Hyaluronic acid (HA) fillers have become a go-to solution for facial volume enhancement due to their quick results and perceived safety. However, a lesser-known side effect is post-hyaluronic acid recurrent eyelid edema (PHAREE), which involves persistent or intermittent swelling of the eyelids. This condition can be quite distressing for patients and a challenge for doctors.
Why Does PHAREE Occur?
Understanding PHAREE involves looking at the unique aspects of the lower eyelid and midface. Here are the key factors:
1. Impermeable Malar Septum: This structure can trap fluids in the midface and eyelids.
2. Delicate Eyelid Lymphatics: The valveless lymphatic vessels in the eyelids are easily damaged, leading to fluid retention.
3. Immunogenic Response: HA fragments can trigger an inflammatory response, causing lymphatic damage and chronic swelling.
A Multi-Step Treatment Approach
Managing PHAREE effectively requires a combination of techniques to dissolve the HA fillers and remodel the affected tissues. Here’s a step-by-step treatment protocol that has shown great promise:
1. Hyaluronidase Injections
Hyaluronidase is an enzyme that breaks down HA fillers. By administering it in controlled doses, the filler material is gradually dissolved, preventing sudden volume loss and skin sagging.
2. Fractionated Radiofrequency Microneedling
This technique involves using RF energy to promote collagen synthesis and tighten the skin. The Morpheus8 device delivers this energy to the dermal and subdermal layers, helping in soft tissue contraction and remodeling.
3. Carbon Dioxide Laser Resurfacing
For patients with suitable skin types, CO2 laser resurfacing can further enhance tissue contraction and improve overall aesthetic outcomes. This is used alongside RF microneedling for the best results.
Combining Techniques for Optimal Results
The combination of hyaluronidase injections, fractionated RF microneedling, and CO2 laser resurfacing (where appropriate) provides an effective treatment protocol for managing PHAREE. This comprehensive approach not only addresses the filler-related swelling but also promotes tissue remodeling, leading to satisfactory and lasting aesthetic outcomes.
By following this multi-step protocol, doctors can offer patients relief from the distressing symptoms of PHAREE and restore the desired appearance of the eyelids and midface.