Intermittent swelling 5 years after tear trough filler. I can feel hard tender nodules when it occurs then it goes away (Photo)

What has been termed "Under-Eye Puffy Pillows" is actually lymphedema or lymphatic obstruction secondary to the too superficial placement of a filler under the eyes and/or an inappropriate choice of filler for the infraorbital region. The problem can start either shortly after treatment or may appear much later. It tends to be a persistent problem and, unfortunately, a very difficult problem to treat. I have, however, had gratifying results when treating patients who have come to me for this using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. You would be wise to consult an experienced, board certified cosmetic dermatologist and best of luck.

Hyaluronic acid filler in the tear trough area doesn't seem to metabolize very quickly. It's safe to say that I have seen this many times before. The filler needs to be dissolved with hyaluronidase. I dissolve far more filler in this area than actually inject it. Tear trough filler is a Class C procedure; it's heavily over-utilized and can have problems for far longer than anticipated.

Swelling and formation of hard, tender nodules years after tear trough filler treatment can be due to a few reasons. One possibility is that it could be a delayed hypersensitivity reaction to the filler material. Another possibility is that these nodules could be granulomas, which are inflammatory reactions that can occur in response to foreign material in the body.
It's important to note that these symptoms should not be ignored, especially if they are recurrent. It's recommended to consult with the physician or dermatologist who performed the procedure or another qualified healthcare provider. They can evaluate the area, possibly using ultrasound or another imaging technique, and determine the best course of action. This may include treatments such as corticosteroid injections, hyaluronidase injections if the filler was hyaluronic acid-based, or in some cases, surgical removal of the nodules.
Remember, it's crucial not to try and self-diagnose or self-treat these issues. Always seek professional medical advice.