Under eye filler puffiness 12+ months after. Should I be concerned? (photos)

Under eye puffiness after filler injection can be due to a number of reasons. First, it can be related to the plane of filler injection that was too superficial (or close to skin) leading to the puffiness. Second, hyaluronic acid filler are naturally hydrophilic (or attracts water). Over time, it absorbs more fluid leading to puffiness. Third, the lymphatic drainage in the under eye is very delicate and sometimes, it can collect fluid that stays and will be difficult to dissipate.
My recommendation is to get an ultrasound to check if it is fluid or filler. If it is filler, the only way to improve the appearance will be to use hyaluronidase to dissolve it then reassess the outcome after 2-3 weeks and address the concern such as using other modalities such as plasma energy device or laser, and PRP.

The under eye area is a very delicate place to put fillers. If this is indeed where you were injected, you may wish to consider consulting your doctor about having the dissolving enzyme if your filler was indeed hyaluronic acid. I hope this helps. Sincerely, Dr. Joseph

If there is any filler still present you can elect to have it dissolved with hyaluronidase. I encourage you to visit with an expert injector near you to determine if filler is present. Puffiness can occur for many reasons which may not be related to filler such as allergies, stress, lack of sleep, etc.

It is not uncommon to experience some puffiness or swelling after receiving under eye fillers, especially in the days following the procedure. However, if you are noticing puffiness more than a year after the procedure, it could be due to a number of factors such as allergies, fluid retention, lack of sleep, or diet.

While occasional puffiness may not be a cause for major concern, it's important to monitor any changes and discuss them with your healthcare provider. If the puffiness is accompanied by pain, redness, or any other unusual symptoms, it's recommended to seek medical attention promptly to rule out any complications such as infection or allergic reaction.

Please consult your healthcare provider or a board-certified dermatologist for a proper evaluation and advice. They will be able to provide you with the most accurate information based on your personal health history and the specifics of your procedure.

Thank you for your question. Please note that clinical questions warrant a comprehensive clinical assessment for the best diagnosis and exploration of your issues. This will never be replaced by any form of technology. I have seen several patients who have puffiness of lower eyelid region following "filler treatment" after more than 12 months as described by patients. There are a constellation of potential reasons for this. Some patients do have residual "filler" that can be further investigated with radiological investigations such as with specific magnetic resonance imaging tests conducted by specialist radiologists who are familiar with these issues. If this is the case, dissolving the residual "filler" may help although it has its inherent potential side effects, complications as well as limitations. Other causes need to be excluded such as underlying conditions or infection. The ageing process may potentially contribute to this. It is important to take time to make a plan of treatment before deciding on any treatment. Seek advice from your general practitioner and get a full medical check up. It would be good to speak with the initial treating doctor , who performed the facial treatment, to get their advice. If you could please upload better imaging that might be helpful. Hope this helps.