Under eye dent when smiling since I had filler in this area 4 years ago, how do I fix it? (Photos)

Question

I had under eye filler 4 years ago ever since then i’ve had a dent when smiling. I’ve consulted with a plastic surgeon about having the filler dissolved and they told me the filler was completely gone. I don’t know how i would go about fixing it.

Kenneth D. Steinsapir, MD · Answer

Provided the filler was a hyaluronic acid filler, hyaluronic acid filler will remove this. I would not just remove this, I recommend removing as much of the retained filler as you have in your cheeks. Aging filler is not helpful. It is not clear to me if the filler ever actually disappears on its own. I have seen patients with issues from services that were performed 15 years before. When you inject the appropriate amount of hyaluronidase, these issues disappear instantly. It is essential for you to see a physician or surgeon who routinely works with hyaluronidase to remove retailed filler. I tell my patients prior to starting hyaluronic acid fillers that they have a life cycle. The filler needs to be topped off at the end of 9 to 12 months but after 3 years of service, the oldest filler will begin to retain water and result in distinctly unnatural volume effects that are not aesthetically helpful, For this reason, I recommend removing all of the filler when this occurs and starting the cycle over again.  You always want the least amount of filler in your face that accomplishes your goals.

Anna Chacon, MD, FAAD · Answer

I can understand why this has been frustrating, especially since it started after your filler treatment and has persisted for years.

Even though your surgeon mentioned that the filler is no longer present, what you’re describing is something I do see from time to time. In many cases, it’s not that the filler is still there—it’s that the area has changed structurally or dynamically after the treatment.

When you smile, a few things happen all at once:

The orbicularis oculi muscle contracts
The cheek lifts upward
The under-eye area compresses and shifts

If there’s even a subtle difference in how the tissue moves—whether from prior filler placement, slight volume changes, or natural anatomy—it can create a visible indentation or “dent” during movement, even if everything looks smooth at rest.

There are a few possible reasons for this:

Residual structural change: Even after filler dissolves, the tissue may not return exactly to how it was before
Volume imbalance: A slight lack of support either in the tear trough or upper cheek can create a dip when smiling
Muscle dynamics: The way your muscle contracts may now highlight an area that was previously less noticeable
How this is usually approached

Treatment really depends on what’s causing the dent, but in general:

Very conservative filler can sometimes be used to support the area—but only if placed precisely and often not directly in the dent itself
Midface (cheek) support is often more helpful than placing more filler under the eye
In some cases, a small amount of Botox can soften the muscle pull that’s creating the indentation when you smile
If the skin is thin, improving skin quality can also make the transition smoother over time
My honest perspective

This is one of those situations where adding more filler without a very clear plan can make things worse, not better. The goal isn’t to “fill the dent,” but to rebalance how the area moves and is supported.

When I evaluate patients with this concern, I focus a lot on how the face behaves in motion—not just at rest—because that’s where the issue is showing up.

The good news is that this is usually something that can be improved, but it requires a very tailored, subtle approach rather than a one-size-fits-all fix.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photos. It is not possible to determine the cause of the bump without seeing it in person. There could be numerous potential causes. Please see an experienced oculoplastic surgeon for detailed evaluation and further guidance. 
Good luck!

Nelson Lee Novick, MD · Answer

At least from the photos and the history of filler use in the area, the problem is likely one that has been nicknamed under-eye "puffy pillows," or more specifically infraorbital lymphedema (lymphatic obstruction) likely secondarily to the use of an inappropriate choice of filler for the area and/or too superficial injection of the filler in that area. Unfortunately, it tends to be a difficult problem to treat and a persistent one, however, I have successfully treated a number of individuals 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 an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Anna Avaliani, MD · Answer

I wish you also included a photo of your eyes looking down and took a photo from below to show the under eye area when you are looking down with your eyes.It definitely looks like a filler. It would don't hurt at all to try to dissolve it a bit. You may also try little botox to the bunny lines to lessen the "bump" formation.
This will require a little bit of hand holding and not everyone is up for it. If it really bothers you, then you need to be prepared to have a few dissolving sessions and maybe will need a little bit of more filler later.
Good luck.

Darryl J. Blinski, MD · Answer

Based on the posted photos, you have significant tear trough denting that can be addressed with capital HA fillers or nano fat crafting. Best of virtual consult with. Fee from $3000 to $5000

Under eye dent when smiling since I had filler in this area 4 years ago, how do I fix it? (Photos)

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