Dark diagonal patches appearing under both of my eyes. Dermal filler complication? (photo)

Question

I got tear trough filler and started noticing these dark diagonal patches appearing under both of my eyes. I was told this is just a ligament and a normal part of aging, but I’m only 28. Is this a possible complication from filler?

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. It’s understandable to be concerned when noticing changes like dark diagonal patches under your eyes after tear trough filler. While it’s true that the area under the eyes can naturally show signs of aging as we lose volume and the ligaments shift, it's also possible that the filler could be contributing to these new concerns. Tear trough filler is typically used to restore lost volume and reduce the appearance of hollowing, but in some cases, if the filler is placed too close to the skin’s surface or too deeply, it can create shadows or unevenness. The appearance of dark diagonal patches could potentially be due to filler either migrating or affecting the natural structure of the skin and ligaments beneath the eyes. It could also result from light reflection where the filler’s volume creates irregularities, causing new shadowing in areas where the ligaments or fat pads are more prominent. While this is not a typical complication, it could be more noticeable in younger individuals whose skin may be thinner and more sensitive. I hope this helps and best of luck!

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns. Dark patches under the eyes following tear trough filler can be unsettling, but there are a few possibilities to consider.

It's true that certain anatomical features, like the orbital ligament, can become more prominent with aging or changes in the skin, but at 28, it's less likely this is solely due to aging. Instead, the appearance of dark patches could be related to the filler itself. Some potential factors include:

Tyndall Effect: If the filler is placed too superficially, it can cause a bluish discoloration due to light scattering, known as the Tyndall effect.

Bruising or Swelling: Post-procedure bruising or swelling can sometimes appear as dark patches and typically resolve over time.

Shadowing: Filler placement can sometimes create or accentuate shadows, which might appear as dark patches.

It's important to follow up with the provider who performed the procedure. They can evaluate the area to determine if the patches are related to the filler and discuss potential solutions, such as adjusting the filler placement or using hyaluronidase to dissolve any misplaced filler.

Please schedule a follow-up appointment to address your concerns and explore the best course of action.

Tanya T. Khan, MD · Answer

Hello, this looks like preexisting darkening or hyperpigmentation of your lower eyelid skin that was likely present before your injections. Over time, when the under eye area is sunken, the lower eyelid skin darkens, as it is thin and adjacent to bone and vessels underneath. You will need to treat the skin hyperpigmentation topically and perhaps with chemical / laser resurfacing. Please see an experienced oculoplastic surgeon for best results.

Eric M. Joseph, MD · Answer

After HA fillers are injected to the under eye area, sometimes people can notice a bluish discoloration of the skin. That is referred to as the Tyndall effect. If this is bothering you a lot, please consider discussion your concerns with your physician. The dissolving enzyme may or may not be helpful. Thank you for this question. Since Julie, Dr Joseph

Leonard Grossman, MD · Answer

When an individual has tear troughs, an individual who is not a Plastic surgeon will frequently jump to a so-called quick fix with a filler such as hyaluronic acid. Unfortunately, hyaluronic acid fillers should not be placed into the tear trough area as it produces unwanted, bubbling, and Tyndal effect, as well as some discoloration of the skin. In my humble opinion, fat grafting produces the absolute best results and that’s me saying this after having been doing this for over 32 years. Fats contain stem cells, which help with all sorts of issues that involve the skin and not just the volume loss. I would see Dermatologist who can perhaps help with the discoloration with the use of pigment removing lasers. I hope this helps and good luck from Leonard Grossman, MD, Organic Plastic Surgery.

Dark diagonal patches appearing under both of my eyes. Dermal filler complication? (photo)

Answers (5)

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