Abstract
Tear trough deformity is a popular target for the treatment with filler injections.
The side effects are generally mild and transient. However, delayed complications
may occur. We aim to perform a thorough systematic review of the published literature
related to delayed complications after tear trough filler injections. A search of
published literature was conducted in accordance with Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines in June 2021 and included
PubMed, ScienceDirect, and Embase databases. The Medical Subject Headings (MeSH) terms
used included the following terms: delayed complications, nodules, granulomas, swelling,
discoloration, dermal filler, hyaluronic acid (HA), polyacrylamide, calcium hydroxyapatite
(CaHA), poly-L-lactic acid (PLLA), eyelid, periorbital, periocular, and tear trough.
Twenty-eight articles consisting of 52 individual cases were included in the final
analysis. 98% (51/52) of patients were female and had an average age of 48.3 years.
HA was the most reported product (71.2%, 37/52), followed by PLLA (4/52, 7.7%), and
CaHA (4/52, 7.7%). The most common delayed complication with any dermal filler was
swelling (42.3%, 22/52) followed by lumps or nodules (25.0%, 13/52). Xanthelasma-like
reaction (17.3%, 9/52), migration (7.7%, 4/52), discoloration (3%, 3/52) also occurred.
The average time of onset of any complication was 16.8 months with xanthelasma-like
reaction appearing soonest (mean: 10 months) and discoloration appearing latest (mean:
52 months). Most swelling cases were caused by HA. Semi-permanent fillers such as
PMMA and synthetic fillers such as PLLA were more likely to be associated with lumps
and nodules than other complications. It is important that clinicians who perform
tear trough augmentation with dermal fillers have a thorough understanding of the
risks of the procedure to diagnose and manage them promptly as well as provide patients
with accurate information regarding the potential adverse effects.
Keywords
tear trough - dermal filler - trough augmentation - complications
