Swelling under eyes after tear trough fillers MONTHS later?

I have seen a similar case involving Volbella in the lips.  Swelling would occur in the upper or lower lip intermittently and then resolve spontaneously (starting several months after injection of the product).  I found it curious that everything wouldn't swell at once, but the filler was the source without a doubt.  While it could represent a bacterial infection or biofilm formation around the product particles, it could also be an inflammatory or immunologic response to the product (or product breakdown) in your body.  Treatment centers around an antibiotic and steroids.  Some physicians will see if this works prior to dissolving the product, but certainly, if medications fail to solve the problem, hyaluronidase is the treatment of choice.  In discussions with other colleagues, it is a possibility (NOT proven or studied to my knowledge), that the Vycross products (Voluma, Vollure, and Volbella) have a higher propensity to cause this type of delayed reaction.  Having said that, these are great products and this seems to be a rare occurrence, so the aesthetic benefits definitely outweigh the rare risk of this reaction.  You should see your injecting physician for further guidance and treatment.  This highlights the importance of seeing board certified core injectors (facial plastic surgeons, plastic surgeons, dermatologists) since we have the knowledge and experience to recognize and treat any sequela following cosmetic injections.  Good luck to you!    

Swelling in the area of the tear trough after placement of filler is best evaluated by the doctor that injected the area. They would have the best understanding about what level the filler was injected into the tissues.  They will also be able to determine if the filler needs to be dissolved.  If the episodes don't last long, perhaps it will disappear completely.  A photograph of the episode would help your doctor best. 

This is difficult to answer without pictures and needs an in-person evaluation. I recommend getting a formal evaluation with a cosmetic dermatologist. If necessary, you can have it reversed with hyaluronidase and try a different technique next time. See an expert. Best, Dr. Emer

Thank you for sharing your question. Unfortunately without a full series of photographs it is difficult to offer definite advice but if it were the Volbella I would think that both eyes would be experiencing these swelling episodes.  There are other possibilities like swelling from allergies or the compression from sleeping that could also play a role so speak with your injector so that the both of you can work on possible diagnoses and treatments.  Ultimately you could have the Volbella dissolved as well to see if if definitely cures the issue. Hope this helps.

Volbella XC is a Hyaluronic-Acid based filler, which uses Vycross technology, (meaning it uses a mixture of Low and High Molecular weighed Hyaluronic-acid). Unfortunately, Volbella may attract excess water leaving the patient with unsatisfactory results when placed in soft tissue areas, such as the under eye. In my experience, it is best to discuss removing the product with your Board-Certified Dermatologist. He/she may dissolve the product with an enzyme known as, Hyaluronidase. Due to the vycross technology in Volbella several treatments may be needed.
Once the excess product has been dissolved it is recommend any remaining hollowness be injected with a Restylane-L or Belotero, which has less water absorption.

Thank you for your question. Yes - this is likely related to the filler. I suggest you have this filler dissolved as this issue is unlikely to resolve once it has become problematic. You amy want to consider fat grafting or PRP to this area instead of HA based filler.  Best of luck! 

This is a rare but NOT unheard of condition, and is related to your filler. Hopefully this will settle down, however most Specialist will investigate and take a through history. The depth of Volbella placement is important, and this filler can be dissolved as last line management. Please see your Specialist injector who performed this procedure, as we all have our own protocols for handling this problem. All the best, Dr Davin Lim. Brisbane. Australia.