I had an under eye filler a year. Does it look like it is migrating? (Photo)

Question

I had filler place around my cheek bones to support the under eye and rid the hollowness under my eyes. I guess it’s a newer technique instead of just going into the tear troughs. It was maybe a year ago that I had it done. Does it look like it’s migrating? I’m getting a deep dimple around my nose (t-zone) that I never noticed before and seems to be get getting worse.

Nima Shemirani, MD · Answer

Hi @Imaginative9719. Thank you for sharing your photo. It does appear that there is filler migration in the T-zone. I would recommend dissolving the product with Hylenex.

Best of luck,

Dr. Nima

Nelson Lee Novick, MD · Answer

The injection of filler into the upper cheek region to support the under eye region and improve the tear troughs is not a new procedure at all. It has been used for quite a few years, after anatomical research demonstrated that lack of this support as a result of age-related volume deficit was a very important factor in the development of tear troughs. From the photo provided, the bulge under the right eye may be a late developing filler nodule, but is more likely a "puffy pillow" due to lymphedema (lymphatic obstruction) that can result when an inappropriate filler was chosen for the area and/or too superficial placement of the filler has occurred. In either case, if it is HA filler late developing nodule, then  it would be reasonable to dissolve it. And if it is puffy pillow lymphedema, it should be aggressively treated with additional anti-inflammatory agents in varying concentrations and combinations. Make sure to consult a board certified cosmetic dermatologist and best of luck.

Yao Wang, MD · Answer

Hi there, yes filler can definitely migrate. Based on your photo - you can see on the right side where there is a pocket of protrusion - this looks like filler edema. On the left it appears more smooth. You could potentially dissolve some of the filler or inject a little more in certain areas to help camouflage this. However, too much filler injected multiple times can also cause persistent edema. You will have to discuss the pros and cons with an experienced physician to see what should be done next. Hope this helps.

Christine Bokman, MD · Answer

Hi there! As an oculoplastic surgeon, I have performed thousands of injections of filler in order to address under eye hollows including the tear trough deformity (which is the nasojugal groove). Oftentimes, I place filler in the nasojugal groove (aka tear trough) directly and at the lateral orbital room if there is a hollow there. I also place it in the cheeks at the zygomatic arch to address volume loss because that contributes to under eye hollows. This cheek placement may explain why your injector put the filler in the cheeks for the under eye hollows. 
The picture sheds some light on the situtation, however, a photo without smiling is perferred as the orbicularis muscle contracts during smiling and can hide filler and under eye hollows. It does appear that there is some filler on your right in the T zone - since I can see it even with smiling. The solution would be to have a skilled injector dissolve that zone of migrated filler by using hyaluronidase, the enzyme that dissolves filler, which is made of hyaluronic acid (which most fillers are). If it does not dissolve and improve with this injected medication, then it is another filler (possibly Radiesse) or facial anatomy. I hope this helped!

I had an under eye filler a year. Does it look like it is migrating? (Photo)

Answers (4)

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