Should I have my under eye filler removed, fixed, or just wait and let it go away? (Photos)

Hi Kpsony,
Restylane in the eyelid area lasts so long that you should not consider any permanent fillers. The longest patient who I have been following without a touch up injection is 7 years and still going. Another patient who I performed upper eyelid filler, which was still going strong after 7 years.  But because I developed a modified upper eyelid filler technique which was better than the technique I was using in 2009, I offered to dissolve the 2009 upper eyelid filler and update her with the newer technique.  It still dissolve easily 7 years later as if I just injected it recently.  No reason to consider permanent fillers in this area.  Fat grafting can also be considered a permanent filler, but I will discuss my thought on fat grafting in another post.
Lumps with Eyelid FillersWhen injecting fillers, getting some lumps is not unusual.   The skin and tissue in the eyelid area is much thinner than the cheeks, which is why we see eyelid filler lumps, but not in the cheeks (maybe overfilled cheeks, but not lumps.) Even though I am super careful in avoiding lumps by injecting smaller amounts, then removing the microcannula to see what it really looks like, before I add any more filler, I know based on experience that some lumps are still possible. 
I want my patients to schedule a follow up 2 weeks after the initial eyelid filling to make sure there are no lumps that I need to address.  If they are happy and don’t want to come in, then can cancel the 2 week appointment, but I like to have it scheduled in “just in case.”  For every 10 patients that I fill I expect 1-3 patients who may have some minor lumps which I want to smooth out so they have a as close to a perfect result as possible. 
If 10 patients come back for a lump, 5 of 10 can be treated with a single session of rolling the lump out with one of our cotton tip applicators (q-tip).  The remaining 5 patients may report that it looked better after the first rolling session, but some or all of the lump returned a few days later.  If they report a significant improvement, usually a second  rolling session should do the trick and they should be fine.   If they report that the lump did not improve with the first rolling session, I will try to roll out the lump a second time, but let them know there’s is a chance I will need to dissolve the lump with a very small amount of dissolver, so that we can keep the rest of the filler which we like. 
I also know that filling the lower eyelid is more art than science. As we fill the skin can swell, some people swell more, while others swell less.  I fill as smoothly as I can on the day of the filling, but I am humble enough to realize that with the variable swelling, I may miss a spot or there may later be a lump which was hidden by swelling. Knowing this can happen, I have tried so many different ways to minimize the possibility of lumps, but I can’t eliminate them completely, because the thing I’m sculpting, the skin can swell and camouflage the real result.   
If a contractor who applies smooth coat (spackle) to drywall, and tells you that they are so good that they can apply a perfectly smooth coat every single time with a single pass, would you believe him or her?  The best contractor will apply a layer sand it down, look for any thin areas, cracks or imperfections and apply another coat, sand it down again before priming and painting.  Imagine if the drywall swells variably as you are working.  When it dries there is a good chance you may need to do more sanding and maybe a touch more filling in spots, then repeat process until perfect.
Dissolving HA FillersIf any of my patients ever need dissolving sooner or later (0- 7 years or whenever) I don’t charge them for dissolving my own filler. Most injectors will dissolve their own filler for free, but charge for dissolving other injectors work. For this reason, if someone comes to my office to dissolve other injectors work, I encourage them to go back to their original injector to save money (which means lost revenue for me during that office visit) because they will likely do it for free. Also, it helps to mend their relationship, if they see their original injector at least remedy the problem free of charge, they will see that although the first injector was not a perfect at filling, they were willing to at least get them back to how they looked before the filler.  Some doctors will throw the first injector under the bus and gouge the patient for the dissolver fees, when they also know that most likely the first injector would have done it for free.  I think it is my duty to let them know they have that option.  When the dissolving is completed, the patient can come back to me if they want to or maybe give the first injector another chance.
I don’t want to get in the middle of a situation where they pay me to dissolve, then ask the original injector to reimburse them for my fees. If they tell me that they had it injected out of state or country, or the original injector retired, and it is impossible to have it dissolved by them, then I will do it immediately.
How Successful is Lower Eyelid Filling?In general, most patients do only need one session of filling which I am not expecting lumps, but if anything, they may like the slightly swollen results even more, which means they may ask for a little bit more filler to get that look.  If I “underfill” versus “overfill” the chance for lumps is lower, since I try to use as little filler as possible to fill the eye area as possible to complete the job. 
Some people who have lower eyelid hollows and bags may also have some upper cheek hollowing. The upper cheek meets the lower eyelid which is the transition point. Some people do fine will lower eyelid fillers alone, while others actually also have fat loss of the upper cheek. If the lower eyelid filler is not blended with some filling to the upper cheek, they may have the appearance of a ridge of filler on the lower eyelid hollow, but have a new transition point below that filler on the upper cheek. 
I could keep going on and on about the nuances and pitfalls which go through my mind as I perform these procedures, but it’s like asking a mechanic to explain the nuances of how a carburetor works and how to fix it in only 5 minutes. 
It may take a more than one visit to get it as perfect as I can make it, but I am not expecting the patient to be coming back every year to add more filler.  In fact, I don’t want them to think that way. If it looks good at year one or two, adding even a half syringe more of filler can make it look bad.   Imagine an injector who truly believes that the filler goes away in 9-12 months and just injects more filler every year.  The first year it looks good then each year after it gets worse.
I hope this explanation helped.  Even though your results are not optimal, at least you used Restylane.  Imagine if you used a permanent filler like Silikon 1000 or Bellafill and you had the results that you have now.  Then you would really be in trouble, how would you get the Silikon or Bellafill out?  What if the permanent filler looks good for the first 5 years then get lumpy later. Then what?  Filling with Restylane is like drawing with pencil. You can alway erase, and the pencil drawing isn’t like disappearing ink, the drawing will still be on the paper years later.  If it fades a bit, you can use a pencil and darken the drawing, or still erase parts of the picture.  Best,
Dr. Yang
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Hi kpsony! I understand your concern. If you are unhappy with your results, you can dissolve the product with Hyaluronidase. Best of luck, Dr. Nima!

If you're unhappy with your final results, you can have it reversed with hyaluronidase and try a different technique next time. See an expert. Best, Dr. Emer