Abstract ID: 26-598
High-Frequency Ultrasound-Guided Surgical Excision of Recalcitrant Lower Eyelid Hyaluronic Acid Filler Following Failed Hyaluronidase Dissolution
Author: Ahmed Raslan Base Hospital / Institution: Aurelle Aesthetics
Presentation Type: ePoster Presentation
Purpose
Hyaluronidase failure in periocular filler complications — due to fibrosis, compartmentalization, or uncertain filler composition — necessitates surgical removal. Without precise localization, blind excision carries significant risk. We describe a technique using surgeon-performed high-frequency ultrasound to map lower eyelid filler deposits and guide safe surgical excision.
Methods
An interesting case of patient presenting us with lower eyelid filler complications who had failed a minimum of [3] HA treatment sessions. The patient underwent high-resolution B-mode US evaluation using the Clarius L20 linear array probe (frequency 20 MHz), performed by the operating surgeon. Ultrasound was used to:
Confirm the presence, echogenicity, and extent of residual filler
Define the anatomical compartment (preseptal, suborbicularis, pre-periosteal)
Identify proximity to the globe, inferior oblique muscle, and inferior orbital vasculature
Map the surgical approach
Surgical excision was performed via a transconjunctival or subciliary approach under GA, with intraop correlation to the preop US map. Outcome measures included completeness of excision confirmed by post-op US, complication rate, cosmetic outcome, and patient satisfaction
Results
Preop US demonstrated hyperechoic nodular deposits within a globular hypoechoic lesion within the pre-septal and suborbicularis plane, multiloculated collections, ill-defined margins suggesting fibrosis. Precise anatomical mapping enabled targeted surgical access.
Complete excision was achieved, confirmed by postop US. No intraop or postop complications including globe injury, diplopia, haematoma, or lid malposition were recorded. Patient satisfaction at [2] weeks was [8/10].
Conclusion
Surgeon-performed high-frequency ultrasound enables precise preoperative filler mapping, facilitating safe and complete surgical excision in hyaluronidase-refractory cases. This technique offers a reproducible, evidence-based approach and should be incorporated into the management algorithm for recalcitrant periocular filler complications.