Solution: Puffy Under Eyes After Filler Injection

A rational approach to fix puffy under eyes after filler injections

One of the most elegant and frequent procedures I offer in my NYC office is under eye filler, also known as the cannula eye lift to smooth out puffy under eyes and dark circles.

When it’s done correctly and in the right candidate, the results look like magic. Eye bags disappear within minutes:

Halfway through a nicely done under eye filler treatment with Restylane

When under eye fillers look puffy

Another frequent activity in my practice as an NYC oculoplastic surgeon is fixing problems with under eye fillers that were done in other offices. Sometimes people travel across the country for me to help them with under-eye filler issues.

The fix is sometimes an injection to dissolve filler (if the filler is dissolvable). Sometimes it involves surgery to remove unwanted permanent filler. Or sometimes a creative approach is required.

There are several reasons why puffiness can happen after under-eye fillers and I list the most common causes below.

Causes of looking puffy after under eye filler

Filler too close to the surface

The eyelid has the thinnest skin in the body. So you can sometimes see what’s underneath it. And that can include superficially placed filler.

Under-eye filler is usually best injected deeply so it’s not visible. There are a few exceptions to this statement, but it’s generally a good rule to follow.

When too much HA filler is too close to the surface, it can take on a blue tint. This is called the Tyndall effect. The fix is an enzyme injection to dissolve the filler.

Tyndall effect under eye from shallow filler placement

Wrong filler choice

Different fillers behave differently, even those that are made of the same basic substance (like stabilized hyaluronic acid or HA gel).

For example, I prefer using Restylane over Juvederm or Belotero for the under eyes even though they are all HA fillers. Juvederm Voluma is notorious for creating swelling and puffiness under the eyes when it’s too close to the thin eyelid skin.

The good news is that all of these HA gel fillers are reversible with an enzyme injection that melts away unwanted filler. Sometimes it takes more than one dissolving injection to do the trick.

Permanent fillers under the eyes can be less forgiving and when problems occur with fillers like liquid silicone or Artefill, a correction is more difficult- sometimes surgery may be required to remove one lump at a time.

Too much filler

Under eye filler can be great but you can definitely have too much of a good thing. Over-filling of the under-eyes looks like there are pouches under the eye bags and the normal eyelid contours are lost.

Immune reaction to filler

Your body may react to certain types of fillers, especially if they are not actual dermal fillers. HA fillers tend to be non-reactive and its very rare to have an allergy to them. Illegal fillers are another story. I discussed this at length in my podcast with Dr. John Martin.

Silicone and other permanent fillers (including Sculptra) can cause immunogenic reactions, lumps or granulomas to form under the eyes and are generally avoided in this delicate area.

It should be noted that no filler is currently FDA approved for under-eyes but as doctors we can use them safely off-label at our own discretion.

Festoons

Festoons, also known as cheek bags or malar mounds can be exacerbated by HA fillers.

Correct filler choice, placement, and injection technique can reduce this risk and in certain cases can improve festoons.

Festoon caused by too much filler in the wrong location

One week after festoon corrected with enzyme injection followed by laser skin resurfacing

Swelling

Swelling can happen after filler treatments and everyone who has an injection (or a cannula treatment) looks at least temporarily puffy.

HA fillers are hydrophilic meaning they attract water after they are placed in the body. This effect dissipates over days and weeks but some HA fillers hold on to water more than others. Massage, warm compresses, head elevation during sleep, and dietary salt avoidance can improve facial swelling after fillers.

How to fix under eye filler in NYC

The vast majority of under eye filler issues can be corrected when you’re with the right expert. After seeing your original provider, a cosmetic oculoplastic surgeon is the first expert to consult with and to find your best options which may include filler dissolving injections or other treatments.

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