Periorbital Edema following Hyaluronic Acid Gel Injection: A Retrospective Review

Introduction: The purpose of this study is to investigate the incidence, clinical features, and treatment of prolonged periorbital edema following the injection of hyaluronic acid gel to the infraorbital hollows. Materials and Methods: Retrospective descriptive study. The medical records of patients from 4 physician practices with prolonged (≥1 month) periorbital edema following the placement of hyaluronic acid gel to the infraorbital hollows, diagnosed between January 1, 2008 and December 31, 2011, were reviewed. Results: A total of 51 charts were reviewed, of which 12 (24%) patients were diagnosed with prolonged periorbital edema with a mean follow-up time of 7.1 ± 4.2 months (range, 1.5–15.3 months). The mean patient age was 50.4 years (range, 36.4–64.9 years), and the edema lasted an average of 5.4 months (range, 2.7–5.3 months). A minority of patients had a preprocedural history of fluid retention (17%), seasonal allergies (25%), previous lower eyelid or midface surgery (25%), or festoons on examination (0%). Hyaluronidase was used to treat 3 of the 12 affected patients. Conclusions: In this retrospective review of patients undergoing hyaluronic acid gel injection to the periorbital region, prolonged periorbital edema of varying severity occurred in approximately 1 in 4 patients. There were no clinical symptoms or signs prior to injection that consistently identified patients susceptible to the edema. Most patients treated with hyaluronidase had successful improvement of their swelling.