Recommendations Address Malar Edema After Hyaluronic Acid Fillers
Key Takeaways
Malar edema occurs in an estimated 11% to 24% of tear trough filler treatments, according to studies cited in a new expert review.
Risk factors include impaired lymphatic drainage, previous periorbital surgery, patient age, filler characteristics, and injection technique.
The CARE advisory board developed a patient-screening questionnaire and stepwise management algorithm for filler-associated malar edema.
New expert recommendations published in Dermatology and Therapy outlined strategies for preventing and managing malar edema following hyaluronic acid (HA) dermal filler injections in the infraorbital region.
The review was developed by the Complication Assessment and Risk Evaluation (CARE) advisory board and examined the anatomical, patient-related, and procedural factors contributing to post-filler swelling.
Risk Factors and Management of Malar Edema After Dermal Fillers
The authors identified impaired lymphatic drainage between the orbicularis retaining ligament and zygomaticocutaneous ligament as a central mechanism underlying fluid accumulation.
Patient-related risk factors included older age, previous periorbital surgery, allergies, rosacea, and systemic conditions. Excessive filler volume, inappropriate product selection, and superficial placement may further increase risk. For prevention, the panel emphasized comprehensive medical histories, physical examinations, and careful filler selection. The recommendations favor nonpermanent HA fillers with low hydrophilicity and elastic modulus, approved for infraorbital use.
For established edema, the proposed management algorithm begins with clinical assessment and observation, followed by conservative measures such as head elevation and lymphatic drainage. Persistent cases may warrant hyaluronidase, corticosteroids, or specialist referral.
"Management should always be tailored to the individual and the availability of treatment," they wrote.
Source
Baranska-Rybak W, et al. Dermatol Ther (Heidelb). 2026. Doi:10.1007/s13555-026-01920-w