How can I fix under eye area issue that was caused by tear trough filler 4 years ago? (Photo)

It’s understandable to feel frustrated when something still doesn’t look or feel quite right years after filler, especially in such a delicate area like the under eyes. Even when filler has been dissolved, it’s possible for tiny remnants to persist, or for the tissue to have changed slightly in response to the filler or the dissolving process. Sometimes this can leave behind mild swelling, uneven texture, or a bit of tethering in the skin that’s hard to capture in photos but noticeable to you.

There are a few gentle approaches that can help improve the appearance and texture over time:

Repeat hyaluronidase treatment – occasionally, a small amount of filler remains even years later, and a careful touch-up with dissolver can help.

Microneedling or radiofrequency microneedling – helps remodel collagen and smooth out irregularities or firmness in the area.

PRP (platelet-rich plasma) – can restore natural volume and tone by improving tissue quality rather than adding synthetic filler.

Laser resurfacing – for any unevenness, discoloration, or fine lines that developed after the procedure.

You’re not imagining it — subtle post-filler changes can be real, even if they’re hard to see under certain lighting. The best approach is to treat this conservatively and focus on restoring balance and texture, not adding more filler.

Thank you for your question.It is likely that the under-eye filler has not completely dissolved, or a mild fibrotic (scar-like) tissue reaction has developed in the area.This is not a permanent condition; with proper evaluation and, if necessary, ultrasound-guided targeted treatment, it can be corrected.
Using high-frequency ultrasound, it is possible to accurately determine whether any filler residue remains in the tissue.If residue is detected, a very low dose of hyaluronidase can be carefully injected to dissolve the remaining filler.However, excessive dissolution may lead to hollowing (volume loss), so this procedure should only be performed by an experienced specialist.
If no filler remains, treatments such as mild microneedling combined with PRP or low-energy radiofrequency (RF) can help regenerate the tissue and smooth out surface irregularities.These methods stimulate the remodeling of the subdermal tissue, promoting a smoother and more natural appearance.Wishing you all the best,

It is very difficult to give you any advice based on the photograph alone. You really need to see a plastic surgeon in person and let them examine you very carefully. You may still need to have a very small amount of hyaluronidase administered to the area. Then wait a few weeks and replace it with some fat and stem cell grafting. That should hopefully resolve the issue. I hope this helps and good luck from Leonard Grossman, MD, organic plastic surgery New York City.