Late-Onset Upper Eyelid Edema Following Temporal Hollow Correction With Hyaluronic Acid

Summary: Hyaluronic acid (HA) fillers are widely used for facial rejuvenation, offering favorable safety outcomes. Although early-onset complications such as lower eyelid edema and tear trough Tyndall effect are well documented, late-onset manifestations—particularly upper eyelid edema occurring more than 6 months postinjection—remain poorly understood and often misdiagnosed. We report the case of a 51-year-old woman who presented with isolated, persistent, bilateral upper eyelid swelling. Imaging and laboratory workup, including thyroid function tests and orbital magnetic resonance imaging, were unremarkable. Given the inconclusive findings, upper blepharoplasty was performed for both therapeutic and diagnostic purposes. Histopathologic analysis revealed dermal basophilic deposits consistent with HA, with no inflammatory reaction. Only after surgery did the patient recall undergoing temporal filler injections 2 years earlier. This case illustrated the resilience and migration potential of HA fillers—especially when injected into avascular gliding planes such as the temporal region—and the capacity for remote complications. Unlike other documented cases involving direct periorbital injection and successful hyaluronidase resolution, our case required surgical intervention due to delayed diagnosis. Clinicians must maintain a high index of suspicion for HA-related complications, even when symptoms manifest far from the typical injection site and long after the procedure. Thorough aesthetic history-taking is essential to avoid misdiagnoses such as thyroid orbitopathy or Melkersson–Rosenthal syndrome. To our knowledge, this is the first reported case of chronic upper eyelid edema secondary to temporal HA filler injection, and we advocate for greater awareness of this presentation within the aesthetic and ophthalmologic communities.