The authors consider the tumescent anesthesia technique to be highly effective and an important adjunct to the procedure of ambulatory phlebectomy.

Background Hyaluronic acid (HA) is a popular, nonsurgical, temporary technique that is commonly used in the periocular region to restore volume in areas that have undergone volume loss, as well as adjusting the height and contour of the eyebrow. Aims Due to the location of glands, nerves, and vasculature, the facial anatomy should be well understood to avoid injections into areas that may result in complications. Patient/Methods A 54‐year‐old woman presented for a cosmetic consultation to address "puffy eyelids". She states she had HA filler injected along the orbital ridge inferior to the eyebrow and medially at the glabellar crease two years prior. Two months after her injection, she began to notice upper eyelid edema, xerophthalmia, and dryness of her nasal mucous membranes. Extensive evaluation and imaging were done by physicians of different specialties with a negative workup. Results A total of 60 units of hyaluronidase were injected into the areas of previous filler placement over a three‐week period. This resulted in complete resolution of the patient's presenting symptoms. Conclusion Familiarity with potential adverse events is arguably the most important aspect of treating patients with HA filler. The anatomy of the orbit and lacrimal system are important to keep in mind when evaluating symptoms related to possible long‐term complications of retained filler injections. Reporting this case should raise awareness about this potential adverse event and further explain the delicate anatomy of the periorbital area.

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Our results do not confirm the theory that lab values of elevated serum ferritin correlate with pigmentation postsclerotherapy. Further study of the correlation between postsclerotic pigmentation and serum ferritin levels are needed. One would anticipate that if a true correlation existed, then an extreme case such as this would clearly support this theory.