Orbit mass secondary to migration of dermal hyaluronic acid filler

The popularity of dermal hyaluronic acid (HA) fillers has grown rapidly in the recent decade as they offer rejuvenation and nonsurgical cosmetic treatments for the correction of contour deformities and facial rhytids. Filler injections are performed with rapid recovery and little discomfort. Although various filler agents are available, the ideal filler has not yet been discovered, as all fillers are may cause complications.1, 2 Fillers can be classified in various ways. One classification is by the duration of its effect: temporary or permanent.1 This classification depends on bioavailability, chemical composition, and degradation. Quickly biodegradable agents, such as HA, may induce complications that generally disappear spontaneously within few months.2 Other types of permanent fillers such as silicone may induce complications that occur years after the procedure.2 These complications may include lumps, allergic skin reactions, edema, migration, scarring, skin necrosis, retinal artery occlusion, paralysis in the face, skin discoloration, and xanthelasma-like reaction.2, 3 These reactions can be associated with significant cosmetic morbidity and may result in the treating physician ordering unnecessary radiologic examinations and performing surgery in attempt to identify the etiology. Consequently, the surgeon should obtain a detailed history of possible soft tissue filler injections in the past, as nonbiodegradable material may persist for years. The patient often does not provide this information and may not recall which product was injected.2, 4, 5 We describe a patient who presented with an orbital mass secondary to filler injection and underwent orbitotomy. This case report adheres to the principles of the Declaration of Helsinki.