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Zein et al. Plast Aesthet Res 2020;7:44 Plastic and
DOI: 10.20517/2347-9264.2020.133 Aesthetic Research

Review Open Access

Complications after cosmetic periocular filler:
prevention and management

Mike Zein , Ryan Tie-Shue , Nathan Pirakitikulr , Wendy W. Lee 3
1
2
3
1 Mcknight Vision Research Center, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL
33136, USA.
2 Department of Biomedical Research, Yale University, New Haven, CT 06520, USA.
3 Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute,
University of Miami-Miller School of Medicine, Miami, FL 33136, USA.
Correspondence to: Dr. Wendy W. Lee, Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology,
Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, 900 NW 17th St, Miami, FL 33136, USA.
E-mail: wlee@med.miami.edu
How to cite this article: Zein M, Tie-Shue R, Pirakitikulr N, Lee WW. Complications after cosmetic periocular filler: prevention
and management. Plast Aesthet Res 2020;7:44. http://dx.doi.org/10.20517/2347-9264.2020.133
Received: 10 Jun 2020 First Decision: 30 Jun 2020 Revised: 8 Jul 2020 Accepted: 15 Jul 2020 Published: 15 Aug 2020

Academic Editor: Wen-Guo Cui Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Soft tissue fillers are a mainstay in contemporary, minimally invasive facial rejuvenation procedures owing to
timely results and minimal recovery period. Although associated with a low complication rate, soft tissue fillers
are not without risk. Complications range from mild superficial skin irregularities to granuloma formation to
vascular occlusion leading to skin necrosis or even blindness. Fillers vary in composition, elasticity, hydrophilicity
and duration of effect that is tailored to specific cosmetic indications. Selecting the right product for the desired
effect can cut down on unwanted outcomes. Severe adverse events can be avoided with safe injection technique,
early recognition of symptoms and a thorough knowledge of the local anatomy. This review outlines several
complications all providers should recognize and discusses strategies for their prevention and management.

Keywords: Fillers, hyaluronic acid, rejuvenation, periorbital, aesthetic, skin necrosis, complications, blindness

INTRODUCTION
Soft tissue fillers have become an increasingly popular intervention for facial rejuvenation over the past two
decades with quick results, minimal recovery time and relatively low complication rate. Since their approval

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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