Facial Plast Surg 2022; 38(03): 250-259
DOI: 10.1055/s-0041-1736390
Original Research

Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review

1   School of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
2   Department of Otolaryngology—Head and Neck Surgery, Mass Eye and Ear, Boston, Massachusetts
,
Kelly C. McGuigan
3   School of Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania
,
4   Department of Otolarynology, Private Practice—Head and Neck Surgery, Los Angeles, California
› Author Affiliations

Abstract

Tear trough deformity is a popular target for the treatment with filler injections. The side effects are generally mild and transient. However, delayed complications may occur. We aim to perform a thorough systematic review of the published literature related to delayed complications after tear trough filler injections. A search of published literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in June 2021 and included PubMed, ScienceDirect, and Embase databases. The Medical Subject Headings (MeSH) terms used included the following terms: delayed complications, nodules, granulomas, swelling, discoloration, dermal filler, hyaluronic acid (HA), polyacrylamide, calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), eyelid, periorbital, periocular, and tear trough. Twenty-eight articles consisting of 52 individual cases were included in the final analysis. 98% (51/52) of patients were female and had an average age of 48.3 years. HA was the most reported product (71.2%, 37/52), followed by PLLA (4/52, 7.7%), and CaHA (4/52, 7.7%). The most common delayed complication with any dermal filler was swelling (42.3%, 22/52) followed by lumps or nodules (25.0%, 13/52). Xanthelasma-like reaction (17.3%, 9/52), migration (7.7%, 4/52), discoloration (3%, 3/52) also occurred. The average time of onset of any complication was 16.8 months with xanthelasma-like reaction appearing soonest (mean: 10 months) and discoloration appearing latest (mean: 52 months). Most swelling cases were caused by HA. Semi-permanent fillers such as PMMA and synthetic fillers such as PLLA were more likely to be associated with lumps and nodules than other complications. It is important that clinicians who perform tear trough augmentation with dermal fillers have a thorough understanding of the risks of the procedure to diagnose and manage them promptly as well as provide patients with accurate information regarding the potential adverse effects.



Publication History

Article published online:
19 October 2021

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  • References

  • 1 Anido J, Fernández JM, Genol I, Ribé N, Pérez Sevilla G. Recommendations for the treatment of tear trough deformity with cross-linked hyaluronic acid filler. J Cosmet Dermatol 2021; 20 (01) 6-17
  • 2 Sharad J. Dermal fillers for the treatment of tear trough deformity: a review of anatomy, treatment techniques, and their outcomes. J Cutan Aesthet Surg 2012; 5 (04) 229-238
  • 3 Aesthetic plastic surgery national databank statistics. Aesthet Surg J 2021; 41 (Suppl. 02) 1-16
  • 4 Urdiales-Gálvez F, De Cabo-Francés FM, Bové I. Ultrasound patterns of different dermal filler materials used in aesthetics. J Cosmet Dermatol 2021; 20 (05) 1541-1548
  • 5 Rohrich RJ, Bartlett EL, Dayan E. Practical approach and safety of hyaluronic acid fillers. Plast Reconstr Surg Glob Open 2019; 7 (06) e2172
  • 6 Philipp-Dormston WG, Goodman GJ, De Boulle K. et al. Global approaches to the prevention and management of delayed-onset adverse reactions with hyaluronic acid-based fillers. Plast Reconstr Surg Glob Open 2020; 8 (04) e2730
  • 7 Bhojani-Lynch T. Late-onset inflammatory response to hyaluronic acid dermal fillers. Plast Reconstr Surg Glob Open 2017; 5 (12) e1532
  • 8 Chang JR, Baharestani S, Salek SS, Piluek WJ, Eberhart CG, McCulley TJ. Delayed superficial migration of retained hyaluronic acid years following periocular injection. Ophthal Plast Reconstruct Surg 2017; 33: S116-S118
  • 9 Kopp S, Lawrence N, Donofrio L, Cox SE. Delayed migration of hyaluronic acid fillers: A new complication?. Dermatologic Surg 2014; 40 (01) 85-87
  • 10 Beleznay K, Carruthers JDA, Carruthers A, Mummert ME, Humphrey S. Delayed-onset nodules secondary to a smooth cohesive 20 mg/mL hyaluronic acid filler: cause and management. Dermatol Surg 2015; 41 (08) 929-939
  • 11 Guduk SS. An unusual delayed type reaction following periorbital filler injection with hyaluronic acid. Aesthetic Surg J 2018; 38: NP109-NP113
  • 12 Decates TS, Kruijt Spanjer EC, Saini R, Velthuis PJ, Niessen FM. Unilateral facial edema after filler injection of the lower eyelid. Dermatol Ther (Heidelb) 2020; 33 (04) e13539
  • 13 Hamed-Azzam S, Burkat C, Mukari A. et al. Filler migration to the orbit. Aesthet Surg J 2021; 41 (06) NP559-NP566
  • 14 Kim MW, Park HS, Yoon HS, Cho S. Late-onset complication of fillers: paraffinoma of the lower eyelids clinically mimicking xanthelasma. Ann Dermatol 2016; 28 (06) 753-756
  • 15 Turkmani MG, De Boulle K, Philipp-Dormston WG. Delayed hypersensitivity reaction to hyaluronic acid dermal filler following influenza-like illness. Clin Cosmet Investig Dermatol 2019; 12: 277-283
  • 16 Shome D, Doshi K, Vadera S, Kapoor R. Delayed hypersensitivity reaction to hyaluronic acid dermal filler post-COVID-19 viral infection. J Cosmet Dermatol 2021; 20 (05) 1549-1550
  • 17 Cozzani E, Rongioletti F, Santoro F, Rebora A, Parodi A. Can ultraviolet rays induce a granulomatous reaction after hyaluronic acid dermal filler injections?. Int J Dermatol 2013; 52 (11) 1432-1434
  • 18 D'Acunto C, Pazzaglia M, Raone B. et al. Xanthelasma palpebrarum: a new adverse reaction to intradermal fillers?. Br J Dermatol 2013; 168 (02) 437-439
  • 19 Ghislanzoni M, Bianchi F, Barbareschi M, Alessi E. Cutaneous granulomatous reaction to injectable hyaluronic acid gel. Br J Dermatol 2006; 154 (04) 755-758
  • 20 Mosleh R, Mukari A, Krausz J, Hartstein ME, Azzam SH. Orbit mass secondary to migration of dermal hyaluronic acid filler. JAAD Case Rep 2019; 5 (06) 488-490
  • 21 Wolkow N, Jakobiec FA, Dryja TP, Lefebvre DR. Mild complications or unusual persistence of porcine collagen and hyaluronic acid gel following periocular filler injections. Ophthal Plast Reconstr Surg 2018; 34 (05) e143-e146
  • 22 Parulan MAA, Sundar G, Lum JH, Ramachandran U. A case report on dermal filler-related periorbital granuloma formation. Orbit 2019; 38: 169-172
  • 23 Alijotas-Reig J, Garcia-Gimenez V, Miró-Mur F, Vilardell-Tarrés M. Delayed immune-mediated adverse effects related to polyacrylamide dermal fillers: clinical findings, management, and follow-up. Dermatol Surg 2009; 35: 360-366
  • 24 Ross AH, Malhotra R. Long-term orbitofacial complications of polyalkylimide 4% (bio-alcamid). Ophthal Plast Reconstr Surg 2009; 25 (05) 394-397
  • 25 Kim H, Cho SH, Lee JD, Kim HS. Delayed onset filler complication: two case reports and literature review. Dermatol Ther (Heidelb) 2017; 30 (05) DOI: 10.1111/dth.12513.
  • 26 Or L, Eviatar JA, Massry GG, Bernardini FP, Hartstein ME. Xanthelasma-like reaction to filler injection. Ophthal Plast Reconstr Surg 2017; 33 (04) 244-247
  • 27 Cecchi R, Spota A, Frati P, Muciaccia B. Migrating granulomatous chronic reaction from hyaluronic acid skin filler (Restylane): review and histopathological study with histochemical stainings. Dermatology 2014; 228 (01) 14-17
  • 28 Mustak H, Fiaschetti D, Goldberg RA. Filling the periorbital hollows with hyaluronic acid gel: long-term review of outcomes and complications. J Cosmet Dermatol 2018; 17 (04) 611-616
  • 29 Witmanowski H, Błochowiak K. Another face of dermal fillers. Postepy Dermatol Alergol 2020; 37 (05) 651-659
  • 30 Wang Y, Massry G, Holds JB. Complications of periocular dermal fillers. Facial Plast Surg Clin North Am 2021; 29 (02) 349-357
  • 31 Tursen U, Eskandari G, Kaya TI, Tamer L, Ikizoglu G, Atik U. Apolipoprotein E polymorphism and lipoprotein compositions in normolipidaemic xanthelasma patients. J Eur Acad Dermatol Venereol 2006; 20 (03) 260-263
  • 32 Fagien S, Bertucci V, von Grote E, Mashburn JH. Rheologic and physicochemical properties used to differentiate injectable hyaluronic acid filler products. Plast Reconstr Surg 2019; 143 (04) 707e-720e
  • 33 Sadeghpour M, Quatrano NA, Bonati LM, Arndt KA, Dover JS, Kaminer MS. Delayed-onset nodules to differentially crosslinked hyaluronic acids: comparative incidence and risk assessment. Dermatol Surg 2019; 45 (08) 1085-1094
  • 34 Seike M, Ikeda M, Matsumoto M, Hamada R, Takeya M, Kodama H. Hyaluronan forms complexes with low density lipoprotein while also inducing foam cell infiltration in the dermis. J Dermatol Sci 2006; 41 (03) 197-204
  • 35 Rowland-Warmann MJ. Hypersensitivity reaction to hyaluronic acid dermal filler following novel coronavirus infection—a case report. J Cosmet Dermatol 2021; 20 (05) 1557-1562
  • 36 Munavalli GG, Guthridge R, Knutsen-Larson S, Brodsky A, Matthew E, Landau M. “COVID-19/SARS-CoV-2 virus spike protein-related delayed inflammatory reaction to hyaluronic acid dermal fillers: a challenging clinical conundrum in diagnosis and treatment”. Arch Dermatol Res 2021; 1-15
  • 37 Alijotas-Reig J, Garcia-Gimenez V, Vilardell-Tarres M. Late-onset immune-mediated adverse effects after poly-L-lactic acid injection in non-HIV patients: clinical findings and long-term follow-up. Dermatology 2009; 219 (04) 303-308
  • 38 Yang JH, Lee SM, Won CH. et al. Foreign body granuloma caused by hyaluronic acid/dextranomer microsphere filler injection. Int J Dermatol 2012; 51 (12) 1517-1518
  • 39 Alsaad SM, Fabi SG, Goldman MP. Granulomatous reaction to hyaluronic acid: a case series and review of the literature. Dermatol Surg 2012; 38 (02) 271-276
  • 40 Park TH, Seo SW, Kim JK, Chang CH. Clinical experience with hyaluronic acid-filler complications. J Plast Reconstr Aesthet Surg 2011; 64 (07) 892-896
  • 41 Park TH, Seo SW, Kim JK, Chang CH. Clinical experience with polymethylmethacrylate microsphere filler complications. Aesthetic Plast Surg 2012; 36 (02) 421-426
  • 42 Teo AA, Mokhtarzadeh A, Cameron JD, Harrison AR. Late presentation of enlarging lower eyelid mass and muscle degeneration secondary to hyaluronic acid filler. Ophthal Plast Reconstr Surg 2017; 33 (3S, suppl 1): S9-S11
  • 43 Iverson SM, Patel RM. Dermal filler-associated malar edema: treatment of a persistent adverse effect. Orbit (London) 2017; 36 (06) 473-475