How to manage Periorbital swelling after Dermal Fillers Treatment

One of the most common complications that follow the aesthetic procedures performed in the lid area is lower eyelid edema. It can also result following the dermal fillers treatment. Peri-orbital swelling can be caused following

How to manage Periorbital swelling after Dermal Fillers Treatment

One of the most common complications that follow the aesthetic procedures performed in the lid area is lower eyelid edema. It can also result following the dermal fillers treatment. Peri-orbital swelling can be caused following the upper face dermal fillers treatment with hyaluronic acid filler. It has been reported to be linked with the various fillers. The swelling in the lower eye-lid can occur due to the migration of the filler from the malar region. Some patients reported the peri-orbital swelling and diplopia following the fillers treatment with hyaluronic acid based dermal fillers. In some others, even a little amount of dermal filler can lead to constant peri-orbital or malar edema which may last longer than effects of the filler, itself.

Note: oedema/swelling arising hours after treatment can be improved with the use of anti-histamines & anti-inflammatories.

That usually occurs when the injector does not have complete and in-depth understanding of the facial anatomy in areas where he is injecting the fillers. It should be injected deeper into the malar area to avoid this complication.

A study was conducted in which diplopia and lower eye-lid swelling was treated with injection of hyaluronidase (source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063423/).  It is an enzyme which metabolizes hyaluronic acid. It has been found that the cross linked hyaluronic acids are vulnerable to hydrolysis process caused by injection of hyaluronidase. Most of the hyaluronidase has ovine(Vitrase®, Bausch&Lomb, Rochester) or bovine (e.g. Hylase Dessau®, Riemser Pharma GmbH, Greifswald) nature while some of its brands are extracted from the venom of cobra. So before using, it is better to conduct a skin test for checking any possibility of allergic reactions.

The brand of hyaluronidase that is commonly used in UK is Hyalase (Wockhardt UK Ltd). It is available in 1500 unit ampoule and is a prescription only drug.  A study has been conducted on 14 patients to test the efficacy of hyaluronidase in resolving peri-orbital oedema that is associated with the dermal fillers treatment. The results showed that it quickly resolved the swelling of eyelid following single treatment (source: S Hilton, H Schrumpf, BA Buhren, E Bölke, PA Gerber,  ‘Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients’.European Journal of Medical Research, (2014) 19(1):30). There were no adverse effects of the treatment and the swelling permanently subsided in the patients who had dermal fillers associated swelling.

How hyaluronidase works?

Hyaluronidase lowers the viscosity of hyaluronan and thereby increasing tissue permeability; it is commonly mixed in tumescent anaesthesia during liposuction. It has also been recommended for treating some adverse reactions to the Hyaluronic acid fillers as its enzymatic activity degrades hyaluronic acid; innate & exogenous. The results of another review study conducted by Berthold Rzany and colleagues, suggested that the treatment with hyaluronidase is safe and effective (source: http://www.laserepilation.ch/files/5113/6386/6556/Hyaluronidase-in-the-correction-of-hyaluronic-acid-based-llers.pdf). By injecting almost 20 units of hyaluronidase peri-orbital swelling or malar edema can be quickly resolved caused as a result of hyaluronic acid filler treatments.

To reconstitute hyalase.

The hyaluronidase is reconstituted with normal saline and is injected slowly right into the center of dermal filler product that is to be removed. It should be reviewed after 24 hours to see the final effects.

There has been considerable evidence and clinical studies which support that the use of hyaluronidase in treating the peri-orbital swelling and malar edema is effective and helps in completely resolving the problem without any further complications.

I graduated from the Royal College of Surgeons Medical School in Ireland, am a full member of the British Association of Cosmetic Doctors and lead the in-house training at CosmeDocs clinics. I specialise in a variety of minimally invasive cosmetic treatments, like Botox for cosmetic / medical use, dermal fillers & PDO Threads for anti-ageing & facial contouring. I enjoy reading extensively on cosmetic skin treatments related to photo-ageing, as well as formulations of ingredients useful in these treatments. I also provide training to aspiring cosmetic physicians in advanced cosmetic treatments at the Harley Street Institute.

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