Introduction

The tear trough region is one of the most delicate and unforgiving areas in aesthetic medicine. When performed skillfully, under-eye fillers refresh the face, reduce shadows, and restore a youthful appearance. But when done incorrectly, they can lead to puffiness, lumps, discoloration, or even more serious complications like vascular occlusion.

This guide explains why under-eye filler procedures sometimes fail, how to correct poor outcomes, and the techniques that keep your results safe and natural. For structured anatomy and safety training, explore the advanced injection courses at Empire On-Demand.

What Can Go Wrong with Under Eye Fillers

Snippet: The most common under-eye filler complications include swelling, lumps, migration, and discoloration.

1. Overfilling

Too much product causes unnatural bulging, distortion of the tear trough, and visible swelling. Overcorrection often results from trying to eliminate every shadow, but a subtle improvement is far more aesthetic.

2. Incorrect Depth of Injection

Superficial placement beneath thin skin leads to surface irregularities or the Tyndall effect, where filler reflects light as a bluish hue. Deep placement is critical to avoid this issue.

3. Wrong Product Selection

Filler rheology matters. High-viscosity or hydrophilic gels can attract water and create chronic puffiness. Only low-density, smooth hyaluronic acid (HA) fillers formulated for the infraorbital area should be used.

4. Filler Migration

Migration occurs when filler shifts beyond its intended site, leading to asymmetry or lumping. It’s more common when filler is placed too superficially or in excessive volume.

5. Infection or Biofilm

Improper aseptic technique or pre-existing contamination can result in delayed nodules or infection. Biofilm formation may mimic granuloma and requires prompt medical management.

6. Vascular Occlusion (Rare but Serious)

Accidental intravascular injection can cause pain, blanching, and skin necrosis — an emergency requiring immediate reversal with hyaluronidase and supportive therapy.

For a complete vascular complication protocol and safety masterclass, see Complications Mastery Program.

Visual Signs That Something Went Wrong

Prompt recognition is vital to avoid long-term damage or scarring.

How to Correct Poor Under Eye Filler Results

1. Hyaluronidase Dissolution

Snippet: Hyaluronidase is the first-line treatment for most hyaluronic acid filler complications.

Injected in precise microdoses, hyaluronidase breaks down HA fillers within 24–48 hours. It’s particularly effective for:

• Overcorrection or lumping

• Migration or uneven texture

• Tyndall discoloration

• Vascular compromise (emergency use)

Administer under aseptic conditions and reassess after 48 hours before re-treatment.

2. Ultrasound-Guided Dissolution

Using high-frequency ultrasound helps visualize retained filler, ensuring accurate enzyme delivery and avoiding tissue trauma. This approach also differentiates residual filler from edema or fat herniation.

3. Combination Correction

After filler removal, address residual texture or hollowness with:

• Radiofrequency microneedling for tightening

• PRP or exosomes for tissue repair

• Low-viscosity filler for refined touch-up once tissue normalizes

Advanced regenerative approaches combining fillers with exosomes are covered in Harnessing the Power of Exosomes, Lasers, and PDO Threads.

Prevention: How to Avoid Filler Failures

1. Deep Anatomical Knowledge

Mastering the infraorbital anatomy is essential — including location of the orbital septum, angular vein, and infraorbital artery. Improper depth or angling is the root cause of most complications.

Hands-on cadaver and anatomy-focused modules, such as Advanced Facial Anatomy Cadaver Workshop for Aesthetics, provide essential insight for safe, confident injection.

2. Conservative Volume

Use the smallest possible amount (0.3–0.5 mL per side) and layer gradually. It’s safer to undercorrect and reassess later than to overfill.

3. Correct Filler Choice

Select cohesive, low-hygroscopic fillers labeled for tear trough use. Avoid thick fillers intended for structural augmentation.

4. Use a Microcannula

Cannulas reduce the risk of vascular penetration and allow smoother, linear filler deposition.

5. Educate Patients

Pre-treatment screening, realistic expectations, and clear post-care instructions significantly reduce dissatisfaction and risk.

Patient Communication and Aftercare

Proper communication is key to managing complications gracefully. When a filler goes wrong, transparency and immediate response build trust. Patients should:

• Avoid panic — most HA filler complications are reversible.

• Follow post-procedure instructions carefully.

• Notify their injector immediately if pain, blanching, or unusual swelling occurs.

When to Refer

If complications persist despite correction or involve vascular compromise, refer the patient promptly to an oculoplastic or facial plastic surgeon for further management. Early intervention preserves both aesthetics and safety.

Clinical Takeaway

Even the most skilled injectors can encounter under-eye filler complications. The difference lies in recognition, correction, and prevention. By understanding anatomy, using the right product, and applying advanced safety protocols, aesthetic professionals can confidently deliver natural, complication-free results.

Continue elevating your injection expertise with specialized Empire On-Demand programs that focus on anatomy, complication management, and regenerative therapies.

FAQs

1. Can bad under-eye filler be fixed?
   Yes, hyaluronidase safely dissolves HA filler within days.

2. Why did my filler make me look puffy?
   Likely from overfilling, water-retaining filler, or superficial placement.

3. Is Tyndall effect permanent?
   No, it resolves once the filler is dissolved.

4. How fast should I act on vascular occlusion?
   Immediately — inject hyaluronidase and refer if vision changes occur.

5. Can filler migration happen months later?
   Yes, movement or edema may shift product over time.

6. How soon can I redo the treatment after dissolving?
   Wait at least 2–4 weeks to allow tissue normalization.

7. Are all fillers reversible?
   Only HA-based fillers can be dissolved; others must break down naturally.

8. Can poor filler placement damage the skin?
   In severe vascular cases, yes — timely reversal prevents scarring.

9. What’s the best filler for tear troughs?
   Soft, smooth, low-hygroscopic HA fillers designed for delicate areas.

10. Can exosomes help repair filler damage?
    Yes, regenerative exosome therapy can support skin healing post-dissolution.

References

• Beleznay K, et al. “Complications of Filler Injection in the Periorbital Region.” Aesthet Surg J. 2021.

• Funt D, Pavicic T. “Hyaluronidase in Filler Correction and Emergency Use.” Dermatol Surg. 2022.

• U.S. FDA. “Dermal Fillers: Risks, Safety, and Labeling.” https://www.fda.gov/medical-devices/cosmetic-devices/dermal-fillers

• DeLorenzi C. “Prevention and Management of Filler Complications.” Plast Reconstr Surg. 2020.

• Sattler G, et al. “Ultrasound-Guided Filler Dissolution in the Tear Trough.” J Cosmet Dermatol. 2023.