Help to remove under eye dents caused by tear trough filler (Photo)

Hi @Compassionate653691! I recommend dissolving the area with Hylenex. It appears that your tear trough filler was not placed in the correct plane. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular.

Fillers like Belotero, Volbella, and Restylane Silk are good for improving under the eyes, but keep in mind that a combination approach will give the most improvement. My patients try to get non-surgical treatments to avoid surgery, so we use fillers, lasers, microneedling/PRP and stem cells. I suggest consulting with an expert to develop a treatment plan best suited for you. Best, Dr. Emer​​​​

From the photos it is very possible that what is being seen are under eye "puffy pillows" (actually lymphatic obstruction, lymphedema) and the indentation that is disturbing is actually not the problem but is the result of bulge above it that worsens with smiling. "Puffy pillows," which are typically very difficult to treat may result when an inappropriate filler is used for the tear trough region and/or is injected too superficially. Unfortunately, the problem is seldom improved by the use of simple hyaluronidase, as appears to be the case here. I have had success with patients who have come to me for this using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. Best of luck.