# Early Clinical Experience in the Management of Nodular Complications Following Cross-Linked Porcine Collagen Injection for Tear Trough Augmentation: A Two-Case Report

## TL;DR

This case report describes the successful treatment of nodules from collagen filler injections in the under-eye area using ultrasound-guided injections.

## Contribution

The paper introduces a safe, minimally invasive method for resolving nodular complications from cross-linked porcine collagen fillers.

## Key findings

- Ultrasound-guided intralesional injection with sterile water and lidocaine resolved nodules effectively.
- Hyaluronidase addition showed additional benefit in one case.
- Early ultrasound assessment enabled accurate diagnosis and targeted treatment.

## Abstract

Cross-linked porcine collagen fillers have been utilized for tear trough augmentation, primarily for the correction of dark under-eye circles. However, when nodular complications occur, their management remains challenging due to the absence of predictable enzymatic degradation and the lack of standardized treatment protocols.

Two patients developed non-inflammatory infraorbital nodules following tear trough augmentation with cross-linked porcine collagen filler. Ultrasound examination demonstrated well-defined hypoechoic lesions within the superficial subcutaneous plane. Both cases were treated with ultrasound-guided intralesional injection using sterile water for injection (SWFI) combined with lidocaine, with hyaluronidase added in one case, followed by local massage. Complete clinical and ultrasonographic resolution was observed within one day and one week, respectively.

Based on these two cases, ultrasound-guided intralesional management using SWFI facilitates the mechanical dispersion of aggregated collagen filler and represents a safe, minimally invasive approach for treating nodular complications in the tear trough. Early ultrasound assessment enables accurate diagnosis and targeted intervention in this anatomically delicate region.