Late-onset periorbital edema in patients with a history of facial hyaluronic acid injection: A review on diagnosis and management

Background: Hyaluronic acid (HA) injections for soft tissue augmentation, particularly in the facial area, have become increasingly popular. Nevertheless, a growing number of reports indicate complications associated with this procedure, posing challenges for practitioners. One commonly encountered complication is periorbital edema. Objective: To review the existing literature on late-onset periorbital edema following HA injections, focusing on clinical presentation, proposed mechanisms, risk factors, diagnostics, and management strategies. Methods: A literature search was conducted to find articles describing findings on malar edema and eyelid edema following HA injections. The gathered data were categorized and juxtaposed to provide a clearer understanding of this phenomenon. Results: Incidence rates of periorbital edema post-HA injection vary, with delayed onset occurring weeks to years later. The manifestation involves diffuse edema in the eyelids and malar area, sometimes worsened by trigger factors like infections. Pathophysiology discussions distinguish between inflammatory and non-inflammatory causes, highlighting lymphatic and venous flow disturbances. Risk factors include filler characteristics, injection depth, and patient predispositions. Proper patient evaluation using ultrasonography aids in treatment planning, which could involve corticosteroids, hyaluronidase for HA removal, and subsequent cosmetic procedures like radiofrequency (RF) microneedling. Surgical interventions should be considered after HA dissolution, especially in cases requiring lower blepharoplasty. Conclusion: Late periorbital edema post-facial HA injections, once rare, is now frequently seen. Understanding and addressing this complication is essential for optimizing patient care and outcomes in clinical practice. Treatment typically involves adjusting hyaluronidase dosage for HA removal. Additional procedures like blepharoplasty, RF needling, or filler reinjection may enhance post-treatment appearance.