{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:07:52Z","timestamp":1791821272593,"version":"4.3.4"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,11,11]],"date-time":"2017-11-11T00:00:00Z","timestamp":1510358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Hyaluronic acid gel has been used for rejuvenation of the periorbital tissues since 2004. The in\u2010office, nonsurgical procedural nature has resulted in the growing popularity of the use of fillers. The periorbital region poses unique challenges to the cosmetic surgeon. Malar edema, blue\u2010gray dyschromia, and contour irregularities are well reported short\u2010term complications. We present a long\u2010term follow\u2010up review of complications associated with periocular injection of hyaluronic acid gel fillers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective review of 147 patients with at least a 5\u2010year follow\u2010up period since the first injection. Five senior masked reviewers were asked to grade photographs of patients in comparison with preinjection photographs. Grading was based on a reference photographic key looking specifically at the presence and severity of malar edema, blue\u2010gray dyschromia, and contour irregularity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Malar edema (11%), blue\u2010gray dyschromia (31.3%), and contour irregularities (30.5%) continue to be problems in longer term follow\u2010up of patients. The vast majority (90%) of these complications were mild and required no intervention. There is no statistically significant difference in the mean volumes injected by severity grading of each measured complication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hyaluronic acid gel fillers of the periorbital region are well tolerated in our long\u2010term follow\u2010up experience. The vast majority of cases of malar edema, blue\u2010gray dyschromia, and contour irregularities are mild and do not require intervention. Conservative treatment and tailored treatment approaches, in terms of volume and frequency of injections, may decrease the tendency of these adverse effects to occur.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.12452","type":"journal-article","created":{"date-parts":[[2017,11,11]],"date-time":"2017-11-11T13:12:35Z","timestamp":1510405955000},"page":"611-616","source":"Crossref","is-referenced-by-count":61,"title":["Filling the periorbital hollows with hyaluronic acid gel: Long\u2010term review of outcomes and complications"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8538-7296","authenticated-orcid":false,"given":"Hamzah","family":"Mustak","sequence":"first","affiliation":[{"name":"Groote Schuur Hospital Division of Ophthalmology University of Cape Town Cape Town South Africa"},{"name":"Stein Eye Institute Division of Orbital and Oculoplastic Surgery University of California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danica","family":"Fiaschetti","sequence":"additional","affiliation":[{"name":"Stein Eye Institute Division of Orbital and Oculoplastic Surgery University of California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Alan","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Stein Eye Institute Division of Orbital and Oculoplastic Surgery University of California Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.iop.0000235820.00633.61"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-005-0071-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X13484492"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2077.184049"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2077.104910"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2011.07.013"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjv018"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1090820X14525035"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000000293"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1473-2165.2012.00622.x"},{"key":"e_1_2_7_12_1","first-page":"1441","article-title":"Probable biofilm formation in the cheek as a complication of soft tissue filler resulting from improper endodontic treatment of tooth 16","volume":"7","author":"Marusza W","year":"2012","journal-title":"Int J Nanomed"},{"key":"e_1_2_7_13_1","first-page":"622","article-title":"Discussion: the role of bacterial biofilm in adverse soft\u2010tissue filler reactions: a combined laboratory and clinical study","volume":"139","author":"Hunter J","year":"2016","journal-title":"PRS Journal"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S114450"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11095-014-1354-y"}],"container-title":["Journal of Cosmetic Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjocd.12452","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.12452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T23:29:39Z","timestamp":1694993379000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocd.12452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,11]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,8]]}},"alternative-id":["10.1111\/jocd.12452"],"URL":"https:\/\/doi.org\/10.1111\/jocd.12452","archive":["Portico"],"relation":{},"ISSN":["1473-2130","1473-2165"],"issn-type":[{"value":"1473-2130","type":"print"},{"value":"1473-2165","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,11]]}}}