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.

If you're concerned by under eye fullness from HA filler, having it dissolved with hyaluronidase makes sense. The best way to proceed after that may depend on how you look once your HA is dissolved. If you have before AND after photos, please consider re-asking your query. Thank you. Dr Joseph

Under-Eye Puffy Pillows in the area of cheeks below the lower lids can occur following the use of an improper choice of HA filler and/or the filler having been injected too superficially within the delicate under-eye tissues. If this is indeed the problem here, this can be a troublesome, persistent and difficult--to-treat problem, since it relates to lymphatic obstruction, lymphedema. Unfortunately, the use of hyaluronidase alone seldom works. I have had a fair measure of success in shrinking these lumps using an algorithm of intralesional anti-inflammatory agents in varying combinations, concentrations and amounts. Make sure to consult with an experienced board certified cosmetic dermatologist and best of luck.

You need based on the posted photos Hylenex injections in a series of 2 months of visits for serial injections. Then after 3 months healing nano fat grafting can be offered.

I have been saying that hyaluronic acid should not be injected into the lower eyelid area for the last 25 years. Adding another filler on top of the one that caused any regularity does not solve the problem, but can in fact compound it. You definitely need to have hyaluronidase injected into the area in a series of treatment in order to dissolve the hyaluronic acid alone and not your own tissues. This is a careful process and should be done by an experienced plastic surgeon . Once the hyaluronic acid filler is dissolved, you should wait a few weeks and only then undergo fat grafting, which should produce natural and practically permanent results. I hope this helps and good luck from New York City Plastic Surgery.

Without an exam and knowing what you were like before, it is difficult to give definitive answers. However, it appears that your filler was don by a non-expert with the filler placed in the wrong place. Your problem may have even worsened. Hyaluronidase may help, but the main thing you need is filler placed properly. Make sure you see an expert in the area next time.