Complications of Periorbital Cosmetic Hyaluronic Acid Filler Injections: A Major Review

Hyaluronic acid (HA) filler injection is one of the most common methods for managing signs of aging in the periorbital area and is considered a safe and reversible procedure. The purpose of this review was to perform a comprehensive analysis of the incidence, risk factors, pathophysiology, signs and symptoms, and treatment methods of complications related to cosmetic periocular HA filler injections, as well as review hyaluronidase indications, appropriate dosage, and safety measures. Complications were classified as immediate injection-related reactions (erythema, early edema, bruising/hematoma), early complications (loss of vision, acute infection, early contour irregularities, persistent edema), late complications (late edema, late contour irregularities), blue discoloration, xanthelasma palpebrarum, and filler in the orbit. Prospective and retrospective studies as well as case reports were reviewed. Immediate injection-related reactions such as erythema, edema, and bruising/hematoma were the most reported complications, followed by early contour irregularities and blue discoloration. Persistent and late edema and late contour irregularities were reported less frequently. These were mainly minor complications that were reversible through conservative management or hyaluronidase injection. Filler-related loss of vision, xanthelasma palpebrarum, and filler in the orbit were infrequent but potentially serious complications that could cause patients significant distress. These were mainly reported through case reports and case series. Urgent treatment with high dose hyaluronidase is necessary for successful management of injection-related vision loss. Physicians must have a thorough knowledge of orbital anatomy, the signs and symptoms of complications, and how to avoid them, and must be equipped to intervene immediately if necessary.