Fat pad or eye trough fillers 10 years later?

It would be unlikely that 10-12 years after your filler treatment that it would still present and causing puffiness. It could be related to herniated fat, allergies, the aging process, or something else. If it is from herniated fat then a lower blepharoplasty would improve the appearance. I encourage you to visit with a board certified plastic surgeon for an evaluation.

Not that long ago, the condition known as Under-Eye "Puffy Pillows" was described following filler treatments to the tear troughs. This typically occurred if an inappropriate filler was chosen for that area and/was injected too superficially. The puffiness, which is believed to be lymphatic obstruction/lymphedema can occur even long after the filler treatments and can be persistent and difficult to treat. I have had gratifying results in treating patients who have come to me with this issue using an algrorithm of varying combinations, concentrations and amounts of anti-inflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps.