Iatrogenic migration from a multiple filler injections for tear trough: A case report.

[INTRODUCTION AND IMPORTANCE] Iatrogenic migration of dermal fillers in the periorbital region represents a rare yet significant complication. Accurate assessment of patient history, imaging, and anatomical knowledge is crucial for achieving optimal outcomes. This report underscores the importance of comprehensive evaluation and tailored surgical intervention when confronted with persistent lower eyelid swelling resistant to conventional enzymatic therapy.

[CASE PRESENTATION] A 48-year-old female presented with persistent right lower eyelid swelling after bilateral tear trough augmentation using a hyaluronic acid-based dermal filler. Despite multiple rounds of hyaluronidase injections, the right-sided mass remained unchanged. MRI revealed an encapsulated fluid collection. Further inquiry revealed a history of polyacrylamide hydrogel (Amazingel) injection a decade earlier, raising suspicion of residual, non-biodegradable filler. Surgical exploration via transcutaneous lower blepharoplasty confirmed extensive deposits of polyacrylamide hydrogel. Complete excision resulted in excellent aesthetic outcomes and high patient satisfaction.

[CLINICAL DISCUSSION] This case highlights how aggressive cannula manipulation, even when using blunt instruments, can disrupt encapsulated hydrogel, leading to unwanted filler migration. Non-biodegradable fillers such as polyacrylamide hydrogel can persist for years, complicating subsequent procedures if unrecognized. Early use of diagnostic imaging and careful review of previous interventions can expedite correct diagnosis. Surgical intervention, rather than repeated enzymatic therapy, is critical when non-absorbable materials are suspected. Precise dissection and removal of capsule-encased filler material are paramount for definitive resolution.

[CONCLUSION] Clinicians must maintain a high index of suspicion for residual non-biodegradable filler in patients presenting with unexplained, persistent swelling post-augmentation. Thorough patient history, meticulous imaging, and appropriate surgical management are integral to addressing iatrogenic filler migration. This case underscores the need for individualized treatment strategies and adherence to cautious injection techniques to mitigate complications and optimize patient satisfaction.