Under eye filler issue. Is it overfilled? Placed wrong? (Photo)

Question

Hi I'm just trying to educate myself on what went wrong with my filler. I had tear trough filler with revance. She inserted with both a cannula and needle. Where she did the needle lies my issue in my left eye. It kind of looks like I have a worm made of filler under my eye. I'm going back for a second "tweaking" tomorrow. Is this overfilled? Placed wrong? Aside from that, the darkness under my eyes is significantly better. Also had terrible Syringoma treated with Morpheus8 - which helped.

Jeffrey Lisiecki, MD · Answer

I see two main problems here.  It looks like the filler was placed too superficially, which is why you can see that "worm" of filler.  The second problem is with the choice of undereye filler as a treatment.  You have volume loss in your cheeks, which should be addressed before considering undereye filler (with either fillers or fat grafting), and your undereye anatomy looks like it would be more suited to a lower blepharoplasty than undereye filler based on the photos you have sent.

Hung William Song, MD · Answer

That little "worm" that you are seeing is the filler under your skin. This is why filler under the eyes is very tricky. The skin is very thin so any irregularity will be very apparent. Hopefully the Revance product used was Redensity which is very thin and may integrate into the skin. You may need to have it dissolved if it does not resolve after about a month. I like to use natural collagen stimulators like PRF or PRP gel or autologous fat in this area because there is less risk of these kind of issues.

Jason Emer, MD · Answer

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.

Nima Shemirani, MD · Answer

Hi @Fantastic1831. 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. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by hyaluronidase injections.

Best of luck,

Dr. Nima

Best of luck,

Dr. Nima

Jeffrey H. Spiegel, MD · Answer

Undereye fillers are the perfect solution for undereye hollowness when your skin is nice and tight. As we get older and our production of collagen and elastin decreases it's time to use additional modalities like IPL and Morpheus to tighten the skin under the eyes. If you are further along with thin skin and undereye bags or hollowness it may be time for a small office procedure called blepharoplasty. 
My recommendation is to go back to your doctor and inquire about a small injection of hyaluronidase to open up the filler placed under the eyes spread the filler and start working on tightening the skin. The situation is salvageable.

Stephen Prendiville, MD · Answer

The answer isn't something that you may want to hear and some of my colleagues will disagree with: under eye filler is a Class D procedure.  I dissolve far more filler in this area than I actually put in.  It's the wrong solution to the lower periorbital area in terms of the aging process.

Robinson Facial Plastic Surgery - Alpharetta · Answer

Hi there! Thank you for your question. This could possibly be a little accumulation of filler in that area, or it may just be a little too superficial. If it was not done too long ago, within 2-3 weeks, it can typically be massaged and smoothed out fairly easily. If it has been a long time and the filler has set, a little dissolving agent can be injected into the area to smooth it out. 
I hope this helps and wish you the best!

Camille Cash, MD · Answer

From the submitted photos it appears the filler was placed too superficially.  It also appears that in addition to loss of volume under the eye there is skin laxity.  You are a good candidate for a lower blepharoplasty if you are considering surgical options.  The results would be superior and longer lasting.  I've included a video that I hope you find helpful.

Under eye filler issue. Is it overfilled? Placed wrong? (Photo)

Answers (8)

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