Filler in my tear trough dissolved, but still puffy (Photo)

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. I'm sorry to hear about your experience. Persistent puffiness after filler dissolution can be frustrating. It’s possible that your lymphatic drainage could be affected, especially after issues like rhinitis and sinusitis. Chronic inflammation can sometimes lead to fluid retention or changes in tissue. I recommend trying microneedling or PRP. These treatments can improve skin texture and circulation, potentially aiding in lymphatic function. Additionally, in some cases, surgery (like lower eyelid blepharoplasty) may be recommended to remove excess tissue or fat. I hope this helps and best of luck!

Thank you for providing the history and photo — it helps clarify your situation.

Even after hyaluronic acid (HA) filler has been fully dissolved, residual puffiness can persist due to a few possible reasons:

Lymphatic congestion or damage: It’s possible that the filler or your history of rhinitis and sinusitis may have impaired local lymphatic drainage, especially in the delicate under-eye area. This can lead to fluid retention or a swollen appearance that mimics filler, even when imaging confirms it’s no longer present.

Tissue changes post-filler: Repeated filler injections and dissolutions can alter the natural contour and elasticity of the skin and soft tissue, sometimes leaving behind uneven texture or swelling due to chronic inflammation or fibrosis.

Anatomical factors or fat pad prominence: Aging or inflammation can cause the fat pads under the eyes to become more visible or displaced, especially after the temporary volumizing effect of filler has been removed. This can create a “puffy” look even without active swelling.

As for plastic surgery, options may include:

Lower blepharoplasty, which can remove or reposition excess fat and tighten loose skin

Fat grafting or micro-fat injections to restore smoother contours if tissue volume was lost

In some cases, microneedling with radiofrequency or fractional lasers can help with texture and mild puffiness

Before surgery, conservative approaches like lymphatic drainage massage with an experienced specialist, or even trialing certain medications or non-surgical modalities (e.g., ultrasound or RF-based therapies), might be beneficial.

You’ve taken a thorough and thoughtful approach so far — and while your MRI and clinical steps rule out many concerns, the remaining puffiness is likely due to structural or drainage-related changes rather than residual filler.