Worse under eye area after filler. Will only hyaluronidase resolve this? (Photo)

Question

I got under eye filler a week ago. Before I had some VERY minor circles at times and sometimes would look a bit drawn. Filler (one of the Restylane's) has now made my under eye area MUCH worse, especially when I smile. The pics speak for themselves. First is a month prior compared to now. Will only hyaluronidase resolve it? Is there a chance it could make things even worse? Why didn't filler help this area? Thank you!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Hung William Song, MD · Answer

I'm sorry that this happened to you, but this is occurs pretty comply when injecting fillers under the eyes. I advise my patients against getting fillers under the eyes because this is a very tight area with very thin skin. Hyaluronic acid fillers work by attracting water to the area. If any of the filler gets into the fat pad under the eye, even a small amount of fluid retention can cause this type of reaction. You will need to have the fillers dissolved with hyaluronidase because It may take several years for the filler to go away. You will probably need to have it done in multiple sessions because if you use too much hyaluronidase, you can dissolve some of your natural hyaluronic acid causing the skin to wrinkle. When treating under the eyes, I like to use autologous fat or PRF gel. You might want to consider one of these natural alternatives after dissolving the filler.

Falguni Patel, MD, FACOG · Answer

Please return to your provider as soon as possible and ask for it to be dissolved. Based on the photos you have provided it appears the product may have been injected too superficially. The skin under the eyes is very delicate and if filler is not placed properly, it can lead to the formation of a "bag"-like appearance.

Erin Smith, MD · Answer

Hello and thank you for the question. Your photographs provide a somewhat limited view for assessment. Many factors can be at play when determining the final result of a filler injection. Some patients will require touch up treatments after their initial injection while others may need hyaluonidase to dissolve the filler for various reasons. On review, it does appear as though there is some volume deficiency/assymetry along the nasojugal grooves, and possibly some swelling, although again, the photos are not clear enough to distinguish this. I would recommend an examination by your initial injector, or a board certified facial plastic surgeon to guide you on the best way to smooth out the contour in these regions.

E. Jacob Simhaee, MD, FACOG · Answer

yes, you can use Hyaluronidase, to get rid of your fillers.
under eye, injections are very tricky due to the small space we have there.
good luck and best of health

Nima Shemirani, MD · Answer

Hi @Chasethedream. I'm sorry you are not happy with your dermal filler results. I recommend dissolving the product with Hyaluronidase.

Best of luck,

Dr. Nima

Michael A. Persky, MD · Answer

Hi CTD,

Sorry to hear about your under eye filler poor experience.  I would advise to wait another 2 weeks to see if some of the edema swelling comes down.  If it remains then I would recommend using hyaluronidase to dissolve the filler.Hyaluronidase should not make things worse.  We can't answer why filler did not help, only advise that patients need to choose their injecting physicians very carefully especially when getting injections around the unforgiving and sensitive under eye area.  Feel free to contact me with any further questions or concerns.  Good luck and be well.
Michael Persky, MD
Encino, CA

Nelson Lee Novick, MD · Answer

I'm really sorry that you are experiencing this. Of course, an in-person examination would allow for a more accurate assessment of the problem. However, one reason for this kind of puffyness under the eyes following HA filler treatment in the region has come to be known as under-eye "puffy pillows."  The causes for this problem include an inappropriate choice of HA filler for the infraorbital region and/or too superficial placement of the filler within the very delicate tissues of the under-eye regions and the underlying issue is believed to be due to lymphatic obstruction (lymphedema). If this indeed the issue here, this can be a very difficult problem to treat. However, I have personally treated patients who were treated elsewhere who have come to me with this condition, and I have had success using a combination of intralesional hyaluronidase combined with an algorithm of varying combinations, concentrations and amounts of certain anti-inflammatory agents. You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist, and best of luck.

Eric M. Joseph, MD · Answer

Based on your photos, you're under eye grooves appear to be puffy. If this is the situation after an under-eye treatment, it seems as though a bit too much was injected. HA fillers under the eyes take a long time to dissipate, so if this is bothering you, please consider discussing with your doctor a dissolving enzyme. I hope this is helpful! Sincerely, Dr Joseph

Cameron Nabavi, MD, FACS · Answer

Under eye filler can have a great effect in reducing the hollowing of the are between the eyelid and cheek. However, in some cases, it can draw extra fluid into the area and create this puffiness. Hyularonidase can help this by dissolving the filler and in some cases surgical excision may be necessary. First I would definitely address it by trying hyaluronidase and it may take a few rounds of treatment to resolve this.

Worse under eye area after filler. Will only hyaluronidase resolve this? (Photo)

Answers (17)

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