Hyaluronidase injection for upper eyelid lumps secondary to hyaluronic acid filler injection: three case reports
DOI:
https://doi.org/10.12809/hkjo-v30n1-417Keywords:
Dermal fillers, Graves ophthalmopathy, Hyaluronic acid, Hyaluronoglucosaminidase, Restylane-LAbstract
Hyaluronic acid dermal filler is effective in treating upper eyelid retraction in thyroid eye disease. We report on three cases of hyaluronidase injection to treat upper eyelid lumps or edema secondary to hyaluronic acid filler injection.
References
1. Bartley GB, Fatourechi V, Kadrmas EF, et al. Clinical features of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol 1996;121:284-90. DOI: https://doi.org/10.1016/S0002-9394(14)70276-4
2. Shah SS, Stokkermans TJ, Patel BC. Thyroid eye disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026.
3. Mancini R, Khadavi NM, Goldberg RA. Nonsurgical management of upper eyelid margin asymmetry using hyaluronic acid gel filler. Ophthalmic Plast Reconstr Surg 2011;27:1-3. DOI: https://doi.org/10.1097/IOP.0b013e3181c2a16d
4. Kim JE, Sykes J. Hyaluronic acid fillers: history and overview. Facial Plast Surg 2011;27:523‐8. DOI: https://doi.org/10.1055/s-0031-1298785
5. De Boulle K, Heydenrych I. Patient factors influencing dermal filler complications: prevention, assessment, and treatment. Clin Cosmet Investig Dermatol 2015;8:205-14. DOI: https://doi.org/10.2147/CCID.S80446
6. Snozzi P, van Loghem JAJ. Complication management following rejuvenation procedures with hyaluronic acid fillers: an algorithm-based approach. Plast Reconstr Surg Glob Open 2018;6:e2061. DOI: https://doi.org/10.1097/GOX.0000000000002061
7. Beleznay K, Carruthers JD, Carruthers A, Mummert ME, Humphrey S. Delayed-onset nodules secondary to a smooth cohesive 20 mg/mL hyaluronic acid filler: cause and management. Dermatol Surg 2015;41:929-39. DOI: https://doi.org/10.1097/DSS.0000000000000418
8. Goldberg RA, Fiaschetti D. Filling the periorbital hollows with hyaluronic acid gel: initial experience with 244 injections. Ophthalmic Plast Reconstr Surg 2006;22:335-43. DOI: https://doi.org/10.1097/01.iop.0000235820.00633.61
9. Karlin J, Vranis N, Dayan E, Parsa K. Post-hyaluronic acid recurrent eyelid edema: pathophysiologic mechanisms and a proposed treatment protocol. Aesthet Surg J Open Forum 2023;5:ojad102. DOI: https://doi.org/10.1093/asjof/ojad102
10. Young SM, Kim JH, Kim YD, Karnsiritanont V, Lang SS, Woo KI. Hyaluronic acid gel injection for dysthyroid upper eyelid retraction in Asian patients. Orbit 2023;42:389-96. DOI: https://doi.org/10.1080/01676830.2022.2117385
11. Kakizaki I, Ibori N, Kojima K, Yamaguchi M, Endo M. Mechanism for the hydrolysis of hyaluronan oligosaccharides by bovine testicular hyaluronidase. FEBS J 2010;277:1776-86. DOI: https://doi.org/10.1111/j.1742-4658.2010.07600.x
12. Brody HJ: Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement. Dermatol Surg 2005;31:893-7. DOI: https://doi.org/10.1097/00042728-200508000-00001
13. Park TH, Seo SW, Kim JK, Chang CH. Clinical experience with hyaluronic acid-filler complications. J Plast Reconstr Aesthet Surg 2011;64:892-6. DOI: https://doi.org/10.1016/j.bjps.2011.01.008
14. Hilton S, Schrumpf H, Buhren BA, Bölke E, Gerber PA. Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients. Eur J Med Res 2014;19:30. DOI: https://doi.org/10.1186/2047-783X-19-30
15. Quezada-Gaón N, Wortsman X. Ultrasound-guided hyaluronidase injection in cosmetic complications. J Eur Acad Dermatol Venereol 2016;30:e39-40. DOI: https://doi.org/10.1111/jdv.13286
16. Shumate GT, Chopra R, Jones D, Messina DJ, Hee CK. In vivo degradation of crosslinked hyaluronic acid fillers by exogenous hyaluronidases. Dermatol Surg 2018;44:1075-83. DOI: https://doi.org/10.1097/DSS.0000000000001525
17. Zhang-Nunes S, Ryu C, Cahill K, et al. Prospective in vivo evaluation of three different hyaluronic acid gels to varying doses of hyaluronidase with long-term follow-up. J Plast Reconstr Aesthet Surg 2021;74:874-80. DOI: https://doi.org/10.1016/j.bjps.2020.10.052
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