Abstract Listings 2026

Purpose

To report a case of granulomatous reaction following injection of a hybrid hyaluronic acid–calcium hydroxyapatite (HA/CaHA) filler in the supratarsal hollow and to highlight management challenges in the periocular region.

Methods

We describe a 42-year-old woman with congenital microphthalmia and an ocular prosthesis who underwent HA/CaHA filler injection for supratarsal hollow correction. Clinical presentation, management, and histopathological findings were analyzed.

Results

Several weeks after injection, the patient developed a firm, painless upper eyelid nodule. Initial treatment with intralesional hyaluronidase and corticosteroid injections failed to achieve clinical improvement. Surgical excision was performed, revealing multiple nodules within the orbicularis muscle. Histopathological examination confirmed a foreign body granulomatous reaction. Postoperative recovery was uneventful with no recurrence at follow-up.

Conclusion

Hybrid HA/CaHA fillers combine immediate volumization with biostimulation but may lead to delayed granulomatous reactions, particularly in anatomically delicate areas such as the eyelids. Unlike hyaluronic acid, CaHA cannot be enzymatically dissolved, which may limit conservative treatment efficacy. This case highlights the importance of avoiding particulate or hybrid fillers in the periocular region and supports surgical excision as an effective treatment in refractory cases.

Additional Authors

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