Complications of Calcium Hydroxyapatite in Lower Eyelid Rejuvenation: Case Report of Granuloma Formation

Calcium hydroxyapatite (CaHA) is a widely used biostimulatory filler for facial rejuvenation. Although it has a favorable safety profile, complications such as nodules, granulomas, and fibrosis can occur. The use of CaHA in the periorbital region remains limited due to safety concerns, and few reports have detailed its complications in this delicate area. We report a case of a 40-year-old patient who developed persistent lower eyelid irregularities and edema following CaHA injection for periorbital rejuvenation. Conservative management, including corticosteroid injections, failed to resolve the complication. Surgical intervention was performed, revealing significant fibrosis and alterations in the orbicularis oculi muscle. A conservative excision was necessary. Histopathologic analysis confirmed granulomatous inflammation. This case highlights the potential risks of CaHA injections in the lower eyelid, emphasizing the need for careful patient selection, precise injection technique, and thorough preprocedural counseling. The complexity of surgical management in this region underscores the importance of recognizing and addressing complications. Further research is needed to better understand the long-term safety and optimal management of CaHA-related complications in the periorbital area.