Am I a bad candidate for undereye fillers?

Question

Hi. I got under eye fillers, RHA4, and months later I had the tyndal affect, and it seems like the filler is not fully gone, even 2 years after having gotten it. I was told it's because of bone loss, so as time has gone on, the filler doesn't have bone to sit on, so it stays in the tear trough. As well, I was told that it has been realized that fillers can stay under the eyes for many years. Does that make me a bad candidate for under eye fillers?

Anna Chacon, MD, FAAD · Answer

You’re not a “bad candidate,” but your experience highlights how delicate the under-eye area is when it comes to fillers. The skin here is extremely thin, so even subtle product placement issues, natural changes like bone loss, or the long-lasting nature of fillers can create visible effects such as the Tyndall effect.

What you’ve been told is correct — filler can remain under the eyes for years, especially in this region where there’s less natural movement to break it down. That doesn’t mean you can’t ever have under-eye fillers again, but it does mean that treatments must be done with extra caution. Sometimes dissolving the old filler first and reassessing is the safest path.

Many patients with similar concerns can still benefit from under-eye rejuvenation, but it may involve alternative approaches such as different filler types, smaller amounts, or even non-filler treatments like laser or skin tightening depending on your goals.

You’re not alone in this — the key is tailoring the treatment carefully to your anatomy and history so you can still achieve a refreshed, natural look without repeating the same issue.

Shanthala Shivananjappa, MD · Answer

Under-eye filler procedures can be complex, especially when factors like age, bone loss, fat loss, skin laxity, ligament elongation, and muscle condition are involved. Most patients often need surgery rather than fillers. Only a small percentage of people will benefit from under-eye filler, and it must be done by highly experienced hands, not just anyone who does dermal fillers. Remember, these are advanced procedures, so don’t assume that anyone who can do fillers can effectively handle under-eye fillers. I recommend seeing an experienced oculoplastic surgeon for a thorough evaluation before considering another under-eye filler treatment.
Best wishes 
Dr.Shanthala

Camille Cash, MD · Answer

It's difficult to determine if you would be a good candidate for under eye fillers without an examination.  I would encourage you to visit with an expert injector near you for an evaluation.  Just because you had one bad experience with results from a prior treatment does not mean you are no longer a candidate.  I've included a video I hope you find helpful.

Leonard Grossman, MD · Answer

You’re absolutely correct, hyaluronic acid fillers can stay in the lower eyelid or tear trough area for generations. That is exactly the reason why I don’t recommend that these fillers should be placed into the lower eyelid area. In my opinion, only fat grafting should be performed to the lower eyelid and tear trough area. in patients who have tyndal effect or exhibit a bubble in the lower eyelid area, should have the hyaluronic acid dissolved and replaced with fat grafting. I hope this helps and good luck from Leonard Grossman empty organic Plastic Surgery.

Am I a bad candidate for undereye fillers?

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