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

Background: Nonsurgical blepharoplasty has been considered as an unmet need particularly for the large potential population of patients who are not interested in or ready for surgery and is generally performed by all providers who offer injectable agents in their practice. Although 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. Although providers often disclose to their patients that undesirable cosmetic adverse events can be 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 the resolution of refractory adverse events using a combination of intraoperative, high-dose, hyaluronidase 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 they received an injection of a hyaluronic acid (HA) product elsewhere. They were treated with lower blepharoplasty in conjunction with intraoperative "high-dose" transconjunctival hyaluronidase injections. Results: All patients showed significant but varied improvement after this treatment when, in most situations, in-office, percutaneous injection of hyaluronidase was insufficient. Conclusions: The combination of intraoperative injection of high-dose hyaluronidase and (upper and/or) lower blepharoplasty can lead to satisfactory outcomes in patients with chronic lower eyelid edema after HA gel injections to the lower eyelid prove ineffective. Level of Evidence 4: