Scar tissue/bruise from fillers in tear troughs. Not sure how to remove. (Photos)

Question

Under my right eye it's been there for years. I've been getting fillers under my eyes for years for deep tear troughs (eye circles) I've developed scar tissue under my right eye so it appears that I have a constant bruise. I would like to fix this as soon as possible but I'm not sure how.

Harold J. Kaplan, MD · Answer

Hello,As the other panel members suggested, you may have a couple of issues:1.  Tyndall effect wherein the filler product was placed too superficially and is now creating a bluish hue under the skin.  This is easily remedied by dissolving with hyaluronidase.  Sometimes the filler will migrate from under the muscle and get trapped just below the surface of the skin.  Hence, why tear trough treatments require meticulous placement of the filler.2.  If you experienced significant bruising in this area from your tear troughs, there is a condition referred to as "hemosideran staining" wherein a bruise leaves behind a stain-like brown discoloration in the tissue.  Being that bruises are self-resolving, you would not have a bruise that never dissipates.  Rather, it may be the hemosideran staining.  In this event, we use our Q-switched YAG lasers to help fade this discoloration.  We suggest a discussion with your primary injector to have his/her thoughts and options.

Shaun Patel, MD · Answer

The timing of the last treatment matters in your case. If you recently had undereye filler treatment, this bluish discoloration may represent a bruise which is expected after injections in this area and which will resolve on its own. However, if your treatment was not recently done, then this may represent discoloration related to Tyndall effect and this would probably require that some of the filler be reversed using hyaluronidase. Finally, it may also represent some chronic swelling, particularly if one of the more hydrophilic fillers such as Juvederm was used. I recommend you followup with your injector to discuss your concerns.

Richard O. Gregory, MD · Answer

The patient complains of pigmentation issues with the right lower eyelid. Having had fillers in the area she is concerned that there may be permanent bruising. Pigmentation issues with the lower eyelid are a very common complaint and can be due to a variety of causes including natural pigmentation, primarily in darker skin patients, pigmentation from fine lines causing shadows, and pigmentation due to the transparency resulting from extremely thin lower eyelid skin which then makes the circulation of the underlying muscle apparent. In addition the patient raises the question of pigmentation as a result of filler injection. Bruising usually is transient but may leave hemosiderin or blood pigments in the tissue which last a long time. Massage and topical treatments such as Arnica may help this. Certain lasers will stimulate circulation and probably be helpful also. Some of this iron blood derivative pigmentation may be permanent. There is also a possibility that filler material in the subcutaneous tissue may be causing a blue discoloration known as the Tyndall effect. Injection of hyaluronidase and even occasionally directly milking this filler material tissue can be helpful.
The photographs also demonstrate what appears to be a scar in the medial lower eyelid margin near the lacrimal punctum. Whether this could be everything to the pigmentation issue needs to be investigated. I strongly recommend that you return to your injector if a well-qualified ophthalmic or plastic surgeon to discuss the various possibilities.

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  The area appears to be bruised or something vascular and not scar tissue.  Please follow up with your board certified Dermatologist who treated you for evaluation and management such as laser therapy.  As this is around your eyes, you must be extra diligent in your safety protocols using any laser.  Regards, Dr. Matt Elias

Davin Lim, MBBS, FACD - Account Suspended · Answer

We all have our own theories and these are put forth in a logical manner, I agree with everything from Tyndall though to other causes of pigmentation - from melasma through to genetic. Scar tissue is difficult to see on the photos and best felt. Pigmentation should be examined in good lighting, it maybe due to Tyndall, but if its brown pigmentation rather than a bluish bruise, other causes of pigmentation need to be considered. The bottom line of good practice Gold standard medicine, history, examination and diagnosis. Once established we can treat. Please see a Board Certified Plastics, Occult-plastics, or procedural dermatologist for an accurate diagnosis. All the best, Dr Davin S. Lim. Brisbane. Australia.

Scar tissue/bruise from fillers in tear troughs. Not sure how to remove. (Photos)

Answers (5)

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