Malar Edema After Cheek Filler

A Comprehensive Guide to Causes, Signs, and Management

That swollen feeling in your cheeks after getting filler isn't just in your head. Malar edema, a common side effect of cheek filler injections, can leave your face looking puffy, lumpy, and just plain weird. If you've noticed an odd swollen sensation in your cheeks after filler, you're not alone. Malar edema is a sneaky side effect that can show up days or even weeks after your injection appointment.

Don't panic yet - the swelling should go down on its own. But it's crucial to know what causes malar edema, what you can do to reduce it, and when to call your doctor. In this post, we'll dive into everything you need to know about malar edema after cheek fillers so you can get back to looking like your gorgeous self again.

What is Malar Edema?

Malar edema refers to swelling located on the malar eminence, which is the protruding part of the cheekbone directly under the eye. It manifests as puffiness and fullness in the under-eye region extending to the upper cheek. Malar edema specifically involves fluid accumulation and inflammation of the soft tissues overlying the cheekbone.

Unlike regular post-procedure swelling which resolves within a few days, malar edema is excessive and persistent fluid buildup. It is an adverse event associated with dermal filler injections in the tear troughs and cheek area. Malar edema can be unsettling given its visibility on the face. Identifying, managing and preventing this condition is crucial for satisfactory outcomes after soft tissue augmentation.

How Can Cheek Filler Cause Malar Edema?

There are several potential causes and risk factors for developing malar edema after dermal filler injections:

• Allergic reactions to the hyaluronic acid material or other ingredients in the filler product. These hypersensitivity reactions trigger inflammation and swelling.
• Over-augmentation of the tear troughs and under-eye area. Too much filler volume in the delicate eyelid region can compress blood vessels and lymphatics, resulting in fluid accumulation.
• Intravascular injection or product placement into a blood vessel. This causes significant inflammation and edema.
• Sleeping on the side of the face after recent injections. This puts pressure on the newly augmented cheek area and inhibits proper lymphatic drainage.
• Genetics. Some patients are intrinsically predisposed to swelling and poor lymphatic drainage.
• Diet and allergies. Salty meals, alcohol intake, and allergies exacerbate inflammation.
• Previous hyaluronic acid filler injections. Repeat treatments in the same area can heighten immune responses and adverse events like malar edema.

Those with thin under-eye skin are especially susceptible, as are patients with a history of malar edema following filler injections. Careful patient selection and injection techniques reduce the risks.

Spotting the Signs of Malar Edema

It is normal to experience some swelling, redness and tenderness after filler injections. However, malar edema is excessive and represents an adverse reaction versus standard post-procedure inflammation.

Malar edema can arise shortly after filler injections or have a delayed onset days later. Typical signs include:

• Swelling, puffiness and fullness of the eyelids, under-eyes, tear troughs and upper cheek area
• A rounded, fluid-filled appearance of the malar eminence and midface
• Indentation of the skin when pressed due to pitting edema
• Tenderness, firmness and discomfort of the swollen tissues
• Increased protrusion of infraorbital fat pads in the lower eyelids

The swelling is most prominent over the malar prominence of the cheekbones. It may be mild or lead to severe fullness extending down to the nasolabial folds. Malar edema should resolve over time but can be persistent. 

Regular swelling resolves in 2-4 days, but malar edema can persist for weeks or longer. It also tends to be firmer and more pronounced despite anti-inflammatory medications. If swelling worsens after the first 1-2 days or remains after a week, patients should notify their provider promptly for evaluation.

Potential Complications with Dermal Fillers

Malar edema signifies an underlying complication from dermal filler injections in the cheek area. Some potential adverse events include:

• Vascular occlusion from intravascular injections resulting in compromised blood flow and hypoxia. This necessitates urgent intervention.
• Necrosis and tissue death from pressure or reduced vascular supply.
• Granuloma formation which are chronic inflammatory nodules.
  
• Migration of filler material causing lumpiness.
• Chronic non-resolving edema.
• Damage to facial nerves.
• Visual disturbances from compression of vessels and orbital structures.

Thus, persistent malar edema warrants examination to rule out serious complications requiring treatment. Patients should discuss the risks before undergoing any dermal filler procedure.

Managing Malar Edema

For mild cases of post-filler malar edema, the following conservative measures may help:

• Head elevation during sleep to minimize gravitational pull and edema.
• Cold compresses and lymphatic drainage massage.
• Avoiding high sodium foods and alcohol which aggravate inflammation.
• Arnica and bromelain supplements to reduce swelling.
• Oral diuretics if edema is severe.
• Low-dose oral steroids like prednisone for some cases of allergic reactions.
• Laser or energy-based treatments to improve lymphatic drainage.
• Hyaluronidase to dissolve excess hyaluronic acid filler if needed.

More persistent or severe malar edema unresponsive to the above therapies may necessitate medical intervention. Intralesional steroids, lancing, draining fluids, surgical excision and other techniques can be considered for refractory edema. Most cases fortunately resolve completely within a few weeks with conservative treatments.

Prevention and Safe Practices

The best way to avoid complications like malar edema is to have cosmetic injections performed by an experienced, qualified provider. Ensure your clinician:

• Has in-depth expertise injecting the under-eye and cheek areas.
• Utilizes meticulous injection methods and advanced technologies like cannulas to minimize risks.
• Customizes treatment based on your unique facial anatomy.
• Is prepared to manage potential adverse events.

Patients should also:

• Realistically communicate their expectations and goals.
• Disclose any allergies, medications or health conditions.
• Avoid alcohol, NSAIDs, and supplements that increase bleeding and bruising for 1 week pre- and post-treatment.
• Employ prudent aftercare such as avoiding extreme head positions and heat.
  

Being well-informed is key. Discuss concerns openly with your provider and do not hesitate to seek help if complications arise after any cosmetic procedure.

Conclusion

Malar edema represents a visible adverse event that can occur with dermal filler injections in the delicate under-eye and cheek areas. However, by selecting reputable injectors, implementing appropriate treatment plans, and utilizing proper techniques, complications can be minimized.

If malar edema does occur, this guide outlines several conservative management strategies in most cases. While a frustrating complication, malar edema is usually temporary and treatable. 

To avoid potential complications with dermal filler treatments, consult with the expert. Schedule your consultation with Dr. Lanna today to learn more about how dermal fillers can help you and ensure a safe, comfortable visit. 

FAQs

Q1: How long does malar edema last after cheek fillers?

For most patients, malar edema resolves within 2 to 6 weeks with conservative treatments. Severe or recurrent cases may persist for several months.

Q2: Is it safe to get fillers again after malar edema?

Yes, it can be safe provided there is careful consideration of the cause and prevention of recurrence. Allow edema to fully resolve, avoid the causative product/area, and ensure an experienced injector performs the procedure.

Q3: How can I reduce the risks of malar edema after fillers?

Choosing an expert injector, following proper aftercare instructions, avoiding NSAIDs/supplements that increase bruising, and discontinuing alcohol and sodium intake can help reduce risks. Communicating concerns to your provider is also key.

Q4:What are the common causes of malar edema after fillers?

Common causes of malar edema after fillers include overfilling, injection technique, product choice, and patient factors such as allergies or underlying medical conditions.

Q5: How can I tell if I have malar edema after fillers?

Symptoms of malar edema after fillers include swelling, redness, tenderness, and bruising in the cheek area. If you experience these symptoms, contact your provider for evaluation and treatment.