Clinical characteristics of patients with a periorbital mass after autologous fat injection for facial augmentation and short-term outcomes of steroid treatment

Abstract

Aim: The aim of this study was to evaluate the clinical features of patients with a periorbital palpable mass or swelling after autologous fat injection for facial augmentation.

Methods: This retrospective case study included 50 patients who developed a periorbital palpable mass or swelling after undergoing autologous fat injection for facial augmentation performed by various plastic surgeons. The patients' medical records were reviewed for clinical history, radiological findings, and treatment outcomes.

Results: All patients were female with a mean age of 43.18 ± 12.04 (range, 19-63) years. After fat injection, the average time of symptom onset was 9.09 ± 8.45 (1-36) months, and the mean follow-up duration was 13 ± 1 (4-36) weeks. Majority of patients complained of eyelid swelling or periorbital palpable mass. All patients had received fat injection in the forehead area, except for the following patients: Five patients who were unaware of the site of fat injection and one patient who had received the injection in the upper eyelid area with simultaneous double-fold surgery. In addition, 39 patients had received a second injection of cryopreserved autologous fat tissue. Forty-five patients developed a mass in the upper eyelid area, four were found to have the mass in the lower eyelid area, and one patient developed the mass in both eyelids. Computed tomography and magnetic resonance imaging revealed isolated fat tissue, periorbital inflammation, or a soft tissue mass with fat density. Oral steroids were used to treat 41 (82.0%) patients; 31 (75.6%) showed satisfactory outcomes, nine (22.0%) patients did not return to the clinic after the first oral steroid treatment, and the periorbital mass persisted in one patient (2%) even after the oral steroid treatment. The patient with the periorbital mass underwent surgical removal and tissue biopsy. Asymptomatic patients (eight; 16%) underwent observation without treatment. As a first treatment, one patient (2%) requested an immediate surgical removal of the periorbital mass. Therefore, surgical excision and biopsy were performed in two patients (4%). During surgery, a granulomatous mass was found in the preseptal region, with liquefied necrotic fat flowing out. Histological examination revealed a lipogranuloma with granulomatous inflammation.

Conclusions: Clinicians should confirm a history of autologous fat injection and be aware of the clinical features in patients who present with a periorbital palpable mass or swelling. Oral steroid therapy should be considered before surgery because it may prove to be effective. Further studies with long-term follow-up periods are necessary.

Keywords: Autologous fat injection; Cryopreserved fat; Lipogranuloma; Periorbital mass.