Very Long-term issues/Disfigurement with fillers under my eyes. What is it and what can I do please? (photo)

The issue could be filler, eye fat, edema, or combination. I have a publication discussing possible benefit of lower blepharoplasty in such cases but first need evaluation by an oculoplastic specialist to determine what issue or issues are present.

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.

Hello - all very disappointing.  Although your question was posted a year ago, we'd like to chime in on feedback.  We do not like SILK in tear troughs due to the migration over time and unpredictability, and we do not ever use  Voluma or Vobella due to the difficulty in trying to dissolve the filler and the higher track record of nodules.  Fast forward to your situation, it would appear that you still have areas or pockets of filler that have not dissolved and now exposed uneven topography of the skin - peaks and valleys, if you will.  It may be hard to want to trust another injector, but we do believe there is an opportunity to blend the under eye areas with the mid face/cheeks to create a better balance and camouflage the other issues.  If you choose to do this, make sure to choose a practitioner that has good before/after photos, explains a treatment plan that makes sense to you.

Its a bit hard to appreciate the white bumps you are describing from the photo, but the hollowness in the tear troughs is apparent.  Its not terrible by any means and I think can still be addressed with filler.  In my practice I prefer to use Restylane L instead of Silk for the tear troughs.  I find it to be more predictable.  The doctor injecting you should just be very conservative and inject small amount at a time improve the volume loss without overfilling.  

I think that adding some filler to your mid and medial cheek might help improve what is bothering you. Part of the problem is from under the eyes but that sometimes improves after treating mid-face so I would fill that area first