Severe swelling and puffy bags under eyes 8 days after Bellafill in tear troughs. Is this permanent?

hi, you do appear to have a good bit of swelling.  I have been using the bellafill with great results for some time now.  But in my office a skin test is recommended and usually we have our patients return in about a week.  I don't believe your puffiness looks like an allergic reaction.  But I did have a patient who required almost three weeks to settle.  She looks great now, but she was very worried initially as well.  I would definitely reach out to your provider and voice your concerns.   If a canula was used, I find sometimes there's a bit more swelling under the eyes.  But it settles very nicely usually in about 2 weeks.  

Filler migration and granuloma formation can cause longterm problems with Bellafill and Artefill fillers. This is similar in patients who have Artecoll and PMMA fillers. Longterm filler complications include migration, edema, chronic swelling, and nodularity. If patients have filler migration or nodules, we recommend a combination approach of filler reversal with enzymes, corticosteroids, and scar tissue modulators. Our HIDEF approach can break down filler scarring and granulomas so that they are less apparent. If the filler material itself does not dissolve, it either means the filler is likely not HA material or is unresponsive to conservative therapy. This technique may be followed by surgical removal of the filler if there is a suitable target for removal and the chance of scarring is low.

Surgical removal of Bellafill is possible and we have a wide ranging experience with the treatment. Some areas of the face can be treated because the Bellafill removal scars are barely visible. We have found that Bellafill nodules, if palpated, can be removed from the tissue. Undereye Bellafill, nasolabial fold Bellafill, and lip filler can be treated successfully. Diffuse Bellafill is difficult to treat.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question. Bellafill can have side effects that include redness, itching, bruising, pain/soreness, swelling and tenderness. These side effects tend to fade within 2-4 weeks, and may be the most noticeable immediately after your procedure. I suggest that you discuss your post op recovery care with your board certified facial plastic surgeon.
Best wishes,

Its understandable that you are anxious regarding the post injection puffiness.  You likely are swollen and your situation should improve over the next two weeks.   Bellafil is a good product and serious complications are uncommon.  Rare reactions such as persistent edema or foreign body reactions can occur.  Problems such as these are delayed and can be managed with steroid injections if needed.  Most physicians using the product for tear troughs are experienced and would inject deep to obicularis muscle  to avoid complications. 

I agree with the other doctor that allergic reactions to Bellafil are extremely unlikely. The skin test for allergy is only performed in the US but is clearly not needed. The swelling caused by Bellafil is quite variable but can last several weeks. This product should be injected not with a needle but a canulla to avoid trauma and vessel perforation that could cause bruising. The ideal levels of placement in the tear trough area is under the orbicularis muscle and not on the surface of the skin. I would advise to give it a little more time to see the final result and go back for advise with your doctor.Good luck

Thank you for sharing your question and photographs.  Bellafill is currently FDA indicated to treat acne scarring and the perioral "smile lines."  That said off-label use of bellafill is very popular because of its semi-permanent effects of 5 years.  The skin patch test requires two weeks to assess any allergic response and due to its physical characteristics Bellafill is not my first line treatment for the tear troughs.  Unfortunately at this point you will have to allow your soft tissue swelling to resolve so that your long-term results will be known.  Bellafill does not have a reversal agent, so I would voice your concerns to your injector, they should be providing you with reassurances.

I don't know if I understand correctly but did you only have a 15 minute skin test? If that is the case, this was done incorrectly. It needs to be accessed after 3-4 weeks to see if you are allergic. The rate of allergy is low, about .6% but I have seen one in my practice. Having said that, this doesn't appear to be out of the ordinary swelling. I caution people about putting Bellafill in the tear troughs because there is a higher complication rate in this area - nodularity and swelling. Sleep on 2-3 pillows to help decrease the swelling. Always inject Bellafill with cannulas except in the acne scars when a needle is used.

Hi,
Thanks for the question.
I highly don't think this swelling is permanent and I believe your physician can help a lot if he/she sees you.  
Best of luck!

I am sorry that you are having this experience but be patient.  Bellafill for tear troughs is a very good treatment alternative but it can cause swelling that can last for 3 weeks or more especially if a needle was used and not a cannula.  Needles cause a lot more bleeding or trauma to the tissue and as a result quite a bit more swelling.  The issue of the skin test is not really a problem.  Reactions to the bovine collagen in Bellafill are so rare that the skin tests are not provided in Canada or S. Korea and are only provided in the US based on insistence by the FDA since the older bovine collagen used in the early 2000's did cause some allergic problems when a hypoallergenic bovine herd was not used to make to make the collagen.  I do not believe a true allergic response has been reported to the makers of Bellafill in the last 10 years.Hopefully you will get a great result but you have to give it some time.  I have added a video about fillers and their risks that may help you.Best regards.