Periocular Fillers–Related Complications: Imaging Features

S. Cohen*, Dana Niry, Ayelet Priel

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


• The surge in popularity of periocular fillers has heralded an increase in filler-related complications. • Short-term complications are usually mild and require no/minimal intervention. However, rare devastating vascular complications can occur. Long-term complications pose a diagnostic challenge and may require radiologic evaluation [1, 2]. • The chapter presents clinical-radiological manifestations of the commonly encountered periocular filler– related complications including intravascular embolism of the injected material, foreign body granuloma, chronic malar edema, and filler migration. • Acquaintance with the key imaging features of periocular filler–related complications is of paramount importance to avoid misdiagnosis and an unnecessary biopsy [3–5]. • Most commonly used fillers (i.e., collagen, HA, and CaHA) induce a physiologic inflammatory response, especially in the early postinjection period. The consequent mild enhancement/increased uptake on FDG PET–CT/MRI is attributed to vascularization and increased glycolysis in activated inflammatory cells and is not, by itself, indicative of infection. • Cellulitis appears as stranding and enhancement of the subcutaneous tissue adjacent to the injected filler (resembling inflammatory reactions). • Abscess formation appears as a rim-enhancing collection. On DWI abscess shows restricted diffusion whereas infected filler collections do not show restricted diffusion. • Foreign body granuloma may show a variable degree of enhancement on MRI. Definitive diagnosis requires histopathological evaluation.

Original languageEnglish
Title of host publicationAtlas of Orbital Imaging
PublisherSpringer International Publishing
Number of pages6
ISBN (Electronic)9783030624262
ISBN (Print)9783030624255
StatePublished - 1 Jan 2021


  • Filler complications
  • Imaging features
  • MRI
  • Periocular filler


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