The puffiness, which is believed to result from under eye lymphatic obstruction (lymphedema), is likely due to inappropriate choice of HA filler for the very delicate under eye area and/or too superficial placement of the filler. It is admittedly a very difficult problem to treat and many say impossible, even following surgery. The bulge is the lymphedema and the dent is much a like a valley created by the puffiness below. I have had success in shrinking this using very high concentrations of hyaluronidase accompanied by high concentrations combined with high concentrations of certain intralesional anti-inflammatory agents. Just one week ago, in fact, I was able to achieve a dramatic flattening under one eye of a patient who came to me and this coming week will be doing the other under eye puffy pillow. Make sure that you consult an experienced, board certified cosmetic dermatologist. Best of luck.
