Lower bleph results perfect and then malar edema occur months later, could it be existing cheek filler?

Based on your photos, you appear to have puffiness below your orbital fat pads, so if you have had HA filler into your under eye grooves, this may indeed still be present. In my opinion, a personal history of fillers along with an examination is better than an MRI at determining whether or not something was done. Sometimes temporary fillers can cause permanent issues like scar tissue. And the under eye area is very delicate and it reveals every little imperfection. Have you considered a dilute triamcinolone acetonide injection? Sometimes this may be helpful for swelling or scar tissue after fillers. I hope this helps. Sincerely, Dr Joseph

It is normal for these eyelids to retain some degree of inflammation for 4 to 6 months after surgery. During this time, activity and diet can trigger swelling. Before you spend more money on enzyme and unhelpful imaging studies, I recommend you let the eyelids heal for another 3 months. If the edema persists after that, it is reasonable to consider another round of enzyme. Imaging of the filler only works when there is enough filler in one location that it can be resolved. Small volumes of retained filler can still affect water balance and not be visualized on MRI or ultrasound. So the imaging studies really don’t provide any information that you don’t already have.

I have encountered this quite a few times. It usually results from the either the use of an inappropriate choice of filler for the upper cheeks region and/or too superficial injection of the filler in the delicate skin of the upper cheek-infraorbital region. I have been able to achieve gratifying results using an algorithm of a series of varying combinations, concentrations and amounts of intralesional injections of anti-inflammatory agents. Hope this helps and best of luck.