摘要

Objectives: Hyaluronic acid (HA) filler injection in the tear trough is widely performed; however, delayed complications such as late-onset eyelid edema may occur and represent a challenging condition to diagnose and manage. Introduction: To report the incidence, clinical features, and management approach of late-onset lower eyelid edema following tear trough HA injections in a personal clinical experience. Materials / method: A retrospective review of patients treated with HA for tear trough correction was conducted, focusing on cases presenting with delayed eyelid edema occurring years after treatment. Injection technique (needle vs cannula), product selection, and subsequent management were evaluated. Results: Late-onset eyelid edema was observed in 26.9% of patients, developing between 2 and 7 years after injection. No clinically relevant differences were noted between cannula and needle techniques regarding complication severity. All procedures were performed using authorized HA products for the periocular area. In selected cases, hyaluronidase was used in a controlled, serial approach (multiple sessions with progressive dosing), achieving improvement while limiting abrupt volume loss and tissue laxity. Conclusion: Late-onset tear trough edema is not uncommon and may present several years after treatment. A careful anatomical understanding, appropriate patient selection, and gradual treatment protocols—often including slow serial dissolution—are key elements for safe and effective management.