29 & had filler for hollows since 19, how to reverse Tyndall under eyes? (Photo)

Question

I am 29 years old and have gotten filler since 19 under my eyes due to hereditary hollow under eyes last 4 years my under eyes have gotten more and more blue/purple. I have had them dissolved once but seen no difference so I’m not sure if this is the best option please help (:

Anna Chacon, MD, FAAD · Answer

Hi there — first, I want to say I can understand how frustrating this must feel, especially since you started treating hereditary hollows at such a young age and were trying to feel more confident. Under-eye filler can look beautiful when done carefully, but this area is very delicate and can change over time.

From your description and photo, the blue/purple discoloration you’re noticing could be related to a few things:

Tyndall effect – This happens when hyaluronic acid filler sits too superficially and light reflects through it, creating a bluish hue.

Filler migration or accumulation – After years of repeated treatments, filler can build up or shift.

Natural thinning of the under-eye skin – As we age, the skin becomes thinner, making underlying structures (and any filler) more visible.

True vascular dark circles – Some of the purple tone may not be filler at all, but natural vascular pigmentation.

The fact that you dissolved it once and didn’t see improvement suggests one of three possibilities:

The filler may not have been fully dissolved.

The discoloration may not be entirely from filler.

There may be long-standing structural thinning that filler initially masked.

In cases like yours, I typically think carefully before adding more filler. Sometimes the best approach is complete and strategic dissolution, possibly done in stages, followed by allowing the tissue to settle for several weeks. Only after that can we truly assess what is filler versus natural anatomy.

In some patients, long-term filler actually stretches or alters the under-eye tissue, and once dissolved, they may benefit more from:

Conservative re-filling placed deeper (if appropriate)

Fat repositioning or surgical consultation in select cases

Skin quality treatments (laser, PRF, microneedling) to thicken the skin rather than adding volume

If I were in your position, I would prioritize clarity first — meaning fully understanding whether the discoloration is truly Tyndall or vascular shadowing. Repeated dissolving without a clear plan can sometimes create more inflammation, so it’s important that it’s done thoughtfully.

You are still very young, and the under-eye area can absolutely be improved — it just requires a careful, anatomy-based strategy rather than continuing the same approach that may have contributed to the issue.

Nelson Lee Novick, MD · Answer

It was difficult to say from the photo, but it did appear that there was some swelling under the eyes, as well. The swelling, if indeed present, has been termed under-eye "puffy pillows,"  and is believed to result from an inappropriate choice of filler for this thin, delicate region and/or too superficial placement of the filler, which would also account for the Tyndall Effect.  In my experience, treating this problem, which can be difficult and persistent, typically requires the use of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

29 & had filler for hollows since 19, how to reverse Tyndall under eyes? (Photo)

Answers (2)

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