9/16/2023 0 Comments Black and bruised intro![]() ![]() Fillers to the tear trough are at higher risk for malar edema than other locations due to the proximity and superior location, where gravitational pull of edema can result malar edema. This occurs because the HA can begin to absorb more water as it slowly depolymerizes into smaller constituents. Patients may present years after treatment. Excessive volume or more elastic product in the superficial SOOF compartment can compress lymphatics and compromise drainage, leading to malar edema. The malar septum is a relatively impermeable barrier, allowing for tissue edema and hemoglobin accumulation above its cutaneous insertion. It divides the superficial orbicularis oculi fat (SOOF) into superficial and deep compartments. The malar septum is a fascial structure, which originates superiorly along the arcus marginalis of the orbital rim periosteum and inserts into the midcheek dermis inferiorly with a lateral border about 2.5 to 3 cm inferior to the lateral canthus and a medial border near the nose. ![]() Anatomically, this occurs because of the malar septum. HA fillers to the tear trough can cause malar edema in up to 11% of cases. Regardless of the mechanism, management options include makeup, dissolution via hyaluronidase, and/or gentle massage. Some physicians dispute the theory that the Tyndall effect is what causes the bluish discoloration, positing that the color occurs because the HA filler displaces veins superficially, causing the skin to appear blue. For example, Belotero Balance has a low viscosity and is less likely to produce the Tyndall effect than more viscous formulations, such as Juvederm or Restylane products. This is believed to occur due to the more homogenous intradermal distribution of less viscous fillers. Less viscous fillers are less likely to produce the Tyndall effect. Thus, if too much HA is placed too superficially, a blue-grey discoloration can occur even without lumps. ![]() The Tyndall effect states that blue light scatters to a larger degree than longer wavelengths when passing through small particles, such as HA. Occasionally, HA filler can result in a bluish discoloration of the skin due to the Tyndall effect. ![]() Management is with firm massage to spread the HA or to inject hyaluronidase in order to dissolve the HA. This can be especially noticeable in superficial areas, as well as over bone with thin overlaying skin. This may occur if the injector places higher amounts pressure onto the syringe, which can occur when using a “sticky” syringe. These can result from larger boluses of filler. Regardless, despite the extreme dilution, this controversial idea can still be dangerous if use of the homeopathic substance slows the patient from obtaining true medical care or if the ingredients in the bottle are either not diluted properly or packaged with other toxic ingredients.Īnother undesirable event that can arise are lumps and nodules. For example, arnica is actually a toxic herb. In short, this is because the nature of homeopathy depends on two illogical concepts: (1) that the “drug” being sold is actually so dilute that it is not actually present in the treatment container and (2) the ingredient being sold has an action that is opposite to the one desired. Of note, homeopathic arnica has been suggested to expedite healing from bruising, but this is not recommended. Another possible method that has been suggested to reduce likelihood of hematoma formation is stopping antithrombotic agents, such as NSAIDs and antiplatelet medications, however, this controversial due to the inherent risk of embolism or thrombosis. On noticing bleeding from injection, direct pressure can reduce hematoma size. It can also sometimes be delayed due to external stretch from swelling secondary to the highly hygroscopic nature of HA. Bruising usually occurs immediately secondary to puncture of periocular vessels. One of the most common complications associated with HA fillers is bruising. This article discusses the complications of HA fillers, along with methods for prevention and management. In cases of HA filler related complications, certain treatments can be attempted, such as hyaluronidase, massage, and hyperbaric oxygen. However, disastrous outcomes can occur, including necrosis, vision loss, and cerebrovascular accidents. These include injection site redness, swelling, or bruising. Fortunately, over 90% of adverse events from the use of HA fillers are mild and transient. These fillers are effective and generally well-tolerated, but complications do arise. Hyaluronic acid (HA) fillers are used in the periocular area, along with many other locations, for both aesthetic rejuvenation and functional disorders. 2.10.3 Orbital migration/ Filler migration. ![]()
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