Autologous Fat Augmentation and Periorbital Laser Resurfacing Complicated by Abscess Formation

Abstract

Introduction:

There are many modalities for rejuvenation of the aging face, including rhytidectomy, soft tissue augmentation, and skin resurfacing. Skin resurfacing modalities for the treatment of rhytides include chemical peels, dermabrasion, and laser resurfacing. Complications of skin resurfacing include infection, prolonged erythema, and scar formation. Autologous fat augmentation used for soft tissue “rejuvenation” of the face has the advantages of having no allergic reactions or rejection. Complications include edema, ecchymoses, pain, nerve or blood vessel damage, infections, and rarely orbital or cerebral emboli. The author presents a case of an abscess formation of the lacrimal duct system in a patient with autologous fat augmentation and laser resurfacing preceded by tear-duct punctal plugs 1 week prior to surgery.

Materials and Methods:

An overall healthy 55-year-old female was seeking treatment of periorbital rhytides and mild dermatochalasis, prominent nasojugal creases, malar fat pad ptosis, prominent melolabial folds, and mild jowling. She underwent periorbital laser resurfacing, autologous fat augmentation (malar eminence, infraorbital region, melolabial folds), and liposuction of the jowls. One week prior to her surgery the patient had punctal tear duct plugs placed for the treatment of epiphora.

Results:

The patient developed unilateral facial pain and edema with subsequent abscess formation along the right infraorbital region. A CT-scan was obtained which showed soft tissue swelling without the presence of a retro-orbital cellulitis. The abscess was drained and antibiotic treatment administered. A diagnosis of dacryocystitis was made and upon dacryocystorhinostomy, a large dacryolith was discovered.

Discussion:

Although surgeons are aware of the complications associated with the procedures they perform, it is extremely important to keep in mind other surgeries that patients may have had elsewhere and the complications associated with them.