{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:24:30Z","timestamp":1792009470491,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T00:00:00Z","timestamp":1696204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Filler injections in the periocular region are regarded as a challenging and advanced maneuver in a high\u2010risk area. Adverse events as malar edema due to filler treatment may occur. To evaluate the possible reasons, the ultrasound images, and medical data of patients that were prospectively referred with malar edema were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>A total of 17 patients (26 eyes) with malar edema after hyaluronic acid filler treatment were included. All cases were assessed with an 18\u2009MHz linear ultrasound device. Exact location of the filler material was noted. Relations with clinical data were analyzed using chi\u2010square tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Onset of malar edema after treatment showed a wide range from immediate (0\u2009days) to 3\u2009years. Most patients had an early onset <jats:italic>N<\/jats:italic>\u2009=\u200913 (76%), a minority showed late onset <jats:italic>N<\/jats:italic>\u2009=\u20094 (24%). In 23 eyes, the filler material was found to be located inside the SMAS. In 3 cases filler material was located on the periosteum of the orbital rim. After duplex\u2010ultrasound guided filler removal, restored venous flow could be seen in the superficial and\/or deep fatty layer often accompanied by flow piercing through the SMAS. Minutes after treatment, clinical improvement of malar edema was observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Malar edema after by filler treatments in the periocular region may be caused by veno\u2010lymphatic compression by filler deposits.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.16012","type":"journal-article","created":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T06:09:36Z","timestamp":1696313376000},"page":"3246-3251","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Periorbital venous stasis may be involved with filler induced malar edema\u2014A duplex ultrasound\u2010imaging\u2010based case series"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5512-1956","authenticated-orcid":false,"given":"L.","family":"Schelke","sequence":"first","affiliation":[{"name":"Department of Dermatology Erasmus University Medical Center  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