Bags from filler still present after 9 years - what can be done to correct this and will more filler make it worse? (photos)

Under-Eye "Puffy Pillows," or more correctly lymphedema (lymphatic obstruction) may occur, even years after treatment with an HA filler that was either inappropriate for the under eye area and/or injected too superficially into the thin, delicate tissue of the infraorbital area. The condition can be persistent or permanent. I have had gratifying results in treating patients who have come to me with this problem using an algorithm of varying combinations, concentrations and amounts of Intralesional anti-inflammatory agents. You would be wise to consult with a board certified cosmetic dermatologist filler expert and best of luck.

It’s understandable that you’re feeling concerned about the long-lasting effects of your under-eye filler. Here's what you can do and consider moving forward:

1. What’s Likely Happening:
Filler Migration or Residual Filler: Even though fillers like hyaluronic acid (HA) are supposed to dissolve over time, some people experience prolonged effects due to filler migration or incomplete absorption. This can result in puffiness or a "bag" under the eye, which is what you might be seeing on your right eye.
Tyndall Effect: If the filler was placed too close to the skin, it can sometimes create a bluish tint (known as the Tyndall effect), which can make the area look worse over time.
2. Is This Permanent?
No, It’s Not Permanent: The good news is that if the filler used was a hyaluronic acid-based product (e.g., Juvederm, Restylane), it can be dissolved using hyaluronidase. This enzyme breaks down the filler and can help improve the appearance of puffiness or any irregularities. However, fillers that are not HA-based (like Sculptra or Radiesse) cannot be dissolved, and surgical intervention might be necessary in those cases.
3. Next Steps:
Consult a Qualified Injector: Make an appointment with an experienced injector or plastic surgeon who can assess the area and determine if the filler is still present. They might recommend using hyaluronidase to dissolve any residual filler.
Dissolve First, Then Consider Re-Filling: If you decide to have fillers again, it's often best to dissolve the old filler completely first to start with a clean slate. This way, you can achieve a more even result.
Improving Technique: For future filler treatments under the eyes, it's important to go to a provider with significant experience in tear trough corrections. Using small amounts of filler in strategic areas, or even opting for other treatments like skin tightening or fat grafting, can prevent this issue from recurring.
4. Will It Happen Again?
There is a possibility of filler migration or similar issues if the procedure isn't done correctly. However, with proper placement by an expert injector who uses the right product and technique, the risk of developing bags or puffiness again can be minimized.
Alternative Treatments: In addition to filler, some patients benefit from treatments like microneedling, laser resurfacing, or even fat transfer, depending on the specific anatomy and skin texture under the eyes.
Conclusion:
The good news is that the bag you're seeing likely isn't permanent, and dissolving the old filler is an option if it’s still present. Once dissolved, you can reassess with your provider about future treatments to achieve the results you want, ensuring a more balanced and smooth appearance.

It’s essential to work with a provider experienced in under-eye treatments, as this is a delicate area and requires precise technique to avoid further issues.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It sounds frustrating to deal with that lingering issue under your eye. The first step would be to consider dissolving the filler in that area. Using hyaluronidase can effectively dissolve hyaluronic acid fillers, which might help reduce the appearance of the bag. After dissolving, you can evaluate the area for any further treatments, like new filler or other options, but it’s essential to wait until the area is fully assessed post-dissolving. As for getting filler again, if done carefully and by a skilled injector, the risk of a similar issue can be minimized, but it’s always important to have an open discussion about your past experiences and concerns. I hope this helps and best of luck!

Dealing with persistent under-eye bags from filler can be concerning, especially when they have lasted for several years. Here are some steps and considerations for addressing this issue:

Consultation with a Qualified Dermatologist or Plastic Surgeon: It's essential to consult with a professional who specializes in cosmetic procedures. They can assess your situation in person and provide tailored advice.

Hyaluronidase Treatment: If the filler used was hyaluronic acid-based, an enzyme called hyaluronidase can be injected to dissolve the filler. This procedure can help reduce or eliminate the under-eye bags caused by the filler.

Alternative Treatments: If hyaluronidase is not an option, or if the filler is not hyaluronic acid-based, your doctor might suggest other treatments such as laser therapy, microneedling, or radiofrequency to improve the appearance of the under-eye area.

Risk of Further Fillers: Adding more filler to the area could potentially exacerbate the issue. However, in some cases, a skilled practitioner may be able to strategically place additional filler to balance the appearance. This decision should be made cautiously and only after a thorough evaluation.

Surgical Options: In some instances, surgical intervention such as blepharoplasty may be recommended to address persistent under-eye bags.

Avoiding Recurrence: If you decide to try fillers again in the future, ensure that you consult with a highly experienced practitioner who can carefully assess your facial anatomy and choose the appropriate type and amount of filler.

It's important to address these concerns with a professional who can guide you through the safest and most effective options based on your specific needs.

Best regards,

One option to treat the under eye area is fillers. This could give volume to the hollowness and improve the look of the under eye. Another option is AccuTite. This minimally invasive procedure uses RF technology to tighten skin and improve the overall look of the under eye. See a provider near you or my website to learn more.

Over 9 years an HA filler will have dissolved. So although it may have been from the filler initially, if in fact an HA filler was used the body should have cleared that. There can be inflammatory nodules that develop post treatment which may have been the case this time. It would be useful to have the dermatologist/plastic surgeon who performed the procedure evaluate for additional options.

Unfortunately, hyaluronic acid fillers in the lower eyelids can last almost a lifetime.. For that reason you have to have a dissolved with hyaluronidase. Once the filler is fully gone, I would consider fat transfer for the best possible results. It may take more than one treatment of hyaluronic is for the best outcome. I hope this helps and good luck from Leonard Grossman MD organic Plastic Surgery.