How do I fix this filler migration under my eyes? (Photos)

Hi @Nurturing3675! 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. Another reason for the prolonged swelling can be due to that fact that too much facial filler product was used. 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.

Filler migration, swelling, and granulomas can cause significant discomfort and cosmetic ramifications. Our office specializes in the use of enzymes and filler reversal techniques without hyaluronidase to help improve the results of botched cosmetic fillers, whether caused by Juvederm, Restylane, or foreign fillers. Our plastic surgery institute provides expertise in filler removal. We begin by examining the facial fillers and assessing the likelihood of fluctuance or liquid volumization. If appropriate, we use Hylenex, or other filler reversal agents to reduce swelling and filler migration. Hylenex can be targeted into the areas of concern using multiple layered injection techniques. If the filler does not completely resolve, then additional concentrations may be employed. The technique has the potential to reduce the filler and may slightly impact normal hyaluronic acid. Treatments are repeated and results can improve immediately and with time.

Best,
Dr. Karamanoukian
Realself100 Surgeon

This can be a tricky problem to manage. It may be the filler itself, but based on where the swelling is, you may also have some swelling or lymphedema in the cheeks related to the presence of the filler. In person examination is definitely important here. Based on your photos and description, likely treatment would begin with dissolving the filler. This may take a couple of rounds. If this didn't help all the way, there are methodologies for helping the swelling to go down and smoothing out the contours of the area. Finally, once you are back to a clean slate, refilling appropriate volume in the appropriate location with fat grafting (possibly in conjunction with a lower blepharoplasty) could be done to get you to the aesthetic result you desire.