27, filler & Hylenex complication with eye cheek junction & permanent fullness, options? (Photos)

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

The first of your two photos demonstrates a prominent fat pad underneath your right eye. If you have congenital under eye fat pads that you were born with, depending on your examination, transconjunctival blepharoplasty maybe considered for removing them without external scars. I hope this is helpful! Sincerely, Dr Joseph

Under-Eye "Puffy Pillows," which appear to be the case here from both the history and physical presentation can result from obstruction of the lymphatics that drain this area typically as a consequence of the use of an improper choice of filler for the under-eyes and/or too superficial placement of the filler. The depressions seen are actually the result of having bulges above and below them, rather than actually being true indentations. This problem can be quite difficult to treat. However, I have had gratifying results in treating patients who have come to me with this issue using an algorithm of varying combinations, concentrations and amounts of intralesional anti-inflammatory injections to flatten the puffy pillows. You would be wise to consult with an experienced, board certified cosmetic dermatologist with considerable experience in dealing with this troubling issue. Best of luck.