Dermal filler - my face was overfilled under my eyes. What can I do? (Photo)

Question

Hi, I need some help. I had filler done in my cheeks and face in November. My face was overfilled under my eyes. I had the filler dissolved but under eyes are swollen, i have a ridge and eyes are smaller appearing, dark circles now which ive never had before. Ive been back twice since with no help. Can you help me i dont know what to do and i loole horrible

James M. Economides, MD, FACS · Answer

I'm really sorry you're going through this—it sounds incredibly frustrating, especially after trying to fix the issue with multiple visits. Here are a few possibilities and steps you can consider:

1. Post-Dissolving Swelling (Hyaluronidase Reaction)
Swelling from Hyaluronidase: It’s possible that your under-eye area is reacting to the hyaluronidase used to dissolve the filler. Swelling and puffiness can sometimes occur, especially in delicate areas like under the eyes. This can take time to resolve but should improve gradually.
Inflammatory Response: Some patients experience a mild inflammatory reaction after filler dissolution, which may explain the persistent swelling and the appearance of a ridge.
2. Residual Filler or Over-Dissolution
Residual Filler: In some cases, not all the filler gets dissolved, especially in tricky areas like the under-eyes. This could cause unevenness, such as the ridge you mentioned.
Over-Dissolution: On the other hand, it’s also possible that too much filler was dissolved, leading to a hollow appearance and exacerbating the look of dark circles or small eyes.
3. Dark Circles and Swelling
Temporary Pigmentation: Swelling can sometimes stretch the skin, causing shadowing or dark circles, especially if there’s fluid retention. This should reduce as the swelling goes down.
Thinner Skin: The dissolving process can sometimes make the under-eye skin appear thinner, making dark circles more noticeable. If there’s residual inflammation, it might also be affecting the skin's texture and color.
Steps You Can Take:
1. Gentle Care and Patience
Give your skin time to recover from the dissolving process. Inflammation and swelling can take weeks or even months to fully resolve, especially under the eyes where the skin is delicate.
2. Consult with a Specialist
Second Opinion: If you feel like your current provider hasn’t been able to resolve the issue, it might be time to seek a second opinion from a board-certified dermatologist or plastic surgeon who specializes in filler complications. They can assess whether more hyaluronidase is needed or if another treatment would help.
3. Treat the Swelling
Topical Treatments: Applying cold compresses and using mild, non-irritating eye creams with anti-inflammatory ingredients like caffeine or peptides can help reduce swelling.
Lymphatic Drainage Massage: A professional lymphatic drainage massage can help reduce any fluid retention, improving the swelling under the eyes.

Nelson Lee Novick, MD · Answer

Under-Eye "Puffy Pillows," or more accurately lymphedema or lymphatic obstruction has been well described as resulting soon after or even long after the injection of a filler inappopriate for use in the infraorbital region and/or too superficially injected in that region. It tends to be a difficult and persistent problem. However, I have had gratifhing result in treating patients who have come to me with this issue using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Camille Cash, MD · Answer

If you recently had the filler resolved you may be experiencing swelling from that treatment which should improve with time.  If you are not finding answers with your current injector you may wish to visit another expert injector near you for a second opinion.  The other option is to wait for the filler to dissolve on its own.

Nuket Eroglu, MD · Answer

Hello; First of all, you are so young and beautiful. I'm so sorry about your detentions. It is unnecessarily deformed. The enzyme, that breaks down the Hyaluronic Acid filler, which we call Hyaluronidase, also damages our own tissue. Therefore, as it breaks down the natural Hyaluronic Acid, it collapses the area where it is made; disrupts it's metabolism and darkens it. If you waited for the fillers to melt on their own, your skin would not be deformed. The best step, to take after this situation is to get appropriate precautions to repair and lift your under-eye area. In this case, I will recommend for you Thermage FLX and Nucleofil. Thermage FLX method is a monopolar radiofrequency system. It creates a natural collagen rise around your eyes. It is a single session. It's effects remain for many years. Addition for these, when you have Nucleophile, you will get benefit from repair and repair molecules as well as a slight feeling of fullness. You will be seen much better after a few months. Please don't become discouraged. I do not advise for you having fillers in any way.

Drew Varano, MD · Answer

A before photo would be ideal for comparison .It appears you have hemosiderin staining which the iron pigment from the blood gets into the skin and can cause brown or darker staining . If you bruised from the treatment this is a likely senerio . This usually goes away with time &  normal skin cell turnover but can take several months. Anything that helps with skin cell turnover ( retinol , microdermabrasion, exfoliation) will speed up the process but being under the eyes is a delicate area. Q-switch lasers can also help but again the location near the eyes is challenging issue itself .
It also appears you have an iatrogenic malar  mound /festoon which occurred when the filler is placed too superficial or in a spot that is blocking the lymphatic chain . It may take several rounds to dissolve this as certain filler products are more difficult to dissolve that others, or just time as the lymphatics will repair internally.  I believe there is a photo of Kylie Jenner who had the same issue

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