Under eye nodules/lumps noticeable when I smile? (Photo)

Under-eye nodules or lumps that become noticeable when you smile, especially after a history of filler injections, can be a challenging issue to address. Here are some considerations and potential steps you can take:

### 1. **Consultation with a Specialist:**
- **Oculoplastic Surgeon:** An oculoplastic surgeon specializes in the delicate area around the eyes and may offer more targeted advice and treatment options.
- **Dermatologist with Expertise in Cosmetic Procedures:** A dermatologist who has extensive experience with fillers and complications may provide additional insights.

### 2. **Diagnostic Imaging:**
- **Ultrasound or MRI:** These imaging techniques can help determine whether the lumps are residual filler, fluid collection, or another type of tissue. This can inform the treatment plan.

### 3. **Treatment Options:**
- **Hyaluronidase Re-evaluation:** Sometimes multiple sessions are required, and different concentrations may be needed. Ensure that the enzyme was administered correctly and in sufficient quantity.
- **Steroid Injections:** If inflammation is contributing to the nodules, a low-dose steroid injection might help reduce swelling.
- **Physical Manipulation:** Gentle massage by an experienced professional might help break down any residual filler, though this should be done cautiously.

### 4. **Non-Invasive Treatments:**
- **Laser Therapy:** Some lasers can help break down filler material or improve skin texture and appearance.
- **Radiofrequency or Ultrasound Devices:** Devices like Ultherapy or Thermage can sometimes help with skin tightening and reducing the appearance of lumps.

### 5. **Surgical Options:**
- **Minor Surgical Removal:** If the lumps are persistent and significantly bothersome, a minor surgical procedure might be considered. However, this comes with risks of scarring and should be done by a highly skilled surgeon.

### 6. **Preventive Measures for Future:**
- **Avoid Further Filler in the Area:** Considering your history, it's advisable to avoid additional filler in the under-eye area.
- **Alternative Treatments:** If you seek cosmetic improvement, consider other options such as PRP (Platelet-Rich Plasma) therapy, micro-needling, or non-filler-based skin treatments.

### 7. **Long-Term Monitoring:**
- **Regular Follow-ups:** Continue to monitor the area with regular check-ups to ensure no new complications arise.

### 8. **Lifestyle and Home Care:**
- **Cold Compresses:** May help with any intermittent swelling or discomfort.
- **Proper Skin Care:** Maintain a gentle skincare routine to avoid further irritation.

### Summary:
Given the complexity of your situation and the mixed opinions from various surgeons, it might be worthwhile to seek a third opinion from a highly specialized professional. Imaging studies can provide more clarity on the nature of the lumps, and various non-invasive treatments might offer some improvement without the risk of scarring. Always prioritize a conservative approach to avoid further complications.

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 infraorbital area.
Treating this condition, which can be resistant to hyaluronidase (as you have already seen), 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.

the injected filler should be long gone. Just based on your photos only, what is present appears to be more like fat. This can be treated surgically, or new nonsurgical treatments are available for excess eye area fat.