Infraorbital nerve disturbance secondary to long-term cosmetic filler nodule migration at the lower eyelid.

Background: Injectable fillers are widespread for antiaging non-invasive treatment. Whereas complications are difficult to manage, basically those of permanent fillers such as Bio-Alcamid. These complications could occur years later and far from the injected site, such as nodule migration. This article aims to highlight the delayed one-set nodules migration diagnosis for each patient with periorbital complaints when a history of cosmetic treatment such as polyalkylimide (Bio-Alcamid®) injection was reported. We also emphasize the knowledge of the product, sometimes given by the patient or predictable on ultrasound findings, to perform effective and efficient treatment. Case presentation: A 32-year-old woman had presented for paresthesia of the right cheek. The clinical examination revealed a palpable but not visible painless nodular and firm mass at the level of the infraorbital nerve emergence, and it was mobile and not pulsatile. A thorough medical history detected a malar injection about four years ago with polyalkylimid. Surgical treatment was performed to extract a well-encapsulated transilluminated lesion located beneath the orbicularis muscle without any adherence to adjacent structures, mainly the infraorbital nerve. Histopathological findings corroborated with a migrated nodule. CONCLUSION: Polyalkylimide injection in the cheek may give rise to leakage of hydrogel droplets in the lower eyelid, leading to nodule formation in the long term. The hardness of the capsule surrounding the hydrogel and the existence of these nodules between the infraorbital nerve and the orbicular muscle could lead to intolerable paresthesia. Corticosteroid injections are widely administered to manage delayed non-inflammatory granuloma related to filler injections. However, they are inefficient on polyalkylimide nodules where surgical excision remains the mainstay approach. [ABSTRACT FROM AUTHOR]