Complications that maybe with hyaluronic acid
Hyaluronic acid-based facial fillers have been positioned in recent years as the best option to solve the issue of wrinkles and sagging face. But despite their effectiveness and the excellent results they provide, they can also produce some unwanted side effects. Edema and inflammation of the eyelids and other parts of the face have been seen infrequently, caused by the previous injection of hyaluronic acid.
It is most common especially on the lips as well as in the periocular areas when trying to create volumes that tighten the skin. It is true that it is reabsorbed in about a year, but sometimes it lasts longer, and there is not always patient.
Persistent edema and inflammation
This complication can be seen by passing beyond the first few weeks. There are cases in which hyaluronic acid is not completely reabsorbed and what persists maintains edema around it. This complication is most often seen on the eyelid, and even more so when used to correct dark circles. This occurs when it infiltrates in a too superficial plane above the Orbicularis muscle, in the lower eyelid, causing inflammation or edema, with a bluish coloration due to the transparency of the darker fibers of the muscle and especially due to the reflex of the light. This last reaction is known as the Tyndall effect.
It is characterized by a bluish discoloration on the skin, just in the area where the application of hyaluronic acid was carried out. The effect can occur for two reasons. The first, most common, when hyaluronic acid is injected in a very superficial way into the skin, the second less frequent, when there is a migration of hyaluronic acid, through the tissues to the surface.
Whatever the reason for the appearance of the Tyndall effect, the fact is that when it occurs, light penetrates the facial filler (let’s not forget that it is transparent) and the blue wavelengths are reflected, giving the skin a bluish tone. Although this effect could scare the patient, the truth is that there is no reason to be alarmed, once the specialist determines that there is no health risk.
This Tyndall effect can appear even after a long time has elapsed since the procedure was performed, and it occurs even more when using low-crosslinked hyaluronic acids, so be careful with the type of hyaluronic acid and the infiltration plane.
Areas that can have complications of inflammation and Tyndall effect
The most common areas where inflammation and Tyndall effect complications can arise are the nasolabial folds, the periorbital region, and the lips.
Inflammation in this area is better concealed, as is the case with dose errors. The depth or degree of crosslinking and viscosity of the gel will depend on the type of wrinkle present, which are lines, folds or already grooves. Highly crosslinked acids suitable for deeper infiltrations usually last almost a year, sometimes longer.
It is a difficult area and requires experience. Many times it is due to too superficial infiltration. It can last for years and the only treatment that is useful is hyaluronidase. In general in this area, hyaluronic acid captures enough water, more than in other areas, and a period of inflammation is common, therefore a somewhat deformed appearance lasting even several weeks. This will depend on the type of acid used and especially on the depth of the infiltration plane. Hematomas are also frequent.
Most cases with poor results are due to excess infiltration. The hyaluronic acid infiltrated in the mucosa lasts from six months to a year, depending on the material used, and can be reabsorbed unevenly depending on the part of the lip. Keep in mind that inflammation is always more striking on the lip than the rest of the face, so the first week it is normal for it to be somewhat deformed, and a definitive appearance is not obtained until about a month.
Solution for these complications
Although the Tyndall effect does not pose a danger to the patient, it is somewhat aesthetically uncomfortable, especially since the discoloration can take a long time to disappear in the absence of treatment; and the truth is that this is quite simple. In any case, in most cases, the resolution occurs spontaneously.
If the patient does not want to wait for the problem to “resolve itself” —something very natural, due to the time it takes to solve it— the best alternatives are the injection of HYALURONIDASE (an enzyme that manages to disperse injectable liquids) or the removal of the material with small punctures.