Why is my dermal filler lumpy after over a year? (Photos)

Question

I’m a 26 year old female, I’ve had tear trough filler over a year ago and no matter how many times I massage them they have been lumpy, and honestly it looks worse than when I didn’t have filler. Should I have them dissolved and get fat transfer instead? I’m also worried fat transfer will have the same lumpy problem.

Alan Gonzalez, MD, FACS · Answer

Hello @busterr1, thank you for your question. The first step should be to check the applied product. Prior to deciding on how to improve, it is important to perform an analysis of what has happened inside the skin. For more information and recommendations, consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Hung William Song, MD · Answer

Hello, the under eye, tear trough area is probably the trickiest area to treat. Fillers are very unpredictable in this area. Lumpiness is very common as well as the Tyndall effect which can cause a bluish tinge in the area treated. I personally only use fat in this area but the fat has to be done correctly otherwise the lumpiness can be permanent. Your options are to either wait for the fillers to dissolve, it can take 2 years or more in the tear troughs, or have someone who is very experienced remove the filler with hyaluronidase. The fat transfer also needs to be done by someone who is very experienced and skilled at performing the procedure. If done correctly the fat transfer is the best treatment because it is regenerative which means, not only will the volume be replaced, the skin itself will be rejuvenated by the stem cells from the fat and the results can last for many years. If you don't have a provider who is skilled at fat transfers in your area, you might want to consider PRP, PRF, PRP gel. Using your own plasma to restore volume and regenerate collagen is the newest technique and very safe even in the tear troughs. The only problem is that it does not last as long.

Raffy Karamanoukian, MD, FACS · Answer

Filler migration and permanence is a very common problem because there are many different types of HA fillers on the market and each is specified for a specific part of the face. Use of highly cohesive fillers on thin skin may cause swelling and nodularity. If patients have filler migration or nodules, we recommend a combination approach of filler reversal with enzymes Hylenex and Hyaluronidase in different strengths to dissolve the filler. We may also need to add Kenalog to the mix in order to reduce fibrous tissue. If the filler does not dissolve, it either means the filler is not HA material or we need more enzyme. The HA reversal can be combined with other lasers and skin treatments at the same time, and it usually (usually) does not affect adjacent tissue.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Unfortunately, it is difficult to tell from the photos provided, but there is a good chance that the problem is one that has come to be called infraorbital (i.e. under eye) "puffy pillows."  These are due to lymphedema (obstruction of the lymph drainage channels) within the delicate under eye tissues due to an improper choice of HA filler for the infraorbital and/or too superficial placement of an appropriate filler choice. Whatever the cause, this problem is notoriously difficult to treat. I have fortunately had success with individuals who have come to me with this problem using varying concentrations and combinations of intralesional anti-inflammatory agents along with hyaluronidase. I personally believe it unwise to add fat injections to the mix for a number of reasons. Fat is a permanent filler and complications from it can therefore be permanent. Fat is a two step minimally invasive, relatively expensive process that requires large bore cannulas to remove the fat from the hips, belly or buttocks and to reinject with large bore cannulas to the under eye region (this also entails real downtime). Moreover, the process that all the fat will survive is seldom realized because much of the fat separated from its original blood supply does not survive, and that which does survive retains the characteristics of the location from which it is taken--meaning that if taken from the belly and belly fat develops a midriff bulge with time, so may the belly fat injected under the eyes. You would be wise to make sure that you consult an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Tanya T. Khan, MD · Answer

Looks like you are harboring some extra fluid which may be due to the filler having been injected too superficially or even the choice of filler that was injected. When the skin adopts that bluish color, it is called a Tyndall effect and usually due to superficial injection. Would definitely be worth dissolving if it was a hyaluronic acid filler that was originally injected. Be careful with fat transfers as those can be more difficult to correct if not done correctly in the first place. Please see an experienced oculoplastic surgeon for best results with your eyelids.

Leonard Grossman, MD · Answer

It is very unfortunate but this is exactly the reason why I don’t recommend having hyaluronic acid fillers placed into the lower eyelid where the filler can migrate because of the action of the orbicularis oculi muscle squeezing it. I think you should have the filler dissolved with hyaluronidase which may require more than one treatment. Once the tear trough is back, I would have it filled out with your own fat as it will provide you with permanent and natural results, as long as the procedure is done by Plastic surgeon with lots of experience in fat grafting techniques. I hope this helps and good luck from New York City plastic surgery

Darryl J. Blinski, MD · Answer

Thanks for questions and posted photos. Appears you have pre granulomae formation HA filler injected lumps. Must obtain a few sessions of HA dissolver, usual fee $500 US. After lumps dissolved or improved then nano fat grafting with PRF is what I recommend, fee $2,500. Best to virtual consult with...

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