Under eye tyndall effect 4 years after Juvederm - will Hylase correct this or should I consider more filler? (photos)

Question

I've had 1cc of juverderm (volite I believe) in 2019, with 0.1cc touch up in 2020. Nothing since. Recently I've been seeing dark undereye circles especially on the left eye again. It does appear to be the tyndall effect that's got more pronounced, presumably from the filler migrating inferiorly . Should this concern be fixed with hylase or just more touch up filler? If I do proceed with hylase, will refilling cause the same thing to occur again?

Anna Chacon, MD, FAAD · Answer

The bluish hue and shadowing you’re noticing, especially years after injection, is consistent with the Tyndall effect, often due to filler migration or persistence in the superficial tissue. Hyaluronidase (Hylase) can dissolve the old product and typically improves discoloration. If volume loss is still present after dissolution, you could consider re-filling — but using a softer filler, placing it deeper, and injecting in small, precise amounts to minimize recurrence of the Tyndall effect. Proper technique and product choice are key to preventing it from happening again.

Anil R. Shah, MD · Answer

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. The Tyndall effect, which causes a bluish tint under the eyes due to the optical scattering of light by improperly placed or overly thick hyaluronic acid (HA) filler, can be a concern with dermal fillers like Juvederm. Addressing this issue typically involves a few different approaches.

1. Using Hyaluronidase: If the Tyndall effect is due to excess or misplaced filler, Hyalase can correct the problem by dissolving the problematic filler, allowing for a clearer, more natural appearance.

2. Adding More Filler: In some cases, adding more filler might be considered to mask or counteract the Tyndall effect by improving volume and contour. However, this approach is less common if the primary issue is the Tyndall effect caused by excess filler. It’s generally a less preferred approach if the primary issue is related to the optical properties of the existing filler.

3. Other: Sometimes, alternative treatments such as laser therapy might be suggested if the Tyndall effect is persistent and problematic.

I hope this helps and best of luck!

Under eye tyndall effect 4 years after Juvederm - will Hylase correct this or should I consider more filler? (photos)

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