Indent above cheek after under eye filler. Can anything be done to fix this? (photo)

Hi @Tammy32587. Chances are the filler was not placed in the proper tissue plane. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. The filler products that are preferred to treat this area will have some degree of affinity for water molecules so all of these products will exhibit some degree of hydration and swell once injected into the body. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by hyaluronidase injections. All the best, Dr. Nima!

An in-person, up close and personal examination is best for evaluating this situation, but the appearance and history of prior filler injection and the subsequent presentation suggest what has come to be called the "pale puffy lower eyelid pillow." The overlying puffy pillow is actually responsible for the appearance of the "dent" below it. If so, the use of hyaluronidase +/-triamcinolone and 5-FU in varying amounts and concentrations can help to remedy this problem You would do well to make certain that you consult with an experienced, board certified dermatologist. Best of luck.

Good morning! Thank you for your question. While unpleasant and definitely not the goal, it is not totally uncommon for the zygomatic cutaneous ligament to be affected after having the under eyes injected. This gives a sort of "pulling" or indented look when one smiles. There are a couple of ways to remedy or at least camouflage this issue. The first is to inject additional filler under the ligament. This sometimes does the trick. Otherwise, the other option would be to dissolve it and start from scratch. I'm so sorry that you did not get the result you were hoping for, and hope you are able to have it resolved soon. Good luck!

Dear Tammy,
Thank you for sharing your photos. Under-eye filler is amazing when it works well but it is a very difficult area for fillers, for many reasons. The thin skin in this area is very unforgiving for a lot of patients. Additionally, patients that have slow metabolism of the filler, migration / lymphatic blockage or granuloma formation (depending on what filler) can occur. This is why an in-person visit is absolutely critical for accurate diagnosis. One of the first treatments to try to mitigate or resolve these issues is to use hyaluronidase to dissolve any remaining filler (at the bulging area usually); however, again, I would find a provider for an assessment to determine if that is appropriate.

Thank you for your question! I would suggest going back to your injector and having them place some hylenex to dissolve any remaining filler that might be there. If that doesn't help at all you may have developed a festoon which is a pocket of fluid. You can try massaging the area and icing it to displace the fluid build up. Hope this helps!

Hi Tammy, it looks like you are experiencing malar edema. This is not an uncommon side effect and is more likely to happen when an injector places the filler too superficially, too much filler, or places filler in a patient who had visible eye bags prior to the procedure. I would recommend visiting the injector who placed the filler and ask them for a course of steroids to help with the inflammation, and inquire about dissolving some of the filler. Malar edema can be tricky to treat and does not resolve with massage. Often, dissolving is the best practice. I hope that answer helps.

Best to see injecting MD in person to dissolve some of the filler. Or try release by minor surgery the indented skin fold under local anesthesia with nano fat grafting.