title: Migrated periocular filler masquerading as arteriovenous malformation:  a diagnostic and therapeutic dilemma.
abstract: Migration of dermal filler is a rare complication in the periocular area. We describe a case that highlights the diagnostic and therapeutic dilemmas posed. A patient presented with a bluish swelling involving the left brow, temple, and glabella. It was ill-defined, mobile, and nontender. An MRI suggested a vascular malformation, while an ultrasound suggested a dermoid. On further questioning, the patient revealed having a permanent polyalkylimide filler injected to the glabella 10 years ago. This raised the possibility of delayed migration. The eyebrow, temple, and glabella were explored through a skin-crease incision. Transparent gel was expressed and cicatrized granulomas were excised. The patient made an excellent recovery through an inconspicuous incision. This case emphasizes the importance of taking a detailed history and revisiting the diagnosis, if necessary. We describe a relatively scar-free approach to remove widely distributed migrated fillers. Clinical and radiologic features of migrated filler can mimic tumor.
authors: University Hospital Coventry and Warwickshire NHS Trust, United Kingdom. Sarmi.malik@uhcw.nhs.uk
authors: Sarmi
authors: S
authors: Malik
authors: Purnima
authors: P
authors: Mehta
authors: Oludapo
authors: O
authors: Adesanya
authors: Harpreet S
authors: HS
authors: Ahluwalia
mesh_terms: D000180:Acrylic Resins / Q000009:adverse effects*; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000209:etiology; D001672:Biocompatible Materials; D003879:Dermatologic Agents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005138:Eyebrows; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D015745:Granuloma, Foreign-Body / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012225:Rhinoplasty; D014463:Ultrasonography
chemical_list: D000180:Acrylic Resins; C470344:Bio-Alcamid; D001672:Biocompatible Materials; D003879:Dermatologic Agents