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Malar Edema After Filler: Prevention Methods and Treatment Options

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Malar edema, a common complication following dermal filler injections in the cheek area, manifests as fluid accumulation beneath the infraorbital rim. Its severity can fluctuate, often worsened by factors such as dietary salt intake, alcohol consumption, or even one’s sleeping position.

While there is no definitive cure for this physiological condition, understanding its causes and implementing lifestyle changes can mitigate its appearance. In-office treatments tailored to individual histories and habits also play a crucial role in managing malar edema, aiming to reduce fluid retention and improve the condition to the greatest extent possible.

Prevention Strategies for Malar Edema

Preventing malar edema involves a multifaceted approach that includes careful patient evaluation, wise filler selection, and meticulous injection techniques. By addressing these factors, practitioners can significantly reduce the risk of this complication.

Patient Selection, History Evaluation, and Proper Patient Selection

A thorough patient evaluation is very important in preventing malar edema. This includes a detailed medical history to identify any underlying conditions that may increase the risk of edema, such as vascular or lymphatic system disorders. The patient’s previous experiences with fillers, any history of allergies, and lifestyle factors should also be considered. Proper patient selection involves assessing the individual’s facial anatomy, skin quality, and the presence of pre-existing malar edema or bags. By carefully selecting candidates for filler treatments and adapting the approach to each patient’s unique needs, clinicians can minimize the likelihood of malar edema development.

Filler Selection and Characteristics

Volume Limitation and Physical Properties: When selecting a filler for midface augmentation, the volume and physical properties of the product are critical considerations. Limiting the volume of filler used can help prevent excessive pressure on the lymphatic system, reducing the risk of malar edema. The rheological properties of the filler, such as its viscosity and elasticity, also play a role in how it interacts with the surrounding tissues. A filler with appropriate physical properties that integrates well with the tissue can support the overlying skin without impeding lymphatic drainage or blood flow.

Comparing Different Types of Fillers: The choice of filler is a key factor in preventing malar edema. Different fillers have varying degrees of cross-linking, particle size, and cohesivity, which can influence their likelihood of causing edema. Hyaluronic acid fillers, for example, are available in a range of formulations designed for different depths and areas of the face. A less cohesive, more fluid filler may be preferable for areas with delicate lymphatic drainage, such as the tear troughs, to minimize the risk of obstruction. In contrast, a more robust filler may be suitable for enhancing the malar eminence where structural support is needed. Understanding the characteristics of each filler type allows practitioners to make informed decisions to achieve optimal results while minimizing complications.

Injection Techniques to Minimize Risk

Preperiosteal Placement of Filler: The preperiosteal placement of filler is a technique designed to minimize the risk of malar edema. By injecting the filler deep, just above the bone, practitioners can avoid disrupting the delicate lymphatic vessels that lie in the more superficial layers of the skin. This technique also allows for a more natural contouring effect, as the filler supports the overlying tissues without creating excessive pressure that could delay lymphatic drainage. Mastery of this technique requires a thorough understanding of facial anatomy and precise control during the injection process to ensure the filler is deposited at the correct depth.

Limited Puncture Sites and Needle Size Considerations: Reducing the number of puncture sites during filler injections can significantly decrease the risk of malar edema. Fewer entry points mean less trauma to the tissue and a lower chance of disrupting lymphatic flow. Additionally, the size of the needle used for injections can influence the risk of edema; using finer needles can minimize tissue damage and subsequent swelling. Careful planning of injection points and the prudent use of appropriate needle sizes are essential components of a strategy to reduce the incidence of malar edema.

Volume and Depth Considerations: The volume of filler injected and the depth of placement are critical factors in preventing malar edema. Overcorrection with excessive volumes can create pressure on lymphatic channels, leading to fluid accumulation. On the other hand, injecting too little may result in suboptimal results, prompting additional treatments that increase the risk of complications. Depth is equally important; superficial injections can obstruct lymphatic drainage, while deeper placements can provide support without compromising lymphatic function. A balanced approach that considers both volume and depth can help achieve desired aesthetic outcomes while minimizing the risk of malar edema.

Molding Techniques Post-Injection: Post-injection molding is a technique used to shape the filler and ensure it conforms to the desired facial contours. Proper molding can distribute the filler evenly, preventing lumps and irregularities that could obstruct lymphatic drainage. However, excessive manipulation can cause the filler to migrate, potentially leading to visible material or making the malar edema worse. Practitioners must employ gentle and precise molding techniques immediately after injection to optimize the filler’s placement and integration with the surrounding tissues, thereby reducing the risk of post-procedural complications.

Treatment and Management of Malar Edema

Effective management of malar edema involves a combination of lifestyle adjustments and targeted treatments. Addressing the underlying causes and contributing factors can significantly improve the condition and enhance patient comfort and satisfaction.

Lifestyle Modifications and Conservative Measures

Salt and Alcohol Intake: Reducing salt and alcohol intake is a key strategy in managing malar edema. Both salt and alcohol can lead to fluid retention, worsening the swelling associated with malar edema. Patients are advised to monitor and limit their consumption of high-sodium foods and alcoholic beverages. This dietary modification can help decrease the likelihood of fluid accumulation in the malar region and reduce the severity of edema. Encouraging patients to stay hydrated with water and to maintain a balanced diet rich in potassium can further support the reduction of malar edema.

Sleeping Position and Facial Compression: The position in which a person sleeps can influence the development and persistence of malar edema. Sleeping with the head elevated can facilitate better lymphatic drainage and prevent fluid from pooling in the face. Additionally, avoiding sleeping on the stomach or sides can reduce facial compression, which may contribute to malar edema. Patients should be counseled on the benefits of sleeping on their back and using pillows to maintain an elevated head position throughout the night to help minimize swelling.

Compression and Massage Techniques: Compression and gentle massage can be beneficial in managing malar edema by promoting lymphatic drainage. Patients can be taught specific techniques to apply light pressure and perform lymphatic massages on the affected areas. These methods can help move excess fluid away from the malar region and reduce swelling. It is important for patients to understand the correct techniques to avoid excessive pressure that could worsen the edema or displace fillers.

Dietary Adjustments: In addition to reducing salt intake, other dietary adjustments can play a role in managing malar edema. A diet rich in anti-inflammatory foods, such as leafy greens, fatty fish, and berries, can help reduce systemic inflammation that may contribute to fluid retention. Adequate protein intake is also essential for maintaining the health of the lymphatic system. Patients should be encouraged to consume a balanced diet that supports overall health and may help mitigate the effects of malar edema.

Managing Allergies and Sleep Habits: Allergies can significantly contribute to facial swelling and malar edema. Patients with known allergies should be advised to manage their condition effectively, which may include the use of antihistamines or avoiding allergens. Additionally, establishing good sleep habits is crucial, as poor sleep can worsen inflammation and fluid retention. Patients should aim for a consistent sleep schedule and ensure they get adequate rest to support the body’s natural healing processes and reduce the risk of malar edema.

Medical Interventions and In-Office Procedures

Dissolving Agents for Hyaluronic Acid Fillers (Hyaluronidase): When malar edema is associated with hyaluronic acid (HA) fillers, hyaluronidase can be used as a dissolving agent to alleviate the condition. Hyaluronidase is an enzyme that breaks down HA, allowing for the correction of overfilled areas or the reduction of excessive swelling. The use of hyaluronidase must be carefully considered and adapted to the individual patient’s needs, as it can also affect the surrounding native HA in the tissue. The procedure should be performed by experienced practitioners who can accurately target the area and adjust the dosage to achieve the desired outcome while minimizing the risk of overcorrection.

Steroid Injections and Their Efficacy: Steroid injections can be employed to manage persistent malar edema that does not respond to conservative measures. Corticosteroids have potent anti-inflammatory properties and can reduce swelling by suppressing the body’s inflammatory response. However, their use must be judicious, as steroids can also lead to potential side effects such as skin atrophy or discoloration. The efficacy of steroid injections varies among patients, and they are typically considered when other interventions have failed to provide relief.

Radiofrequency Technology for Lymphatic Drainage: Radiofrequency technology is a non-invasive treatment option that can enhance lymphatic drainage and reduce malar edema. By delivering controlled heat to the affected area, radiofrequency can stimulate collagen production, tighten the skin, and promote the movement of lymphatic fluids. This technology can be particularly beneficial for patients with mild to moderate malar edema, offering a safe and effective way to improve the condition without the need for more invasive procedures.

Long-Term Management, Expectations, and Patient Response

Patient-Specific Treatment Plans: Long-term management of malar edema requires a patient-specific approach that considers the individual’s unique anatomy, the severity of the condition, and their response to previous treatments. A comprehensive treatment plan may include a combination of lifestyle changes, in-office procedures, and at-home care. Regular follow-up appointments are essential to monitor the patient’s progress and make any necessary adjustments to the treatment plan. Open communication between the patient and practitioner is crucial to set realistic expectations and ensure patient satisfaction.

Potential for Improvement and Limitations: While many patients experience significant improvement in malar edema with appropriate treatment, it is important to understand the limitations and set realistic expectations. The extent of improvement depends on various factors, including the cause of the edema, the patient’s adherence to the treatment plan, and their individual healing process. Some patients may see a dramatic reduction in swelling, while others may achieve more modest results. It is essential for practitioners to discuss the potential for improvement with patients, acknowledging the limitations and the possibility of ongoing management to maintain results.

Longevity of Malar Edema: The duration of malar edema can vary widely among individuals, with some experiencing transient swelling while others may have persistent edema. Factors influencing the longevity include the underlying cause of the edema, the type and amount of filler used, and the body’s response to it. In cases where the edema is a reaction to a temporary condition, such as a salty diet or alcohol consumption, the swelling is likely to subside once the trigger is removed. However, if the edema is due to structural changes in the lymphatic system or from long-standing issues, it may persist until adequately addressed. It’s crucial for patients to understand that while some may see quick resolution, others might require ongoing management to keep the edema at bay. Practitioners should provide a clear overview of what patients can expect in terms of the longevity of their malar edema and the factors that can influence its duration.

Frequently Asked Questions

Can malar edema be permanently cured or resolved?

Malar edema can often be managed and improved, but a permanent cure is not guaranteed due to its physiological nature and potential for recurrence.

How long does malar edema typically last after filler injections?

The duration of malar edema after filler injections varies, but it can last from a few days to several months, depending on individual factors and treatment efficacy.

How does alcohol consumption affect malar edema?

Alcohol consumption can exacerbate malar edema by causing dehydration and subsequent fluid retention, leading to increased swelling.

Are certain types of fillers more likely to cause malar edema?

Yes, fillers with higher viscosity or those placed superficially can increase the risk of malar edema due to potential lymphatic obstruction.

What are the signs that I might be developing malar edema after filler?

Signs include persistent swelling, puffiness, or a fluid-filled appearance in the cheek area below the infraorbital rim after filler injections.

Is it possible to prevent malar edema if I have had it before?

While previous occurrence can increase risk, malar edema can be minimized with careful filler selection, injection technique, and lifestyle modifications.

Is it possible to correct malar edema without removing the filler?

In some cases, malar edema can be managed with conservative measures like massage and compression without removing the filler.

Conclusion

Malar edema is a multifaceted condition that requires a personalized approach to treatment and management. Understanding the underlying causes, recognizing early signs, and employing preventive measures can significantly improve outcomes. While some cases may resolve with conservative methods, others may require medical interventions. Setting realistic expectations and maintaining open communication between patients and practitioners are key to managing this complex condition.

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References:

Funt D. K. (2011). Avoiding malar edema during midface/cheek augmentation with dermal fillers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3244361/

Funt, D., & Pavicic, T. (2013). Dermal fillers in aesthetics: an overview of adverse events and treatment approaches.

https://www.dovepress.com/dermal-fillers-in-aesthetics-an-overview-of-adverse-events-and-treatme-peer-reviewed-fulltext-article-CCID

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.