Navigating Lower Eyelid Blepharoplasty in Patients with Under-Eye Filler: Challenges, Complications, and Recommendations

Background: To report on the clinical course of patients with a history of hyaluronic acid (HA) filler injections undergoing lower eyelid blepharoplasty, including pre-operative, intra-operative and post-operative effects of HA filler. Methods: Retrospective case series of patients with a history of HA filler injections to the lower eyelid/tear trough or cheek, who subsequently underwent lower blepharoplasty surgery. Data collected included demographic information, aesthetic history and pre-operative features. Intra-operative findings and post-operative course was documented, as was requirement for additional treatments. Results: 50 cases were assessed, of which 48 met inclusion criteria. 17 had a history of filler more than 3 years before presentation (35.4%), and 15 (31.3%) were unable to recall the timeframe of filler injection. The majority (83.3%) showed evidence of ≥1 filler-associated adverse effect. In preparation for lower blepharoplasty, additional peri-operative treatments were often indicated, most commonly hyaluronidase for dissolution of filler. A subset of patients experienced prolonged post-operative oedema (43.8%), requiring further intervention and follow-up. Conclusion: Individuals receiving HA-filler to the eyelids and cheeks may in time seek eyelid surgery many years later. Eyelid surgeons should therefore be prepared to recognise and deal with HA filler-related issues in all individuals seeking eyelid surgery. The presence of HA filler in this region can significantly influence outcomes of lower blepharoplasty surgery, both intra-operatively and post-operatively. Early identification and anticipation of these issues with pre-operative counselling to avoid unrealistic expectations is required.