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Farber et al. Plast Aesthet Res 2020;7:72 I http://dx.doi.org/10.20517/2347-9264.2020.152 Page 21 of 28

Figure 18. Tear trough filler injection strategies. Various strategies for using filler to correct the tear trough deformity are shown
including injection along the tear trough and along the infraorbital rim (top) and within the volume defect in the midcheek (bottom)

Figure 19. Nasolabial fold filler injection. The directions and pattern of injection for correcting nasolabial fold

Mild adverse events following filler injection include bruising, edema, and erythema that are self-limiting.
A herpes flare is a more concerning reaction, which highlights the importance of thorough preoperative
history taking to determine the need for pre- and postprocedural prophylaxis. Nodules may form if too
much filler is injected in one area or if highly cross-linked fillers are placed too superficially. A trial of
massage can be initiated followed by dissolution of the nodule with hyaluronidase (20 units of enzyme for
every 0.1 mL of filler). Most of the dissolution should occur within a few minutes of injection. Vascular