What am I dealing with here? Old filler? Fluid retention? Anatomy? - How can I improve the under-eye/malar fullness? (Photos)

Question

37F with prior tear trough filler placed about 2 years ago that caused persistent under-eye/malar fullness. I’ve had several conservative dissolving sessions with no improvement, but still notice a soft contour/fullness in the upper cheek/malar area that can look really noticable in certain lighting and photos. This hasnt really happened until I got that under eye filler and since then ive just been dealing with it hoping it goes away. Ive since had another dissolver session a week ago where they said maybe going deeper would help but now it still looks the same but maybe almost worse since the surrounding filler has been dissolved and this pad is more noticnoticeable. Im just tired of looking at them and looking tired because of it. Not sure what my options are. It looks better when I pull my face back but I think 37 may be too young for a face lift but if anyone has any ideas if its not actually filler.

Thomas A. Mustoe, MD, FACS · Answer

Unfortunately you have a difficult problem without reliable solutions. I have seen filer underneath the eyes result in persistent swelling which is fluid accumulation and has not resolved with dissolving the filler probably because not all of the breakdown products from the filler are eliminated and the residual trace amounts trace amounts result in chronic low grade inflammation.   The malar area is particularly prone to visible fluid accumulation.

I avoid filler in this location: although your condition is uncommon I have seen it many times. Laser has been used in some cases to tighten the skin with some success and surgical solutions have been utilized with occasional success bit that wouls only be misdeed for more severe cases. I Woukd be hopeful that over several years it would improve

Semih Yildiz, MD, FEPOBRAS · Answer

The photos show fullness mainly at the lower eyelid-upper cheek junction, but photos cannot tell whether this is residual filler, malar edema, or your underlying midface anatomy. A facelift would usually be too aggressive for this type of localized concern, especially at 37, unless there are separate lower-face findings on examination.

At this point the useful step is not more blind dissolving, but a careful in-person assessment, ideally with ultrasound if hyaluronic acid filler was used. If filler is still present, targeted hyaluronidase may help; if the fullness is edema or anatomy, more filler can make it worse and treatment may involve time, reducing inflammation, lower eyelid/midface evaluation, or other tailored options after exam.

Darryl J. Blinski, MD · Answer

Most treatments are not successful. Recently using the Endo laser under local anesthesia in 2-3 sessions with 50%+ improvement. Fee per session $1,800. Best yo virtual consult with

What am I dealing with here? Old filler? Fluid retention? Anatomy? - How can I improve the under-eye/malar fullness? (Photos)

Answers (3)

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