Objectives: To define malar mounds and malar edema.
To discuss etiologies of malar mounds and edema.
To show ultrasound findings of malar edema.
To understand anatomy and lymphatic drainage in periobital area.
To understand the treatment of HA related malar edema.
Discuss favorable and non-favorable risk factors to good outcomes.
Introduction: Malar mounds and malar edema have many etiologies. Unfortunately, filler related edema is becoming epidemic. Patients seeking treatment must be prepared for a prolonged treatment which includes multiple modalities. It is important to know the anatomy for both treatment and prevention. Ultrasound is a useful adjunct to treat these patients.
Materials / method: Several patients have been seen and treated in the last 4 years at the authors clinic. Clinical and ultrasound findings will be displayed. Treatment options will be discussed, and outcomes revealed. Choice of filler, plane of injection will be discussed, and which are most likely to cause problems. RF microneedling as an adjunct to hyaluronidase will be thoroughly discussed. Ultrasound potentially can decrease the number of hyaluronidase treatments.
Results: Treatment of malar edema patients usually required multiple treatments with hyaluronidase. Ultrasound guidance potentially improved the number of treatments. Favorable and non-favorable risk factors will be discussed. Patients often required RF microneedling as an adjunctive therapy.
Conclusion: Malar edema is a common complication for cheek and tear trough filler. Prevention is key to success and involves proper injection plane (deep) and choice of proper HA product. Treatments include dissolving with hyaluronidase using ultrasound guidance. Most require multiple treatments and additional modalities to get optimal results.
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