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Mild Complications or Unusual Persistence of Porcine Collagen and Hyaluronic Acid Gel Following Periocular Filler Injections

Wolkow, Natalie, M.D., Ph.D.*; Jakobiec, Frederick A., M.D., D.Sc.*; Dryja, Thaddeus P., M.D.*; Lefebvre, Daniel R., M.D.

Ophthalmic Plastic & Reconstructive Surgery: September/October 2018 - Volume 34 - Issue 5 - p e143–e146
doi: 10.1097/IOP.0000000000001029
Case Reports

The purpose of this study was to describe the histopathologic appearance of dermal eyelid fillers that were unexpectedly encountered in ophthalmic plastic surgery samples from patients with mild eyelid disfigurements, and to review eyelid cases with complications that had previously been described in the literature. A retrospective histopathologic study with Alcian blue, elastic, and Masson trichrome stains of 2 cases that were submitted to the Ocular Pathology Department was conducted, and a critical review of previously published cases of the histopathologic characteristics of dermal filler material in the periocular region was also conducted. Two periocular tissue samples were found to contain dermal filler material. In one case, porcine collagen appeared as amorphous or indistinctly microfibrillar aggregates that stained light blue with the Masson trichrome method. In the other case, hyaluronic acid gel appeared as vivid blue amorphous pools of material in extracellular locules after staining with the Alcian blue method. An inflammatory response was not observed in either case. Patients who undergo facial filler procedures may, at a later time, require a surgical excisional procedure from which a specimen is generated. Previously injected dermal filler that the patient neglected to mention may be present in the pathologic sample, potentially perplexing the unsuspecting pathologist. Both ophthalmic plastic surgeons and ocular pathologists should be aware of the histopathologic features of dermal fillers. It is helpful if a surgeon who submits a specimen to the pathology service makes note of any known prior use of facial filler material or is alert to its possible presence when unfamiliar foreign material is discovered in the dermis of the eyelids.

Dermal fillers including absorbable porcine collagen and hyaluronic acid may last many years in ocular adnexal tissues and complicate clinical and histopathologic interpretation, particularly when a complete and relevant history is not obtained.

*David G. Cogan Ophthalmic Pathology Laboratory

Ophthalmic Plastic and Reconstructive Surgery Service, Department of Ophthalmology of the Massachusetts Eye and Ear Infirmary and the Harvard Medical School, Boston, Massachusetts, U.S.A.

Accepted for publication October 10, 2017.

Supported by Heed Fellowship (NW).

The authors have no conflicts of interest to disclose.

Correspondence address and reprint requests to Frederick A. Jakobiec, M.D., D.Sc., David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Suite 328, Boston, MA 02114. E-mail:

© 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.