The Treatment of Cosmetic Lower Eyelid Adverse Events After Injection of Hyaluronic Acid Gel Fillers

Abstract Background Non-surgical “blepharoplasty” and has been considered as an un-met need particularly for the large potential population of patients that are not interested or ready for surgery and is generally performed by all providers who offer injectable agents in their practice. While favorable outcomes can be achieved in most areas of the face, the lower eyelid has shown to be less forgiving and a source of overwhelming unsatisfactory outcomes. While providers often disclose to their patients that undesirable cosmetic adverse events can reversed with the injection of hyaluronidase, a larger experience has suggested that this application is not always successful. Objectives The author describes an algorithm for resolution of refractory adverse events using a combination of intra-operative, high-dose, hyaluronidase combined with lower blepharoplasty. Methods From June 2016 to present, 70 consecutive patients, 65 females and 5 males, with ages ranging from 31 to 76 years presented with unsatisfactory results after injection of a hyaluronic acid product performed elsewhere where treated with lower blepharoplasty in conjunction with intra-operative “high-dose” trans-conjunctival hyaluronidase injections. Results All patients showed significant but varied improvement after this treatment when, in most situations, in-office, per-cutaneous injection of hyaluronidase was insufficient Conclusions The combination of intra-operative injection of high-dose hyaluronidase and (upper and/or) lower blepharoplasty can lead to satisfactory outcomes in patients with chronic lower eyelid edema after hyaluronic acid gel injections to the lower eyelid that have been refractory to other treatments.