Tear trough filler - why would it last so long? My eyes are still swollen 4 years later

Without a close up photo or better still an in-person examination that allows for manipulation of the tissue, two possibilities come to mind for this issue. A condition that has come to be known as under-eye "puffy pillows" is one and the other simple persistence of filler in a location well nown for the persistent treatment response. When an inappropriate HA filler is chosen for the under eye area and/or injected too suiperficially in this region of delicate tissue the result may be "puffy under-eye pillows" (lymphatic obstruction or lymphedema)--a problem that can be persistent and quite difficult to treat. At the same time, the under eye area is also well-known for yielding surprisingly prolonged durations of response to treatment even with appropriately chosen HA fillers. While it is true that most HA fillers are gone by 12 months (and even the most robust HA fillers by 1.5-2 years), when injected in the soft tissue under the eyes, they may persist for several years. This is because two factors come into play when it comes to naturally dissolving HA fillers. One is due to the natural hyaluronidase we all have, which can be a relatively slow process. The second is due to the amount of mechanical pressure placed upon the injected filler. in particular region: the more pressure the faster the filler will break up. Under the eyes, even when we squeeze hard, there is really comparatively very little pressure placed upon the filler. Hence, in this location breakdown of the filler will primarily occur via the slow dissolution process. Additionally, Rovolax is highly cross-linked product, and therefore it will generally take even longer to be dissolved. I have had success with treating both of the aforementioned possibilities via the use of an algorithm of varying combinations, concentrations and amounts of injectable anti-inflammatory agents. I hope this helps to clarity things. Make sure to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

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​​​​