A sinus infection is a potential source of infection during dermal filler treatment, so it is best to postpone the procedure until you are feeling better. Before the treatment, it is important to stop taking any medications that may cause bruising, such as fish oil, krill oil, and anti-inflammatory drugs like Nurofen. The FDA analysis of studies and reported problems found that accidental injections of facial filler into blood vessels are more likely to occur between the eyebrows and nose, in and around the nose, on the forehead and around the eyes. A very common issue that we see in our clinic is the worsening of malar pockets due to a previous lacrimal canal filling treatment.
Fillers tend to cause bloating, so any patient with malar bags or festoons should avoid this type of treatment as it will only aggravate the problem. Dermal fillers may also cause HSV reactivation. Most relapses of HSV occur in the nasal mucosa, the perioral area and the mucosa of the hard palate. If a patient has a history of cold sores, they should take valacyclovir 1 gram the day before and continue for three days after the injection, as well as if an episode of HSV occurs after the injection.
In patients with active herpes lesions, HA fillers should be delayed until complete resolution. Silent sinus syndrome is a unique diagnosis characterized by spontaneous enophthalmos and hypoglobes as a result of collapse of the orbital floor secondary to chronic subclinical sinusitis. Although it is reported in ophthalmology and otorhinolaryngology literature, there is no mention of silent sinus syndrome in plastic surgery literature. The authors present a case report, together with a brief overview of silent sinus syndrome, so that knowledge of this rare but potentially devastating clinical entity can complement the differential diagnosis of plastic surgeons to ensure proper diagnosis and treatment. In some cases, additional injections of facial filler placed correctly into the tear canal or other facial areas can give excellent cosmetic results. It is best to give a “fill pass” to the patient who notes which filler was injected, when and where.
As noted above, some hyaluronic acid products tend to spread more than others after being injected, and these products may not be ideal for treating tear canals or lower eyelid voids. Scallops or malar bags are puffy bags that appear under the eyes due to aging of half of the face. Patients with unilateral and spontaneous enophthalmos and hypoballoons should make their doctor suspect silent sinus syndrome. If your doctor uses a cannula and does multiple injections under your eye to fill that area and you feel like it was deep and you scream from pain; it could be exactly where your sinuses are. Late-onset nodules occur in 0.5% of HA filling treatments, usually from four weeks to more than one year. In these cases, surgical rejuvenation of the lower eyelids is usually the most appropriate treatment, and surgery may be necessary to achieve the best possible cosmetic result.
For some patients, non-surgical rejuvenation of lacrimal canal may be a reasonable procedure that gives excellent results to improve dark shading or even camouflage larger fat pockets (bags) under the eyes. After lacrimal groove under eye filling, some patients may experience swelling under eye area or in middle region of cheek. Facial filler particles of hyaluronic acid that are placed too close to surface of skin can cause light incident on area to scatter in such way that it can create bluish tint on skin that overlies treated area. Most cases were due to autologous fats (N%3d4), hyaluronic acid (N%3d2) and collagen (n%3d), while all other substances used as fillers were below 5%. If you have an area of lower eyelid that appears to have Tyndall effect, hyaluronidase injections will usually correct problem by dissolving facial filler product. Without much pigmentation, thin skin of eyelid is not always able to effectively protect facial filler product from light which causes light scattering in area and appearance of bluish color in treated area.
We report clinical case of spontaneous unilateral enophthalmos and hypoballoons after botulinum toxin injection, in which clinical entity of silent sinus syndrome stands out. Although there is core group of physicians who are traditionally trained in these treatments for aesthetic enhancement, this also includes many other types of doctors who were originally trained in other specialties and who may not have same training or extensive experience in delicate anatomy of eyelid or similar areas of face.
