Radiesse injection left with undereye bags. Would SmoothEye Fontana laser help? (Photo)

Question

Hello, In May of 2020, I was injected with Radiesse in my under eyes. (I now know Radiesse is not supposed to be injected there). It has been nearly 4 years and I still have eye bags. I had a thiosulfate injection which helped significantly but I still have a bag. Would a SmoothEye Fontana laser help with the bag? Is there still filler in there almost 4 years later? Please help! I have tried everything.

Anna Chacon, MD, FAAD · Answer

I’m sorry you’ve been dealing with this for so long. It’s understandably frustrating, especially after learning that Radiesse (calcium hydroxylapatite) is generally not recommended for the tear trough/undereye area because the skin there is extremely thin and the product can create persistent fullness, nodules, or contour irregularities.

The encouraging part is that you’ve already had some improvement after sodium thiosulfate injections, which suggests that at least part of the problem may have been related to residual calcium hydroxylapatite material.

Can Radiesse still be present almost 4 years later?

Yes — it is possible.

Although the manufacturer often quotes a duration of 12–18 months, Radiesse can sometimes persist much longer, particularly when:

it is placed superficially,
injected into an area with very little movement,
surrounded by fibrous scar tissue, or
used in a region that was not ideal for the product, such as the tear trough.

In many patients, what remains after several years is not necessarily pure filler, but a combination of:

residual calcium particles,
collagen stimulated by the Radiesse,
fibrosis/scar tissue, and
true orbital fat prolapse (“eye bags”) that may have become more noticeable with age.

The fact that the thiosulfate helped significantly makes me think there may indeed have been persistent calcium-based material contributing to the swelling.

Would SmoothEye Fontana laser help?

Possibly, but I would be cautious about expecting it to eliminate the bag.

SmoothEye (a non-ablative Er laser protocol) is designed primarily to improve:

skin tightening,
fine lines and crepiness,
mild lower-eyelid laxity, and
overall skin texture around the eyes.

It works best when the problem is loose or crepey skin, not when there is volume underneath the skin.

So the key question is what is creating the remaining bag:

Loose skin / crepiness → SmoothEye may help somewhat
Residual Radiesse or fibrosis → SmoothEye is unlikely to remove it
Protruding orbital fat → Laser tightening usually provides only limited improvement
Looking at your situation

Because your bag has persisted for nearly four years and improved after thiosulfate, I would place residual filler/fibrosis high on the list of possibilities.

A very useful next step in cases like this is high-resolution ultrasound of the lower eyelid. Ultrasound can often distinguish between:

residual calcium hydroxylapatite deposits,
scar tissue/fibrosis,
fluid, and
herniated orbital fat.

That information is extremely valuable before investing in another procedure.

My honest impression

Based on your history, I would not rely on SmoothEye Fontana laser as the primary treatment for a persistent undereye bag after Radiesse. It may provide modest skin tightening and improve the appearance of the overlying skin, but it is unlikely to dissolve remaining Radiesse or significantly reduce a true volume-related bag.

The persistence of the problem for almost four years, combined with the response to sodium thiosulfate, makes me more suspicious of residual calcium hydroxylapatite and/or fibrosis rather than simple skin laxity alone.

The most important thing is identifying whether the remaining fullness is residual filler, scar tissue, or actual orbital fat, because each of those requires a different treatment approach, and that distinction is what will give you the best chance of finally resolving the issue rather than continuing to try treatments that only address the surface of the skin.

Nelson Lee Novick, MD · Answer

The problem here may very be what has come to be called under-eye "puffy pillows," which is actually lymphedema/lymphatic obstruction secondary to use of an improper choice of an under-eye filler and/or one too superficially injected. I have personally had success in treating this difficult and persistent condition using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory agents. Bear in mind that so many of the expensive light and energy-based catchy-named gizmos out there are backed a whole lot more by marketing hype and social media buzz than hard science. So, "buyer beware" when considering these. You would be wise to consult with an experienced, board certified cosmetic dermatologist and best of luck.

Radiesse injection left with undereye bags. Would SmoothEye Fontana laser help? (Photo)

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