Does tear trough filler top-up create complication later? (Photos)

Thank you for your detailed question.

It’s not uncommon for tear trough filler to still be present a year after treatment, especially if hyaluronic acid-based products like Restylane or Juvederm were used. These fillers can persist in the under-eye area longer than in other parts of the face due to reduced movement and thinner skin.

If your results are not as smooth as before and you're considering a top-up, it's important to weigh both benefits and risks:

Top-ups can help refine the contour and improve volume loss when done conservatively.

However, overfilling or repeated treatments in this area increase the risk of complications such as lumpiness, bluish tint (Tyndall effect), chronic swelling, or migration.

Tear troughs are anatomically delicate, and even small changes can be noticeable.

If you’re still feeling residual filler after a year and it’s no longer giving you the desired result, your provider may consider dissolving the old filler first before re-treating. This can give you a cleaner and more predictable outcome.

You also mentioned that PRF and PRP aren't options due to your schedule, which is understandable. If you pursue filler again, make sure it's with a highly experienced injector using minimal product, ideally with a cannula to reduce trauma.

In summary:

Tear trough filler top-ups can be effective but carry increased risk if done too frequently or in the presence of old product.

Consider dissolving existing filler if it's uneven.

A conservative approach by a skilled injector is key to minimizing complications.

Listening to your intuition and comfort level is important—if you feel unsure, it may be worth reassessing your goals or seeking a second professional opinion before proceeding.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. At 32, having had tear trough filler a year ago, it's understandable that you might be concerned about the long-term effects and the potential need for a touch-up. It’s not uncommon for fillers to remain for an extended period, though they can become uneven or less smooth over time. If the filler is still present but not providing the desired aesthetic effect, a touch-up could help restore a more even appearance. However, given the complexities and potential risks associated with tear trough treatments, including migration or lumps, it's crucial to follow up with your provider in order to assess whether a touch-up is appropriate or if alternative solutions might be better suited to address your concerns. I hope this helps and best of luck!

Hello there A,
I prefer to use the 100% natural EZ Gel product in young patients tear troughs. The risk for late complications from malar edema is non-existant with this 100% natural product. On the other hand, if you have an expert physician injector place a small amount of HA filler in the proper place, your chance of late problems is very small. Good luck and be well.
Michael A. Persky, MD
Encino, CA

You are absolutely correct in your observation that the fillers are still there. We used to think that hyaluronic acid fillers dissolve away after 6 months, but we now know that HA fillers can last for decades. The reason we thought they dissolve was because when we inject areas like the lips, the effect wears off after 6 months or even less. What is happening is that the fillers just migrate. Over the years they tend to accumulate in areas that you don't want them to. The tear troughs are are very small confined space, so there is nowhere for the fillers to go and bad results can last for years or even permanently unless you get them dissolved with hyaluraonidase. You are lucky that you had a decent outcome with your first injection. Doing it again is pressing your luck. You can risk swelling that does not go away, bluish discoloration that can look like a permanent bruise and lumpiness. I appreciate your concern about PRP and PRF but if it is done correctly you can have the treatment with less down time than fillers. We now have the AutoCorre technique which uses a gel made with Plasma and PRP to give you instant results that last. The results will be very natural because the procedure stimulates your own collagen to build up the area. And you wont have the risk of dermal fillers.

I would go deep with a cannula using a low g’ dermal filler up to mid cheek groove but i really avoid that tear trough nasojugal groove as you have the angular artery there that is high risk area to inject and create vascular complications…i believe the mid cheek groove where you have “malar bag area” is where should focus on for 2nd injection. Just don’t get so close to medial canthus. Not directly tear trough area…

It is fine to get another treatment of under eye filler even if there is some filler still present. Be sure to see an expert injector for your treatment. I've included a video I hope you find helpful.