Skip to main content Skip to main navigation menu Skip to site footer
  • Register
  • Login
  • Menu
  • Home
  • Current
  • Archives
  • Announcements
  • About
    • About the Journal
    • Submissions
    • Editorial Team
    • Privacy Statement
    • Contact
  • Register
  • Login

Quality in Sport

An Overview of Complications and Treatment Strategies in Periocular Dermal Fillers: A Literature Review
  • Home
  • /
  • An Overview of Complications and Treatment Strategies in Periocular Dermal Fillers: A Literature Review
  1. Home /
  2. Archives /
  3. Vol. 37 (2025) /
  4. Medical Sciences

An Overview of Complications and Treatment Strategies in Periocular Dermal Fillers: A Literature Review

Authors

  • Aleksandra Ciesielska Mazovian Rehabilitation Center "STOCER" Sp. z o.o. Railway Hospital in Pruszków, Poland https://orcid.org/0009-0000-5015-6140
  • Aleksandra Sieradzka Medical University of Warsaw https://orcid.org/0009-0004-2281-7617
  • Krzysztof Szerej District Hospital in Sochaczew, Poland, https://orcid.org/0009-0003-7581-4965
  • Alicja Kot Medical University of Warsaw https://orcid.org/0009-0001-2999-6775
  • Marta Wojtczak County Health Center in Otwock Sp. z o.o. Otwock, Poland https://orcid.org/0009-0007-0032-7520
  • Natalia Myśliwiec National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland https://orcid.org/0000-0002-4359-9899
  • Adrian Różycki Medica Plus Family Clinic Sp. z o. o., Gdańsk, Poland https://orcid.org/0000-0002-9110-5443
  • Michał Pniak John Paul II Memorial Masovia Provincial Hospital in Siedlce, Poland https://orcid.org/0009-0006-2982-6078
  • Paweł Miklis University Clinical Center of the Medical University of Warsaw, Poland https://orcid.org/0009-0008-4578-233X
  • Maciej Mawlichanów Military Institute of Medicine, Warsaw Poland https://orcid.org/0000-0002-6543-8105

DOI:

https://doi.org/10.12775/QS.2025.37.57034

Keywords

dermal fillers, periocular, hyaluronic acid, calcium hydroxylapatite, poly-lactic acid, polymethyl methacrylate, polyalkylimide, hyaluronidase, complications, vision loss, treatment

Abstract

Introduction:  The dermal filler market is a continuously expanding billion-dollar industry with the number of performed injections growing concurrently with the amount of post-injection complications. Most adverse events are mild and resolve spontaneously. Ischemic complications due to accidental intra-arterial filler injection may lead to skin necrosis and even irreversible vision loss.

Aim of the study: This review aims to critically evaluate the use of dermal fillers in the periocular area, possible post-injection complications and treatment options for adverse events, providing further guidance for aesthetic medicine doctors.

Methods: Databases such as PubMed, Medline and Research Gate were searched for articles published over the last 20 years.

Results: Dermal fillers in the periocular area are often chosen over surgical procedures due to their efficacy and outstanding safety profiles. The reversing agent hyaluronidase causes hyaluronic acid fillers to be the primary choice for periocular filler injections. Post-injection complications after permanent fillers may require surgical excision.

Conclusions: The periocular region is exceptionally demanding, requiring excellent anatomical awareness and proper administration techniques for uneventful procedures. Individually adjusted treatment plans and proper product selection is crucial. Doctors must follow preventative guidelines to minimize the complication risk, including aspirating before injecting the product, performing injections in the mid or deep dermal plane and administering small volumes with slow injections. Imaging techniques are significantly beneficial for minimizing the risk of the most severe ischemic complications.

 

References

1. Wang Y, Massry G, Holds JB. Complications of periocular dermal fillers. Facial Plast Surg Clin North Am. 2021;29(2):349-357. doi:10.1016/j.fsc.2021.02.001

2. American Society of Plastic Surgeons. Plastic Surgery Statistics Report 2023. Available at: https://www.plasticsurgery.org/documents/news/statistics/2023/plastic-surgery-statistics-report-2023.pdf. Accessed [28.11.2024].

3. Dermal filler market size, share, competitive landscape and trend analysis report, by type, by gender, by service provider : Global opportunity analysis and industry forecast, 2024-2033. Allied Market Research. Available at: https://www.alliedmarketresearch.com/dermal-filler-market-A07289. Accessed [28.11.2024].

4. Ziai K, Lighthall JG. Periocular rejuvenation using hyaluronic acid fillers. Plast Aesthet Res. 2020;2020. doi:10.20517/2347-9264.2020.151

5. Borba A, Rodrigues M. Periorbital filling with the MD codesTM algorithm: A narrative review and a practical guide. J Cosmet Dermatol. 2021;20(11):3398-3406. doi:10.1111/jocd.14491

6. Thanasarnaksorn W, Cotofana S, Rudolph C, Kraisak P, Chanasumon N, Suwanchinda A. Severe vision loss caused by cosmetic filler augmentation: Case series with review of cause and therapy. J Cosmet Dermatol. 2018;17(5):712-718. doi:10.1111/jocd.12705

7. Mandal P, Gama F. The use of periocular fillers in aesthetic medicine. J Plast Reconstr Aesthet Surg. 2021;74(7):1602-1609. doi:10.1016/j.bjps.2020.12.079

8. Murthy R, Roos JCP, Goldberg RA. Periocular hyaluronic acid fillers: applications, implications, complications: Applications, implications, complications. Curr Opin Ophthalmol. 2019;30(5):395-400. doi:10.1097/ICU.0000000000000595

9. Iverson SM, Patel RM. Dermal filler-associated malar edema: Treatment of a persistent adverse effect. Orbit. 2017;36(6):473-475. doi:10.1080/01676830.2017.1337203

10. Uwe Wollina and Alberto Goldman. Hyaluronic acid dermal fillers: Safety and efficacy for the treatment of wrinkles, aging skin, body sculpturing and medical conditions. Clin Med Rev Ther. 2011;3:107-121. doi:10.4137/cmrt.s6928

11. DeLorenzi C. Complications of injectable fillers, part I. Aesthet Surg J. 2013;33(4):561-575. doi:10.1177/1090820X13484492

12. Jung H. Hyaluronidase: An overview of its properties, applications, and side effects. Arch Plast Surg. 2020;47(4):297-300. doi:10.5999/aps.2020.00752

13. Attenello NH, Maas CS. Injectable fillers: review of material and properties. Facial Plast Surg. 2015;31(1):29-34. doi:10.1055/s-0035-1544924

14. Kadouch JA. Calcium hydroxylapatite: A review on safety and complications. J Cosmet Dermatol. 2017;16(2):152-161. doi:10.1111/jocd.12326

15. Pavicic T. Calcium hydroxylapatite filler: an overview of safety and tolerability. J Drugs Dermatol. 2013;12(9):996-1002.

16. How to choose a facial filler: 8 different types explained. Carecredit.com. September 1, 2020. Available at: https://www.carecredit.com/well-u/health-wellness/types-of-facial-fillers/. Accessed [01.12.2024].

17. Injectable calcium hydroxylapatite. Asds.net. Available at: https://www.asds.net/skin-experts/skin-treatments/injectables/injectable-calcium-hydroxylapatite. Accessed [02.12.2024].

18. Corduff N. An alternative periorbital treatment option using calcium hydroxyapatite for hyperpigmentation associated with the tear trough deformity. Plast Reconstr Surg Glob Open. 2020;8(2):e2633. doi:10.1097/GOX.0000000000002633

19. Witmanowski H, Błochowiak K. Another face of dermal fillers. Postepy Dermatol Alergol. 2020;37(5):651-659. doi:10.5114/ada.2019.82859

20. Ezzat WH, Keller GS. The use of poly-L-lactic acid filler in facial aesthetics. Facial Plast Surg. 2011;27(6):503-509. doi:10.1055/s-0031-1298782

21. Oh S, Lee JH, Kim HM, et al. Poly-L-lactic acid fillers improved dermal collagen synthesis by modulating M2 macrophage polarization in aged animal skin. Cells. 2023;12(9). doi:10.3390/cells12091320

22. Mani N, McLeod J, Sauder MB, Sauder DN, Bothwell MR. Novel use of polymethyl methacrylate (PMMA) microspheres in the treatment of infraorbital rhytids. J Cosmet Dermatol. 2013;12(4):275-280. doi:10.1111/jocd.12065

23. Lam SM. Periocular Injectables with Hyaluronic Acid and Polymethyl Methacrylate Using Microcannulas. In: Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. Springer New York; 2015:491-495.

24. Park TH, Seo SW, Kim JK, Chang CH. Clinical experience with polymethylmethacrylate microsphere filler complications. Aesthetic Plast Surg. 2012;36(2):421-426. doi:10.1007/s00266-011-9803-z

25. DelMauro MA, Paul Lorenc Z. Background/basic science of polymethylmethacrylate fillers. Rejuvenation Resource. March 2, 2021. Available at: https://www.rejuvenationresource.com/articles/background-science/background-basic-science-of-polymethylmethacrylate-fillers. Accessed [05.12.2024].

26. Boylan PM, Santibañez M, Lounsbury N, Eltaki SM. A nonthrombotic pulmonary embolus caused by polyalkylimide dermal filler: A case report and literature review of medication management. J Am Pharm Assoc (2003). 2021;61(4):e324-e331. doi:10.1016/j.japh.2021.03.003

27. American Society of Plastic Surgeons. American Society of Plastic Surgeons. Available at: https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/types. Accessed [06.12.2024].

28. AlHarbi ZA, Alkatan HM, Alsuhaibani AH. Long-term outcomes of surgically removed migrated polyalkylimide (bio-alcamid) filler to the periorbital area. Saudi J Ophthalmol. 2019;33(3):251-254. doi:10.1016/j.sjopt.2019.06.001

29. Wilson YL, Ellis DAF. Large needle suction aspiration of permanent fillers: Suction Aspiration of Permanent Fillers. Laryngoscope. 2011;121(10):2146-2149. doi:10.1002/lary.21555

30. Hwang CJ. Periorbital injectables: Understanding and avoiding complications. J Cutan Aesthet Surg. 2016;9(2):73-79. doi:10.4103/0974-2077.184049

31. Stefura T, Kacprzyk A, Droś J, et al. Tissue fillers for the nasolabial fold area: A systematic review and meta-analysis of randomized clinical trials. Aesthetic Plast Surg. 2021;45(5):2300-2316. doi:10.1007/s00266-021-02439-5

32. Nagendran ST, Ali MJ, Dogru M, Malhotra R. Complications and adverse effects of periocular aesthetic treatments. Surv Ophthalmol. 2022;67(3):741-757. doi:10.1016/j.survophthal.2021.04.009

33. Urdiales-Gálvez F, Delgado NE, Figueiredo V, et al. Treatment of soft tissue filler complications: Expert consensus recommendations. Aesthetic Plast Surg. 2018;42(2):498-510. doi:10.1007/s00266-017-1063-0

34. Vedamurthy M, Vedamurthy A. Dermal fillers: tips to achieve successful outcomes. J Cutan Aesthet Surg. 2008;1(2):64-67. doi:10.4103/0974-2077.44161

35. Complications of hyaluronic acid fillers - EyeWiki. Eyewiki.org. September 30, 2024. Available at: https://eyewiki.org/Complications_of_Hyaluronic_Acid_Fillers. Accessed [06.12.2024].

36. Mehta P, Li J, Woodward J, Zhang-Nunes S. Non-ischemic complications of dermal fillers. Plast Aesthet Res. Published online 2023. doi:10.20517/2347-9264.2022.28

37. Sykes JM. Complications of Facial Implants. In: Complications in Head and Neck Surgery. Elsevier; 2009:671-676.

38. Barańska-Rybak W, Świerczewska Z, Lemiec A, Walker L. Triamcinolone injection in the treatment of malar edema. Dermatol Pract Concept. 2024;14(2):e20234117. doi:10.5826/dpc.1402a117

39. Mehta P, Kaplan JB, Zhang-Nunes S. Ischemic complications of dermal fillers. Plast Aesthet Res. 2022;9(10):57. doi:10.20517/2347-9264.2022.19

40. King M, Walker L, Convery C, Davies E. Management of a vascular occlusion associated with cosmetic injections. J Clin Aesthet Dermatol. 2020;13(1):E53-E58.

41. Navarro-Hernandez E, Pérez-López M. Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review. Arch Soc Esp Oftalmol (Engl Ed). 2022;97(9):521-538. doi:10.1016/j.oftale.2022.06.005

42. Hong GW, Hu H, Chang K, et al. Adverse effects associated with dermal filler treatments: Part II vascular complication. Diagnostics (Basel). 2024;14(14):1555. doi:10.3390/diagnostics14141555

Downloads

  • PDF

Published

2025-01-10

How to Cite

1.
CIESIELSKA, Aleksandra, SIERADZKA, Aleksandra, SZEREJ, Krzysztof, KOT, Alicja, WOJTCZAK, Marta, Myśliwiec Natalia, Różycki Adrian, PNIAK, Michał, MIKLIS, Paweł and Mawlichanów Maciej. An Overview of Complications and Treatment Strategies in Periocular Dermal Fillers: A Literature Review. Quality in Sport. Online. 10 January 2025. Vol. 37, p. 57034. [Accessed 23 May 2025]. DOI 10.12775/QS.2025.37.57034.
  • ISO 690
  • ACM
  • ACS
  • APA
  • ABNT
  • Chicago
  • Harvard
  • IEEE
  • MLA
  • Turabian
  • Vancouver
Download Citation
  • Endnote/Zotero/Mendeley (RIS)
  • BibTeX

Issue

Vol. 37 (2025)

Section

Medical Sciences

License

Copyright (c) 2025 Aleksandra Ciesielska, Aleksandra Sieradzka , Krzysztof Szerej , Alicja Kot , Marta Wojtczak , Natalia Myśliwiec , Adrian Różycki , Michał Pniak , Paweł Miklis , Maciej Mawlichanów

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Stats

Number of views and downloads: 154
Number of citations: 0

Search

Search

Browse

  • Browse Author Index
  • Issue archive

User

User

Current Issue

  • Atom logo
  • RSS2 logo
  • RSS1 logo

Information

  • For Readers
  • For Authors
  • For Librarians

Newsletter

Subscribe Unsubscribe

Tags

Search using one of provided tags:

dermal fillers, periocular, hyaluronic acid, calcium hydroxylapatite, poly-lactic acid, polymethyl methacrylate, polyalkylimide, hyaluronidase, complications, vision loss, treatment
Up

Akademicka Platforma Czasopism

Najlepsze czasopisma naukowe i akademickie w jednym miejscu

apcz.umk.pl

Partners

  • Akademia Ignatianum w Krakowie
  • Akademickie Towarzystwo Andragogiczne
  • Fundacja Copernicus na rzecz Rozwoju Badań Naukowych
  • Instytut Historii im. Tadeusza Manteuffla Polskiej Akademii Nauk
  • Instytut Kultur Śródziemnomorskich i Orientalnych PAN
  • Instytut Tomistyczny
  • Karmelitański Instytut Duchowości w Krakowie
  • Ministerstwo Kultury i Dziedzictwa Narodowego
  • Państwowa Akademia Nauk Stosowanych w Krośnie
  • Państwowa Akademia Nauk Stosowanych we Włocławku
  • Państwowa Wyższa Szkoła Zawodowa im. Stanisława Pigonia w Krośnie
  • Polska Fundacja Przemysłu Kosmicznego
  • Polskie Towarzystwo Ekonomiczne
  • Polskie Towarzystwo Ludoznawcze
  • Towarzystwo Miłośników Torunia
  • Towarzystwo Naukowe w Toruniu
  • Uniwersytet im. Adama Mickiewicza w Poznaniu
  • Uniwersytet Komisji Edukacji Narodowej w Krakowie
  • Uniwersytet Mikołaja Kopernika
  • Uniwersytet w Białymstoku
  • Uniwersytet Warszawski
  • Wojewódzka Biblioteka Publiczna - Książnica Kopernikańska
  • Wyższe Seminarium Duchowne w Pelplinie / Wydawnictwo Diecezjalne „Bernardinum" w Pelplinie

© 2021- Nicolaus Copernicus University Accessibility statement Shop