Bleeding at the injection site is rare and may cause local and upper eyelid ecchymosis. Proper delicate injection avoiding blood vessels may control bleeding. Immediate compression is advisable in these cases. Infection is very rare due to the rich blood supply at this area. Local pain and discomfort during injection is probably the result of touching the periosteum with the needle.
Edema after injection is quite common and should be explained to the patient. Surface irregularities result from irregular placement of
the fillers. Asymmetry can be corrected with complementary injections of fillers.
The most feared complication is migration of the filler down to the upper eyelid. This can be avoided by using the proper technique and injecting only small quantities of the required product. Other complications, such as those found in association with surgical procedures (e.g., numbness, paresis, scars, alopecia, and nerve damage) do not occur as a result of treatment with fillers.
Fillers injected into the eyebrow may be nicely combined with BoNT-A in the upper part of the face. This will improve the eyebrow position, especially in its upper lateral part. Care should be taken to avoid migration down to the skin of the upper eyelid.
atrophy of the underlying fatty tissue combined with deficient bone structure at the zygoma level may produce excessive deep folds and wrinkles in the midface. One of the main goals of aesthetic medicine is to balance the proportions of the facial features. During a patient's aesthetic evaluation, the cranial bones and the overlying soft tissue elements should be carefully analyzed for symmetry, equality of proportions, and the relationship between the aesthetic units.
Fillers may be an important tool for correcting mild asymmetries and for promoting augmentation in the cheeks and cheekbones. However, severe asymmetries and disproportions should be treated surgically. Soft tissue advancement is not an easy task even when surgical procedures are undertaken. For example, if the base of the nose advances 4 mm per 7 mm of maxillary advancement, the nasal tip advances only 2 mm (Frei-hofer 1976). Injectable fillers may also be useful as a pretreatment before surgery during the planning phase and as an option for correcting minor defects after surgery.
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