The Possible Long-Term Unwanted Effects of Injectable Fillers Around the Eyes

Before and 6 months after upper and lower Blepharoplasty by Dr Hodgkinson

Have you had non-permanent injectable fillers around your eyes and been told that the injectables would resorb in 6-12 months?  Recent studies have shown that whilst there might be some resorption of the fillers that they can still be present and cause side effects up to 10 or more years later.

An article from the prestigious Aesthetic Surgery Journal in February of this year (penned by plastic surgeons, oculoplastic surgeons & dermatologists from Australia, Italy, Israel, Brazil and Puerto Rico) noted that delayed chronic swelling of the lower lids due to previous injectable fillers was not only common but could develop or recur for years after the initial injection of fillers. *  The subjects in their study had late onset oedema ranging from 1-10 years after initial treatment to the lower eyelids with temporary injectable fillers.  Permanent injectable fillers are problematic in many ways (not to be discussed in this blog) but “temporary” injectable fillers it turns out are also not without their issues, especially if injected around the eyes.  Temporary injectable fillers are made from hyaluronic acid.  Hyalunronic acid is a naturally occurring substance in the body that has been touted for keeping skin moist, joints lubricated and more.  It is most commonly found in our skin, connective tissue and eyes, and whilst it has a history of thirty plus years as a hypoallergenic cosmetic injectable filler for lips and lines post-ceding collagen, it is around the eyes where it is found to have potential long lasting issues.

The article noted the swelling (known in clinical terms as “oedema”) is very difficult to treat and requires injections of hyaluronidase, an enzyme that breaks down the hyaluronic acid in the filler, to try and remove/reverse the effect of the injectables.  The patients in the study showed improvement after the hyaluronidase injections but the question remains as to whether or not the initial treatment with injectables to the lower eyelids given the risks was appropriate.

Many patients who are having injectable treatments to their lower eyelids may benefit best by a surgical blepharoplasty (eyelid surgery) but may have been convinced to try injections as a first and non-invasive step to correct their blepharocholasis (sagging or bagging eyelids) or hollows.  Sadly, for some, the subsequent swelling secondary to the injections can render them with unwanted persistent oedema making them look worse than before their “non-invasive” treatment and with the ongoing concern of developing or redeveloping persistently puffy & swollen lower eye bags.

Whilst injectable fillers have their place in cosmetic medicine, their use for “tear troughs” and around the eyes has long been controversial with varying success and sometimes devastating consequences including blindness due to vascular embolism.

Be very wary if you have concerns about the appearance of your lower lids and seek an expert’s opinion as to whether or not you are a candidate for surgery and what the long term effects and risks of a temporary fix like injectables around the eyes actually are.  Most of all, do not allow anyone who is not a highly trained medical specialist to inject anything near or around your eyes.  The complex anatomy of this area is not something to take lightly if you value your long-term appearance and sight.

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*Associazione Italiana Chirurgia Plastica Estetica: Skippen B, Baldelli I, Hartstein M, Casabone G, Montes JR & Bernardini F; “Rehabilitation of the Dysmorphic Lower Eyelid From Hyaluronic Acid Filler: What to Do After a Good Pericocular Treatment Goes Bad”, Aesthetic Surgery Journal (2020) 40(2):197-205


About Dr Darryl Hodgkinson

Dr. Darryl J. Hodgkinson is recognized world-wide as an expert in cosmetic plastic surgery with more than thirty years of experience in both cosmetic and plastic/reconstructive surgery.

Dr. Hodgkinson did his plastic surgical training at the prestigious Mayo Clinic in the United States and is amongst an elite group of a very few surgeons to hold two degrees in plastic surgery from American Board of Plastic and Reconstructive Surgeons and the Royal College of Surgeons, Canada.

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