Robert J. Applebaum, MD

Delayed swelling or edema even months after the placement of undereye filler is not uncommon. The undereyes and tear troughs are very sensitive areas. Even when the filler is done well, complications are fairly common. Many physicians and surgeons more commonly recommend surgery or laser resurfacing as safer and more effective alternative treatment for these areas. However, in the right patient, undereye filler can be appropriate.

In your case, you could try a short course of oral steroids such as a Medrol Dose Pack to see if it helps with the swelling. After that, dissolving the filler with hyaluronidase is most likely going to be your best option. Fortunately, this is not likely going to be associated with any long-term negative side effects. Once the filler is dissolved, you may consider one of the other options I noted above.

I hope this information is helpful.

I have a good deal of experience with patient's who developed Botox resistance in my training and practice. It seems to be more common in my patients who I inject with neurotoxins (Botox, Dysport, Xeomin) for medical reasons like uncontrollable spasms but also occurs in cosmetic patients occasionally. My experience is that Xeomin is likely to be effective after developing Botox resistance but you have to try it to be sure. I hope this helps.

It is possible that the cheek filler migrated and became a bump on your eyelid. However, this would be less likely this long after the injection since the filler should have integrated with your natural cheek tissues by this time. At this point, it is more likely to be an unrelated issue. I agree that you should see your injector for an evaluation, but he or she will likely refer you to an oculoplastic surgeon or eyelid specialist for an evaluation if it's truly a bump in the lid.

The good and bad thing about Botox is that it lasts approximately 3 months. Fortunately, this means that its side effects, like decreased muscle function in unintended areas, also resolve in approximately 3 months. The medicine likely just migrated from the injection site into one of the cheek muscles that affects your smile, however your smile will go back to normal once the Botox wears off.

Swelling after Botox is also uncommon but could be a mild allergic reaction to the medication or to the liquid if was dissolved in. Typically, this does not last long. If this happens again or persists, talk to your injector about different options. You could always try one of alternative neurotoxins (Jeuveau, Xeomin, Dysport) that work equally well.