What is swelling under the eyes after filler injections called?

Malar Edema: Swelling Under the Eyes After Filler Injections

Swelling under the eyes after filler injections is most commonly referred to as "malar edema," which is a recognized complication of periorbital filler treatments.

Causes of Malar Edema

Malar edema following filler injections can occur due to several mechanisms:

1. Veno-lymphatic compression:

   • Recent evidence suggests that filler deposits can compress the venous and lymphatic drainage in the periocular region 1
   • Ultrasound studies have shown that in 23 of 26 affected eyes, filler material was located inside the SMAS (superficial musculoaponeurotic system), potentially disrupting normal fluid drainage 1

2. Filler placement issues:

   • Improper placement of filler material, particularly when injected too superficially or in excessive amounts
   • Filler placement on the periosteum of the orbital rim has been associated with malar edema in some cases 1

3. Timing of onset:

   • Can present as either early-onset (within days of injection) or late-onset (weeks to years after treatment)
   • Studies show approximately 76% of cases have early onset, while 24% show late onset 1

Clinical Characteristics

Malar edema presents with:

• Soft tissue swelling under the eyes
• May be unilateral or bilateral
• Can persist for extended periods (chronic cases)
• Occurs in approximately 11% of patients receiving periocular fillers 2

Management Options

1. Hyaluronidase treatment (for hyaluronic acid fillers):

   • The most effective treatment for malar edema caused by HA fillers
   • Local infiltration of approximately 0.2-0.5 ml of hyaluronidase (20-75 IU) per eyelid 3
   • Ultrasound-guided filler removal has shown immediate clinical improvement in malar edema cases 1
   • After hyaluronidase treatment, restored venous flow can be observed in the superficial and/or deep fatty layers 1

2. For permanent fillers (e.g., Bio-Alcamid):

   • More challenging to manage
   • Attempted removal by aspiration or bimanual expression may result in further migration of the product 4
   • Surgical excision may be necessary in some cases

Prevention Strategies

To minimize the risk of malar edema:

• Use appropriate injection techniques and placement
• Avoid overfilling the periocular area
• Consider the patient's anatomical features and predisposition to edema
• Use hyaluronic acid fillers rather than permanent fillers in the periocular region
• Understand the periorbital anatomy, including the location of glands, nerves, and vasculature 5

Important Considerations

• Malar edema is a unique complication specific to the periocular area 2
• While most adverse events are mild and self-resolve within 1 month, chronic cases can persist for years 2, 5
• Patients with a history of malar edema should be cautioned about receiving additional filler treatments in the periocular region
• Proper anatomical knowledge is crucial when performing periocular filler injections to avoid complications 5

Pitfalls to Avoid

• Do not attempt to remove permanent fillers through aspiration or expression, as this may cause migration and abscess formation 4
• Avoid excessive filler placement in the periocular region
• Be aware that malar edema can occur even years after initial filler placement 5, 4
• Don't confuse malar edema with other causes of periorbital swelling such as allergic reactions or infections