Tear trough filler looks worse What would cause this to happened? I had filler under eyes in February. (photo)

Question

What would cause this to happened? I had filler under eyes in February. It never looked better afterwards. I went to a board certified plastic surgeon. Afterwards, I had odd vertical lines along the sides of my nose when looking down and the bags under my eyes look worse than before. He used 1 ml of Restylane.

George Volpe, MD · Answer

Although it is difficult to fully answer this question without a good exam and without knowing exactly what was injected and where, if one has fullness in the tear trough area or just below, there may be too much hylauronic gel. Unfortunately in this location on the face, it can take quite a while for this to subside. This may be an indication for treatment to remove the filler material if it is felt that is the cause by your surgeon. This could be done with hyaluronidase injections. Sometimes, it can be performed simply with just a small needle incision and the product milked out of the area. It is important to discuss this concern with your injector.

Nima Shemirani, MD · Answer

Hi @PrimroseCA! There are a few reasons for this swelling. One being that the filler was not placed in the proper tissue plane. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Another reason for the prolonged swelling can be due to that fact that too much facial filler product was used. Hyaluronic acid facial filler products can be dissolved by hyaluronidase injections.

Azita Madjidi, MD, MS, FACS · Answer

Lower eyelids and tear trough areas are not ideal areas for fillers for this reason. It's a delicate area and irregularities show very easily. Even trying to dissolve the filler may not get rid of this or make it worse due to the inflammation caused by the reaction. Best would be to wait until it is absorbed by your body. I personally prefer fat to fillers but that is a different topic.

Nelson Lee Novick, MD · Answer

Unfortunately, it appears that filler may have been misplaced and will need to be dissolved with hyaluronidase. Even before the FDA approval of Restylane Silk, experienced injectors would often dilute regular Restylane before injecting it under the eyes to miminize lumps, bumps and the unwanted, bluish/gray Tyndall Effect that was common when it was injected into the delicate, thin under eye tissues. Nowadays, I prefer Belotero Balance for this region, since its smoothness and cohesivity work well under the eyes. In my Israel satellite facility, where a far greater number of regulatory agency approved fillers are available, I opt for Teosyal Redensity II or Neauvia GB. Make sure that you consult with a board certified aesthetic physician and insist upon seeing his/her personal before and after photos before agreeing to proceed. Best of luck.

Camille Cash, MD · Answer

I'm sorry you are unhappy with your filler treatment.  It appears the product was not placed correctly.  You may want to have it dissolved with hyaluronidase.

Melvin Elson, MD · Answer

It appears there was overcorrection and misplacement of the material and you may need hyaluronidase injection to remove it, wait 6 weeks afterward and have it redone if you want.

Tear trough filler looks worse What would cause this to happened? I had filler under eyes in February. (photo)

Answers (6)

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