms. Familiarity with all the potential causes of adverse events after injections with hyaluronic acid gel fillers accelerates the treatment and healing of the patient with complications. Reporting this case should raise awareness about possible teeth‐related complications.

Highlights

The use of hyaluronic acid gel fillers for rejuvenation of the face has been increasing in popularity over the years.[1,2]
We present an unusual case of unilateral edema, which occurred 2 weeks after placement of filler in the tear trough on both sides
When a patient visits a clinic with unilateral edema, one should consider other possible causes

Summary

Introduction

The use of hyaluronic acid gel fillers for rejuvenation of the face has been increasing in popularity over the years.[1,2] This nonsurgical technique with a temporary effect is commonly used in the periocular region to restore volume. A 32-year-old woman presented for a cosmetic consultation to address unilateral swelling of the left cheek (Figure 1A) She states she had a hyaluronic acid filler injected (Stylage S, 0,5 mL per side) in the tear trough on both sides, with a canula, 2 weeks earlier. The original injector already injected 50 units of hyaluronidase into the left tear trough, without any result Her medical history shows a purified medical silicone (PMS) treatment of the lips 10 years earlier. Ultrasound is very helpful in cases of adverse events after being injected with hyaluronic acid gel fillers.[4] With this a large hypo-echogenic area, interpreted as an abscess, was visible and there existed a hypo-echogenic tract toward the second bicuspid on the left side of the maxilla (tooth nr 25), possibly a fistula (Figure 1B).

Objectives

Findings

Conclusion