Dent below tear trough filler, especially when smiling. What should I do? (Photos)

Question

I had HA fillers placed in my tearthrough area by a top dermatologist in Toronto more than 6 months ago and I have had dents under the filler since. The dent is more obvious when I smile, and makes me look much older than before. I don't know what to do about it. Should I: 1-wait longer for the filler to dissolve naturally?(dermotologist said it will last a long time) 2-put more filler in the dent? (Or will that lead to more bumps?) 3-use hyaluronidase?(will that leave other dents?)

Marc DuPéré, MD · Answer

Thank you for your question and pictures.An in-office examination would confirm but I would melt your old products as it looks like the Tyndall effects (fillers injected too superficially).  Best to then start from the beginning.Options will then be fillers again (maybe with a different injector), lower eyelid surgery and fat redraping and/or a small tear trough implants.If using fillers, use a fine one and ask for the cannula technique, which is safer in this area of the face.  Plastic surgeons have been using cannula since the 1990's.Hope this helps.Kind regards,Dr. Marc DuPere, aesthetic plastic surgeon

Nima Shemirani, MD · Answer

Hi @hundrin. Thank you for sharing your photos. I recommend dissolving the filler with Hyaluronidase.

Best of luck,

Dr. Nima

Mehryar (Ray) Taban, MD, FACS · Answer

The dent is likely filler which should be dissolved. Then consider lower blepharoplasty with fat bags repositioning to both address the under eye bags and tear trough hollowness. I have published on performing this procedure in patients with previous filler like yours.

Shaun Patel, MD · Answer

First, I believe that the filler should be reversed using hyaluronidase. Then the tear trough should be reevaluated. If filler is the appropriate treatment, I would inject Restylane into the undereyes using a microcannula. The filler should be placed deep to minimize the risk of lumps/bumps, swelling and discoloration.

Ohan Ohanes, MBBCh · Answer

It looks like a filler placed superficially, it is better to be seen by a well experienced doctor in treating this area. I will recommend to dissolve the filler using hyaluronidase and reinject the area with a soft, specific filler for tear trough.

Robert Whitfield, MD · Answer

Tear trough filler placement is done in a deep plane.  It should not leave a superficial appearance.  You can wait and let this resolve.  I would have to examine you and see what happens when you smile to make any other recommendations.

Dent below tear trough filler, especially when smiling. What should I do? (Photos)

Answers (6)

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