Tear trough edema: 3 rounds of Hyaluronidase done but nothing changed. What can I do? (Photo)

Question

Had a tear though filler in June 2022 with high density hyaluronic acid. Since then, I have reddish marks under both my eyes at rest, and when smiling or frowning two big lumps under both my eyes. Since January 2024 I’ve gone through 3 rounds of ultrasound guided hyaluronidase per eye, 12 Units every round, to little or no avail: lumps are still quite noticeable in backlights. Ultrasound shows no more nodules, but “there could be more in eye socket”. What else could be done?

Kenneth D. Steinsapir, MD · Answer

The role of ultrasound in managing late onset edema is primarily for research. Here is the issue, it is very clear what is affected by edema. The edema is caused by the filler. One does not need the imaging tool to tell you where the filler is. The big problem here is the woefully inadequate dose hyaluronidase. You received 36 units of hyaluronidase. I would likely recommend 300 units including placement of enzyme behind the orbital septum, and advise you that you might benefit from a second round of 300 units of hyaluronidase. Your well meaning injector does not know what they are doing in my opinion.

Nelson Lee Novick, MD · Answer

I have answered many questions about this condition already on RealSelf  Under-Eye Puffy Pillows, or, more accurately infraorbital lymphedema (lymphatic obstruction) can come about as a result of the use of too superficially placed filler and/or the use of an inappropriate choice of filler for the area. 
Treating this condition, which can be resistant to hyaluronidase, can be difficult and the problem can be persistent. I have had success treating this condition 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 filler expert and best of luck.

Tear trough edema: 3 rounds of Hyaluronidase done but nothing changed. What can I do? (Photo)

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Everything you need to know about Hyaluronidase

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Tear trough edema: 3 rounds of Hyaluronidase done but nothing changed. What can I do? (Photo)

Answers (2)

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Recommended reading

Everything you need to know about Hyaluronidase

Our mission is to create a world where every investment in modern beauty is Worth It.