Table 9.
Overview of the Early and Delayed Adverse Events in Patients Who Underwent Tear Trough Deformity Treatment with Hyaluronic Acid (HA) Fillers
| Early Adverse Events | |
| Event | Prevention/Treatment |
| Pain | To use HA fillers with lidocaine |
| Erythema | N.A. |
| Swelling/Bruising | To avoid all blood-thinning medications. Fillers that incorporate lidocaine and epinephrine (adrenaline) may reduce the amount of postinjection bruising. To apply firm pressure and ice packs before and after the treatment session. |
| Asymmetry | N.A. |
| Migraine | N.A. |
| Delayed Adverse Events | |
| Event | Prevention/Treatment |
| Orange-brown staining | Preinjection ice application. Proper depth of injection. Discontinuation of anticoagulants at least seven days before injection. |
| Postinflammatory hyperpigmentation | It is usually associated with dark skin types due to bruising and hematoma. It can be difficult to treat |
| Puffiness | Its incidence may be reduced by proper patient and filler selection. |
| Infections | Filler injections should not be performed if there is an infection in the adjacent site. It can be treated with antibiotics active against frequent skin bacteria including Staphylococcus epidermidis or Propionibacterium acnes. |
| The Tyndall effect | It occurs when particulate HA fillers are inappropriately implanted into the superficial dermis or epidermis. Hyaluronidase should be the initial approach to treatment. |
| Nodules | They can be treated with local massage, aspiration or incision and drainage of the product. Hyaluronidase can be used to dissolve a nodule or a focus of overcorrection. |
| Blindnessa | To limit the amount of filler bolus injected in one site. One way to do this is to use blunt cannulas. To apply minimal pressure on the syringe, which decreases the risk of retrograde flow into the retinal arteries. |